Breast Cancer Among Asian Americans: Is Acculturation Related to Health-Related Quality of Life?

Jinsook Kim

Kimlin T. Ashing-Giwa

Marjorie Kagawa Singer

Judith S. Tejero

ONF 2006, 33(6), E90-E99. DOI: 10.1188/06.ONF.E90-E99

Purpose/Objectives: To examine the association of acculturation with health-related quality of life (HRQOL) among Asian American breast cancer survivors.

Design: Cross-sectional.

Setting: Analysis of an Asian American subsample of breast cancer survivors from a larger multiethnic study.

Sample: 206 Asian Americans, including Chinese, Filipinos, Koreans, and Japanese. Most were diagnosed with early-stage breastc cancer (stage 0-II) and were an average of 54 years old.

Methods: Participants completed a mailed questionnaire or answered a telephone survey in English, Mandarin, or Korean. HRQOL was measured using the Functional Assessment of Cancer Therapy-Breast Version 4. Acculturation was measured using an eight-item scale adapted from Marin's Short Acculturation Scale.

Main Research Variables: HRQOL, acculturation, health insurance, life stress, and social support.

Findings: Acculturation was significantly associated with HRQOL when demographic, medical, socioecologic, and healthcare access factors were controlled. However, the significant association between acculturation and HRQOL disappeared when Asian subgroup membership was considered. Subgroup differences in HRQOL remained after controlling for covariates, with Korean Americans reporting lower HRQOL than the other Asian American subgroups.

Conclusions: The absence of a significant association between acculturation and HRQOL in the final model is likely a result of the strong association between acculturation and Asian American subgroup membership. The results suggest that the correlation between acculturation and HRQOL is not an effect of having health insurance, life stress, and social support.

Implications for Nursing: Closer attention is needed regarding acculturation level; Asian American subgroup differences, including language capacity; and socioecologic characteristics in nursing practice and research.

Jump to a section

    References

    American Cancer Society. (2006). Cancer facts and figures 2006. Atlanta, GA: Author.

    Arcia E., Skinner, M., Bailey, D., & Correa, V. (2001). Models of acculturation and health behaviors among Latino immigrants to the U.S. Social Science and Medicine, 53, 41-53.

    Ashing, K.T., Padilla, G., Tejero, J., & Kagawa-Singer, M. (2003). Understanding the breast cancer experience of Asian American women. Psycho-Oncology, 12, 38-58.

    Ashing-Giwa, K. (1999). Quality of life and psychological outcomes in long-term breast cancer survivors: A study of African American women. Psychosocial Oncology, 17(3/4), 47-62.

    Ashing-Giwa, K., & Ganz, P.A. (1997). Understanding the experience of breast cancer in African-American women. Psychosocial Oncology, 15, 19-35.

    Ashing-Giwa, K., Ganz, P.A., & Petersen, L. (1999). Quality of life of African-American and white long-term breast carcinoma survivors. Cancer, 85, 418-426.

    Ashing-Giwa, K.T. (2005). The contextual model of HRQoL: A paradigm for expanding the HRQoL framework. Quality of Life Research, 14, 297-307.

    Ashing-Giwa, K.T., Padilla, G., Tejero, J., & Kim, J. (2004). Breast cancer survivorship in a multiethnic sample: Challenges in recruitment and measurement. Cancer, 101, 450-465.

    Ashing-Giwa, K.T., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., et al. (2004). Understanding the breast cacer experience of women: A qualitative study of African American, Asian American, Latina, and Caucasian cancer survivors. Psycho-Oncology, 13, 408-428.

    Asian Pacific Amrican Legal Center of Southern California & United Way of Greater Los Angeles. (2004). The diverse face of Asians and Pacific Islanders in Los Angeles County: Asian and Pacific Islander demographic profile. Retrieved June 10, 2004, from http://apalc.org/pdffiles/ASP_Report.pdf

    Baider, L., Kaufman, B., Ever-Hadani, P., & De-Nour, A.K. (1996). Coping with additional stresses: Comparative study of healthy and cancer patient new immigrants. Social Science and Medicine, 42, 1077-1084.

