The interplay of social support and education on diabetes knowledge: a focus on Korean American women.

OBJECTIVE: Although diabetes is one of the leading causes of death among Korean Americans, the levels and predictors of diabetes knowledge in this group have not been sufficiently reported. This study aimed to (1) describe the level of diabetes knowledge of Korean immigrant women in the U.S. and (2) examine whether there is an interaction effect between social support and education on diabetes knowledge. DESIGN: This study conducted a cross-sectional survey design. The sample included 227 Korean immigrant women living in the southeast region of the U.S. The fourteen items of the Diabetes Knowledge Test were used to assess the diabetes knowledge level of Korean American women. A multiple linear regression analysis was conducted to examine the interaction effect between social support and education on diabetes knowledge. RESULTS: Only 6% of the participants presented a good diabetes knowledge level, 12.5% had a poor level, and the majority (81.5%) had a moderate level. We found a significant interaction effect between social support and education on diabetes knowledge. The highest diabetes knowledge was observed when individuals with a lower education level had higher social support. CONCLUSION: Future health practices and policies may focus on increasing knowledge among Korean American women with lower education levels and lower social support. Implementing peer-led initiatives can enhance diabetes knowledge and encourage better self-care practices within the community.

The impact of resilience and coping strategies on depressive symptoms among Korean American older adults during COVID-19.

OBJECTIVES: This study examined how resilience and coping strategies were associated with depressive symptoms among Korean American older adults during COVID-19. The prevalent depressive symptoms and low use of mental health services in this population have raised significant concerns among healthcare professionals. Therefore, this study aims to understand the relationships between resilience and coping types on depressive symptoms and provide valuable insights into addressing these issues within this ethnic group. METHOD: A cross-sectional survey was conducted with 132 Korean American older adults. Hierarchical linear regression analyses were performed to assess the effect of sociodemographic factors (age, gender, marital status, years of living in the U.S., self-rated health, financial security), resilience, and coping strategies (problem-focused coping, emotion-focused coping, avoidant coping) on depressive symptoms. Next, the interactions between resilience and three coping strategies for depressive symptoms were tested. RESULTS: The findings show that depressive symptoms were associated with financial security and avoidant coping. Also, resilience interacted with avoidant coping and emotion-focused coping. Among the participants with low resilience, depressive symptoms increased rapidly when avoidant and emotion-focused coping strategies increased, respectively. CONCLUSION: This study emphasizes the importance of culturally tailored interventions to promote resilience and decrease avoidant and emotion-focused coping among Korean American older adults.

Prevention of partner violence: virtual case simulation for religious leaders of Korean American immigrant communities.

The project 'Religious Leaders for Healthy Families' aims to prevent intimate partner violence (IPV) and increase access to resources for immigrant victims by enhancing the capacity of religious leaders. Due to cultural and psychosocial barriers, immigrant women prefer to exhaust informal resources, including religious leaders, before seeking help from professional service providers. This study reports the development of a virtual case simulation in which Korean American (KA) religious leaders living in the USA practice how to prevent and address IPV in their congregation. Intervention mapping (IM) guided the development of the simulation. This process was informed by theory, research and expertise in prevention and virtual case simulation. We partnered with victim service organizations and received feedback from religious leaders. The simulation was pilot tested with nine KA religious leaders and three community leaders with IPV expertise in the KA community. The resulting intervention consists of 4 behavioral outcomes and 24 performance objectives. We identified the knowledge, attitudes, outcome expectations and self-efficacy needed to accomplish each objective. The most creative phase was the development of four modules, as interactive virtual case simulations, that address all performance objectives. IM and social cognitive theory provided a useful framework for developing this virtual case simulation. With culturally responsive modifications, the intervention has the potential to be adapted for religious leaders from other immigrant communities.

Religion can play a pivotal role in helping immigrant women. Religious institutions help immigrants maintain their ethnic identity and language and support their integration into the new culture. This study explains the development of an online intervention for Korean American religious leaders to prevent partner violence. Religious leaders in immigrant communities can play a significant role in perpetuating cultural norms that contribute to partner violence or, conversely, create norms that promote equity between partners and value seeking help. Partner violence is high in cultures that adhere to traditional gender roles, with male-dominated interactions, and perceive seeking help as a failure that would bring shame to the whole family. The intervention consists of four modules that depict interactions between a religious leader and female parishioners: (i) a deacon worried about a parishioner who might be a victim, (ii) an immigrant woman married to an abusive husband, (iii) a woman in the hospital because of multiple bruises and a broken arm and (iv) a graduate student concerned about her fiancé's behavior. Experts in various fields, community leaders in the prevention of partner violence, and religious leaders provided their feedback and expertise for program development.

Help-Seeking Among Battered Immigrant Filipina, Indian, and Pakistani Women in the United States: Perceived Barriers and Helpful Responses.

This study examines the nature of helpful responses received and barriers to seeking help following the experience of intimate partner violence among women of Filipina, Indian, and Pakistani descent (N = 143) in the United States. Instead of aggregating women from diverse backgrounds, we investigated these groups of women separately. A content analysis found that while emotional support was the most helpful response, there were important variations by ethnicity and immigration position in the perceived helpfulness of various assistance resources as well as barriers to help-seeking. This study of disaggregated Asian immigrant groups enhances our understanding of both common and unique challenges faced by each immigrant group, which can inform development of socioculturally relevant intervention programs.

Help-Seeking Behaviors for Intimate Partner Violence Among College Students: Implications for Intimate Partner Violence Prevention and Intervention.

This study applied Andersen's Model of Health Service Use to examine help-seeking behaviors for intimate partner violence (IPV) and predisposing, enabling, and need factors for help-seeking among college students. The sample (N = 2,719) consisted of those who experienced IPV and was recruited from six universities in the United States and one university in Canada through an online survey. Results showed that 45.4% of the sample had sought some form of help for IPV. The most utilized source of formal help was from medical services, and friends were the number one source of informal help. Gender, age, sexual orientation (predisposing factors), IPV training (enabling factor), experiencing psychological and technological violence, and IPV consequences (need factors) were associated with seeking help. Implications for research and practice are discussed.

A Review and Assessment of Intimate Partner Violence Interventions and Trainings for Service Providers and Frontline Staff.

Despite a long history of various service providers' interactions with the survivors of intimate partner violence (IPV), previous reviews of interventions for service providers addressing IPV have only focused on those employed in medical settings. This review closely examines evidence related to interventions for service providers and frontline staff in nonmedical settings to identify effective interventions to address IPV and assist IPV survivors. Using explicit criteria, 16 studies were included in this review. This review offers a synthesis of the 16 studies by illuminating types of the interventions, outcomes and their effectiveness, settings of the interventions, and their quality of design. Specific implications are discussed to guide future practice, research, and policy.

Factors Associated with Korean American Women's Health-Related Internet Use: Findings from Andersen's Behavioral Model.

Literature suggests that access to health information improves health outcomes in various medical domains. This study investigated health-related Internet use levels and examined which factors influence health-related Internet use in Korean American women, grounded by Andersen's Behavioral Model. Participants included 243 Korean American women aged 19-85 years old residing in a Southeastern metropolitan area. Health-related Internet use was assessed by 11 items taken from HINTS 4 Cycle 2. Multiple regression analysis was conducted to reveal factors significantly associated with health-related Internet use of Korean American women. Predisposing factors of being aged 60 or older (ß = - 0.329, SE = 0.694, p = 0.004) and employment status (ß = 0.179, SE = 0.404, p = 0.037), as well as an enabling factor of having a primary care physician (ß = 0.217, SE = 0.423, p = 0.013), were significantly associated with health-related Internet use. The differences in health-related Internet use may exacerbate disparities in access to healthcare services. The primary care physician's role is important in enhancing health-related Internet use. Research, policy, and programmatic attention are necessary to enhance physicians' encouragement and education for patients to use existing digital technology to improve their health and wellness.