    Berry, J.W. (2003). Coneptual approaches to acculturation. In K.M. Chun, P.B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 17-38). Washington, DC: American Psychological Association.

    Brady, M.J., Cella, D.F., Mo, F., Bonomi, A.E., Tulsky, D.S., Lloyd, S.R., et al. (1997). Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. Journal of Clinical Oncology, 15, 974-986.

    Cella, D.F., Tulsky, D.S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., et al. (1993). The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology, 11, 570-579.

    Constantine, M.G., Okazaki, S., & Utsey, S.O. (2004). Self-concealment, social self-efficacy, acculturtvative stress, and depression in African, Asian, and Latin American international college students. American Journal of Orthopsychiatry, 74, 230-241.

    Dapueto, J.J., Francolino, C., Servente, L., Chang, C.H., Gotta, I., Levin, R., et al. (2003). Evaluation of the Functional Assessment of Cancer Therapy-General (FACT-G) Spanish version 4 in South America: Classic psychometric and item response theory analyses. Health and Quality of Life Outcomes, 1(1), 32. Retrieved March 19, 2006, from http://www.pubmed central.gov/articlerender.fcgi?tool=pubmed&pubmedid=12969512

    Deapen, D., Liu, L., Perkins, C., Bernstein, L., & Ross, R.K. (2002). Rapidly rising breast cancer incidence rates among Asian-American women. International Journal of Cancer, 99, 747-750.

    dela Cruz, F.A., Padilla, G.V., & Agustin, E.O. (2000). Adapting a measure of acculturation for cross-cultural research. Journal of Transcultural Nursing, 11, 191-198.

    Fumimoto, H., Kobayashi, K., Chang, C.H., Eremenco, S., Fujiki, Y., Uemura, S., et al. (2001). Cross-cultural validation of an international questionnaire, the General Measure of the Functional Assessment of Cancer Therapy Scale (FACT-G), for Japanese. Quality of Life Research, 10, 701-709.

    Gill, T.M., & Feinstein, A.R. (1994). A critical appraisal of the quality-of-life measurements. JAMA, 272, 619-626.

    Gotay, C.C., Holup, J.L., & Pagano, I. (2002). Ethnic differences in quality of life among early breast and prostate cancer survivors. Psycho-Oncology, 11, 103-113.

    Gupta, R., & Yick, A.G. (2001). Preliminary validation of the acculturation scale on Chinese Americans. Journal of Social Work Research and Evaluation, 2(1), 43-56.

    Hyman, I., & Dussault, G. (2000). Negative consequences of acculturation on health behaviour, social support, and stress among pregnant Southeast Asian immigrant women in Montreal: An exploratory study. Canadian Journal of Public Health, 91, 357-360.

    Jang, M., Lee, E., & Woo, K. (1998). Income, language, and citizenship status: Factors affecting the health care access and utilization of Chinese Americans. Health and Social Work, 23, 136-145.

    Jenkins, C.N., Le, T., McPhee, S.J., Stewart, S., & Ha, N.T. (1996). Health care access and preventive care among Vietnamese immigrants: Do traditional beliefs and practices pose barriers? Social Science and Medicine, 43, 1049-1056.

    Kagawa-Singer, M., Wellisch, D.K., & Durvasula, R. (1997). Impact of breast cancer on Asian American and Anglo American women. Culture, Medicine, and Psychiatry, 21, 449-480.

    Kim, J., & Shin, H. (2006). Public health insurance enrollment among immigrants and non-immigrants: Findings from the 2001 California Health Interview Survey. Journal of Immigrant and Minority Health, 8, 303-311.

    Ku, L., & Freilich, A. (2001). Caring for immigrants: Health care safety nets in Los Angeles, New York, Miami, and Houston. Washington, DC: Henry J. Kaiser Family Foundation.

    Kuo, W.H., & Tsai, Y. (1986). Social networking, hardiness, and immigrants' mental health. Journal of Health and Social Behavior, 27, 133-149.

    Lee, E.H., Chun, M., Kang, S., & Lee, H.J. (2004). Validation of the Functional Assessment of Cancer Therapy-General (FACT-G) Scale for measuring the health-related quality of life in Korean women with breast cancer. Japanese Journal of Clinical Oncology, 34, 393-399.