Health Literacy among Korean American Immigrant Women in the USA: Role of Social Support.

Health literacy is associated with health behaviors and outcomes. Using Andersen's Behavioral Model of Health Services Use, this study examined the role of limited English proficiency (LEP) and social support for the health literacy of Korean American immigrant women, one of the most affected groups by LEP. Researchers surveyed 232 Korean American immigrant women in a metro area in a Southeastern state, U.S. Health literacy was measured by the CDC Behavioral Risk Factor Surveillance System Questionnaire and the California Health Interview Survey. Participants with better English proficiency and larger social support had higher health literacy. LEP and social support interaction was significantly associated with health literacy, illustrating social support as a buffer that mitigates the negative impact of LEP on health literacy. Community programs that enhance social support through community health advocates or peer educators may increase health literacy and reduce health disparities among Korean American immigrant women with LEP.

"They Knew They Were Still Safe with Us": Experiences of Domestic Violence Shelter Staff on Survivors' Experiences in Shelter in the Early COVID-19 Pandemic.

Background: Domestic violence (DV) shelters are an essential service for survivors and their children. While research has demonstrated global increases in DV during COVID-19, little is known about the experiences of DV shelter staff. This study aimed to understand DV shelter staff's experiences and how they navigated the early stages of the pandemic. Methods: Researchers disseminated a cross-sectional online survey, first to state DV coalitions and then directly to DV shelters. Univariate and bivariate analyses were used for multiple-choice items, and patterns were identified using thematic analysis for open-ended responses. Results: Survey participants included 368 DV staff (180 leadership, 167 direct services, and 21 other roles) from 48 states. They reported little change to their schedules and mixed feelings of shelter preparedness for the pandemic. Participants described shelter methods for preventing the spread of COVID-19, changes in shelter policies and satisfaction with such policies, and the impacts of the pandemic on themselves and survivors. Balancing survivor autonomy with the health and safety of staff and other residents proved to be one of the most consistently challenging tasks. Participants also described how programs adapted to changing regulations and continued to serve survivors throughout this challenging time. Conclusion: Several innovative practices were implemented by staff throughout the pandemic, including expansions in technology use and non-residential services. Most reported feeling prepared for a similar crisis in the future. We offer five recommendations for DV shelters and their funders, including increased mental health support for staff and greater transparency in policies for both shelter residents and staff.

Promoting Survivor Safety in Immigrant Communities: Online Simulation Training for Korean American Faith Leaders.

This study examined the efficacy of a short virtual case simulation for Korean American (KA) faith leaders, "Religious Leaders for Healthy Families." The goal of the program is to increase knowledge about intimate partner violence (IPV) and healthy intimate partner relationships, enhance self-efficacy in IPV prevention and intervention, strengthen attitudes that support their roles on IPV prevention and intervention, increase positive outcome expectations of their actions, and increase behavioral intentions and behaviors on IPV prevention and intervention. KA faith leaders from two large metropolitan areas with a high concentration of KA immigrants were invited to participate in the study (N=102). Participants completed three online assessments: baseline, a 3-month, and a 6-month follow-up. After the baseline assessment, participants were randomized to either intervention (n = 53) or control (n = 49). The intervention consisted of four online simulation modules, each taking approximately 15-20 min to complete. At the 6-month follow-up, faith leaders in the intervention group significantly increased their knowledge and self-efficacy in IPV prevention and intervention compared to the control group. Mean scores for attitudes against IPV and prevention behaviors increased from baseline to the 6-month follow-up for the intervention group more than the control group, but the differences were not statistically significant. "Religious Leaders for Healthy Families" has the potential to reduce disparities in accessing resources and services for immigrant survivors of IPV. With its ease of use, this short, free online intervention has a high potential for uptake among faith leaders. Results are promising, but the COVID-19 pandemic negatively affected the study, with participants having scarce opportunities to practice the skills learned from the intervention. A larger follow-up study that combines "Religious Leaders for Healthy Families" with a community-wide intervention that targets all community members is warranted to reach more faith leaders and community members.

Domestic Violence Victimization among South Asian Immigrant Men and Women in the United States.

Domestic violence is a pernicious social problem in the United States and a cause of national concern. The South Asian culture disempowers individuals experiencing domestic violence from recognizing and reporting victimization. Structural inequities may also discourage reporting victimization. These issues have led to inconsistent findings of domestic violence prevalence rates. Additionally, domestic violence studies with South Asians in the United States have predominantly focused on women, omitting men from this purview of research. The purpose of this study was to examine domestic violence victimization rates as well as their correlates among South Asian immigrant men and women. The sample for this cross-sectional study included 468 South Asians across the 50 U.S. states. Descriptive statistics were used to establish rates of domestic violence victimization. Hierarchical logistic regression was used to examine the correlates of domestic violence victimization. All of the sociodemographic information was added in step 1, and acculturation and gender-role attitudes were added as covariates in step 2.The most prevalent type of domestic violence victimization was physical violence (48%), followed by emotional (38%), economic (35%), verbal (27%), immigration-related (26%), in-laws related (19%), and ultimately sexual abuse (11%). Prevalence rates were higher for women than for men in each type of violence. According to the logistic regression results, education, generational position, family type, and employment were significant correlates of domestic violence victimization. Prior to development of prevention programs by community agencies, it is essential to understand the nature and prevalence of domestic violence experiences among South Asians. The victimization of men in addition to women adds to the novelty of this research study and paves the way for practitioners and scholars to engage in conversations about providing both male and female victims of domestic violence with the needed resources and support. The article will discuss implications for research, practice, and policy.

The effects of disability status and perceived neighbourhood cohesion and safety on adverse childhood experiences among college students.

Adverse childhood experiences (ACEs) are early traumatic events that can have adverse long-term developmental effects on a person's health and well-being. Individuals with disabilities are at a greater risk of all types of ACEs. However, the impact of having a disability and neighbourhood context on ACEs is under-researched, and even less is known about whether neighbourhood cohesion and safety affect the relationship between disability status and ACEs. The purpose of this study is to examine the direct and indirect pathways between disability status, childhood neighbourhood environment and ACEs. The final study sample of this study was 2,049 college students, consisting of 494 students with disabilities and 1,555 students without disabilities from six universities in the U.S. and Canada between March 2016 and June 2017. Data analysis included Pearson correlations and structural equation modelling procedures using Stata 16 software to test a partial mediation model. Having a disability has both a direct effect and an indirect effect through the neighbourhood environment on ACEs after controlling for socio-demographic characteristics associated with neighbourhood environment or ACEs. The findings suggest that neighbourhood cohesion and safety can be a mediator between disability status and ACEs, and the potential cumulative risk and protective factors that can contribute to ACEs. To elucidate the relationship between disability status and a higher risk for ACEs fully and prevent ACEs that can negatively impact the long-term health outcomes, greater attention to environmental risk and protective factors is urgently needed.

Childhood Community Risk Factors on Intimate Partner Violence Perpetration and Victimization Among College Students.

The study examined the effect of community environments, such as community cohesion, community safety, and community poverty, in childhood on the likelihood of Intimate Partner Violence (IPV) perpetration and victimization in young adulthood. The study used the cross-sectional survey data of 2,082 college students collected in 2016-2017 from six universities in the U.S. and the data for the childhood community environment from the 2007-2011 American Community Survey. Hierarchical regressions were performed separately by gender to 1) assess the effects of community factors in addition to individual factors for IPV perpetration and victimization, and to 2) identify the interaction effect of community cohesion with community poverty on IPV perpetration and victimization. Community factors of community cohesion and community poverty were significantly correlated to different types of IPV. For IPV perpetration, only community cohesion was significant for, the interaction effect between community cohesion and poverty showed that higher community cohesion lowered the risk of community poverty on later IPV perpetration in both genders. For IPV victimization, only female students were affected by community poverty, whereas none of the community factors had an impact on male students. The findings imply the significance of early interventions and policies strengthening the community environment, especially community cohesion, for preventing IPV. The findings also suggest that assessing risk and protective factors on IPV in multiple contexts during childhood is important to develop effective programs preventing IPV.