    Lehto, U.S., Ojanen, M., & Kellokumpu-Lehtinen, P. (2005). Predictors of quality of life in newly diagnosed melanoma and breast cancer patients. Annals of Oncology, 16, 805-816.

    Li, C.I., Malone, K.E., & Daling, J.R. (2003). Differences in breast cancer stage, treatment, and survival by race and ethnicity. Archives of Internal Medicine, 163, 49-56.

    Marin, G., Sabogal, F., Marine, B.V., Otero-Sabogal, R., & Perez-Stable, E.J. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences, 9, 183-205.

    Maxwell, A.E., Bastani, R., & Warda, U.S. (2000). Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. American Journal of Preventive Medicine, 18, 62-68.

    McQuellon, R.P., Kimmick, G., & Hurt, G.J. (1997). Quality-of-life measurement in women with breast cancer. Breast Journal, 3, 178-186.

    Ries, L.A., Eisner, M.P., Kosary, C.L., Hankey, B.F., Miller, B.A., Clegg, L., et al. (Eds.). (2005). SEER cancer statistics review, 1975-2002. Retrieved March 20, 2006, from http://seer.cancer.gov/csr/1975_2002

    Salant, T., & Lauderdale, D.S. (2003). Measuring culture: A critical review of acculturation and health in Asian immigrant populations. Social Science and Medicine, 57, 71-90.

    Sanders-Phillips, K. (1996). Correlates of health promotion behaviors in low-income black women and Latinas. American Journal of Health Promotion, 12, 450-458.

    Sarna, L., Tae, Y.S., Kim, Y.H., Brecht, M.L., & Maxwell, A.E. (2001). Cancer screening among Korean Americans. Cancer Practice, 9, 134-140.

    Shen, B.J., & Takeuchi, D.T. (2001). A structural model of acculturation and mental health status among Chinese Americans. American Journal of Community Psychology, 29, 387-418.

    Sherbourne, C.D., & Stewart, A.L. (1991). The MOS Social Support Survey. Social Science and Medicine, 32, 705-714.

    STATA. (2000). STATA reference manual. College Station, TX: STATA Press.

    Thamer, M., Richard, C., Casebeer, A.W., & Ray, N.F. (1997). Health insurance coverage among foreign-born U.S. residents: The impact of race, ethnicity, and length of residence. American Journal of Public Health, 87, 96-102.

    Trimble, J. (2003). Introduction: Social change and acculturation. In K.M. Chun, P.B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 3-13). Washington, DC: American Psychological Association.

    U.S. Census Bureau. (2003). The foreign-born population: 2000. Retrieved June 10, 2004, from http://www.census.gov/prod/2003pubs/c2kbr-34.pdf

    Wellisch, D., Kagawa-Singer, M., Reid, S.L., Lin, Y.J., Nishikawa-Lee, S., & Wellisch, M. (1999). An exploratory study of social support: A crosscultural comparison of Chinese-, Japanese-, and Anglo-American breast cancer patients. Psycho-Oncology, 8, 207-219.

    Wenzel, L.B., Fairclough, D.L., Brady, M.J., Cella, D., Garrett, K.M., Kluhsman, B.C., et al. (1999). Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer, 86, 1768-1774.

    Yeh, C.J. (2003). Age, acculturation, cultural adjustment, and mental health symptoms of Chinese, Korean, and Japanese immigrant youths. Cultural Diversity and Ethnic Minority Psychology, 9, 34-48.

    Yoo, H.J., Ahn, S.H., Eremenco, S., Kim, H., Kim, W.K., Kim, S.B., et al. (2005). Korean translation and validation of the Functional Assessment of Cancer Therapy-Breast (FACT-B) Scale version 4. Quality of Life Research, 14, 1627-1632.

    Yu, C.L., Fielding, R., Chan, C.L., Tse, V.K., Choi, P.H., Lau, W.H., et al. (2000). Measuring quality of life of Chinese cancer patients: A validation of the Chinese version of the Functional Assessment of Cancer Therapy- General (FACT-G) Scale. Cancer, 88, 1715-1727.