Cumulative Violence Exposure and Alcohol Use Among College Students: Adverse Childhood Experiences and Dating Violence.

Multiple types of childhood adversities are risk factors for dating violence among college-age youth and in turn, dating violence is associated with alcohol use. This work quantitatively examines associations of childhood adversity and dating violence with alcohol use among college students using a cumulative stress approach. Multi-campus surveys were collected from March to December 2016 in four universities across the United States and Canada (n = 3,710). Latent class analysis identified patterns of childhood adversity and dating violence. Regression analyses investigated the associations of latent class patterns with past year number of drinks, alcohol use frequency, and problematic drinking. Latent class analysis produced seven classes: "low violence exposure" (18.5%), "predominantly peer violence" (28.9%), "peer violence and psychological child abuse" (10.8%), "peer and parental domestic violence" (9.9%), "peer and psychological dating violence" (17%), "peer and dating violence" (6.6%), and "childhood adversity and psychological dating violence" (8.3%). Compared to the "low violence exposure" group, "peer and psychological dating violence" (B = .114, p < .05), "peer and dating violence" (B = .143, p < .05), and "childhood adversity and psychological dating violence" (B = .183, p < .001) groups were significantly associated with problematic drinking. Results highlight how childhood adversity and dating violence contribute to problematic alcohol use, suggesting interventions that address both childhood adversity and dating violence may be most effective at reducing alcohol misuse among college students.

Risk factors for intimate partner violence perpetration among college students: Impact of childhood adversities.

Objective Intimate partner violence (IPV) among college students is a significant problem that negatively affects their physical and emotional health. This study aimed at examining risk factors, especially childhood adversities at the individual, relationship, and community levels, of IPV perpetration among college students. Methods: The sample from seven universities in the U.S. and Canada (N = 3,725) completed an online survey. Major variables included IPV perpetration, five types of childhood adversities, alcohol and drug use, depression, and demographic information. Logistic regression was performed. Results: Peer violence victimization, witnessing parental IPV, experiencing child maltreatment, drug use, and depression were associated with a higher odd of perpetrating IPV. Conclusions: Research and practice must account for exposure to multiple risk factors when intervening with college students. An integrative approach that combines trauma-informed interventions with substance use and mental health treatment may be most successful at IPV perpetration prevention and intervention among college students.

Adapting an HIV/STDs Prevention Curriculum to Fit the Needs of Women With Alcohol Problems.

Alcohol and drug dependent women are at increased risk for HIV/STDs. This paper discusses how a prevention curriculum, "Safer Sex Skill Building" (SSB), designed to reduce the contraction of HIV/STDs among drug-abusing women, could be modified to fit the needs of alcohol-abusing women in a residential treatment program. Authors modified the SSB by incorporating feedback from expert consultants as well as by engaging study participants in revising the therapy manual in order to create a curriculum that speaks to participants' experiences. Specific steps to assist those who would want to adapt an empirically-based manual-driven treatment intervention are provided.

Adherence to Cervical Cancer Screening in Korean American Immigrant Women: Identifying Malleable Variables for Intervention Development.

Introduction. Despite Korean American women having a high incidence rate of cervical cancer, many are unaware of the significance of Pap test. The purpose of this research was to examine the rates of Pap test receipt and factors associated with the uptake. Method. The study was guided by Andersen's Model of Health Service Use and used a cross-sectional research design. A sample of 230 women residing in metro-Atlanta, Georgia, participated in this study. Results. Slightly more than half (55.7%) had lifetime Pap tests while less than half (45.7%) had it within the last 3 years. Binary logistic regression indicated that marital status, monthly income, and annual checkups were significantly correlated with receiving Pap tests. Discussion. Special attention is needed for women who are unmarried and have low income to increase Pap test receipt. Suggested intervention programs include better communication strategies, extended Medicare coverage, and outreach programs within Korean American community.

Predictors of Cervical Cancer Screening Awareness and Literacy Among Korean-American Women.

BACKGROUND: Korean-American women experience a higher incidence of cervical cancer than non-Hispanic White women as well as other Asian-American women. A prominent cause of such a disproportional health risk among Korean-American women is a lack of awareness and knowledge of cervical cancer screening. Identifying factors related to cervical cancer screening awareness and literacy is critical for increasing cervical cancer screening among this population. METHODS: Researchers surveyed 230 Korean-American women in a metro area in a Southeastern state, USA. Based on Anderson's Behavioral Model of Health Services Use, predisposing, enabling, and need factors were explored to predict cervical cancer screening awareness and literacy. RESULTS: Monthly income, education, English proficiency, and annual checkups had significantly positive associations with cervical cancer screening awareness. Having an acquaintance giving support and receiving an annual checkup had significantly positive relationships with cervical cancer screening literacy. DISCUSSION: This study recommends culture specific guidelines to promote annual checkups through primary care physicians and the transfer of information about cervical cancer screening through acquaintances giving support.

Literacy of Breast Cancer and Screening Guideline in an Immigrant Group: Importance of Health Accessibility.

Little is known about predictors of breast cancer literacy among immigrant women. A cross-sectional survey investigated predisposing, enabling, and need factors of breast cancer literacy among 233 Korean American women living in a southeastern U.S. city. Breast cancer literacy was measured by questions that asked awareness of cancer screening methods and a 5-item questionnaire derived from the American Cancer Society's breast cancer screening guidelines and risk factors. Annual checkup was an enabling factor of awareness of Clinical Breast Exam (CBE) and mammogram, and also for breast cancer literacy covering the knowledge of breast cancer screening guidelines and risk factors. Health status was a need factor of CBE awareness. Marital status was a predisposing factor of mammogram awareness, and age and years of residence in the US were predisposing factors of breast cancer literacy. The findings of the study illuminate probable avenues of intervention to promote breast health knowledge for Korean American women.

Korean clergy for healthy families: online intervention for preventing intimate partner violence.

BACKGROUND: Intimate partner violence (IPV) among immigrant women is a serious public health problem. Churches and clergy play a fundamental role in their lives, as a form of social organization and alternative to community services. PURPOSE: To describe the implementation and evaluation of an intervention for Korean American faith leaders designed to increase knowledge about IPV and about resources to handle IPV, strengthen attitudes that do not support IPV, enhance self-efficacy to handle IPV, and increase prevention and intervention behaviors about IPV. METHODS: Korean American faith leaders in a Southeastern state of the USA were invited to participate in the study (n = 55). Participants completed two online assessments: baseline and a 3-month follow-up. After the baseline assessment, participants were randomized to either the intervention (n = 27) or the control (n = 28) group. The intervention consisted of three online modules, each taking approximately 30-45 min to complete. Modules were developed based on the researchers' work with Korean American faith leaders. Assessments and interventions were available in Korean and English. RESULTS: Compared to the control group, the intervention group significantly improved their knowledge of resources and enhanced attitudes against IPV. The intervention group increased their self-efficacy and behaviors to prevent IPV more than the control group, but these changes were not statistically significant. CONCLUSIONS: The online training provided a safe and convenient environment for the Korean American clergy, for whom anonymity and convenient access were important. Results are promising, but highlight the need to include more specific training of skills, which could be incorporated into the online modules in the form of an avatar. This online training could serve as a template to be adapted for other immigrant groups.