The Association of Acculturative Stress with Self-reported Sleep Disturbance and Sleep Duration among Asian Americans

Study Objectives This study aims to examine associations between acculturative stress– defined as the psychological impact, or stress reaction, of adapting to a new cultural context –and self-reported sleep outcomes among Chinese and Korean immigrants in the United States. Methods In this cross-sectional study, acculturative stress was assessed using a 9-item scale, and sleep disturbance was measured using the 8-item scale. Sleep duration was self-reported. Poisson and linear regression analyses were conducted to examine the associations between acculturative stress, sleep disturbance, and sleep duration. Results Our sample consists of 400 participants (females: 52%, Chinese: 50%, Koreans: 50%, the mean of age=58.4). 81.8% of them were classified as having no sleep disturbance, while 18.2% were classified as having sleep disturbance. Poisson models revealed that greater acculturative stress was associated with a higher prevalence of sleep disturbance (Prevalence Ratio (PR): 1.18, 95% confidence interval (CI): 1.06-1.31). In linear models, a one-unit increase in acculturative stress was associated with 0.08 hours less sleep (p <0.05). Interaction tests indicated effect modification for sleep disturbance by sex and ethnic identity: only women had a significant association between acculturative stress and sleep disturbance (PR: 1.30; 95% CI: 1.13-1.49), while the association was significant for individuals identifying as “very Asian” (PR: 1.21; 95% CI: 1.08-1.35), but not for those identifying as “mostly Asian” or “bicultural/western”. Conclusions If findings are replicated, we suggest developing intervention programs for Asian immigrants to minimize acculturative stress and bolster protective factors that decrease the risk for poor sleep outcomes.

Social Determinants of Health among Older Korean Immigrants in the United States: A Systematic Review

The visible impact of the SDoHs on health and behavioral health as well as health disparities among minority populations is heightened due to COVID-19. One group about which little is known in relation to SDoHs is the older Korean immigrant population in the U.S. To examine the impact of SDoHs on the health, mental health, and health care utilization, a systematic review of studies focused on SDoHs for this population was conducted. Using multiple indexing terms, databases were searched for articles published in English between January 1, 2011 and December 2020. Articles were included in the search if they examined social determinants of health of older Korean immigrants defined as foreign-born Koreans aged 60 or older who live in the United States regardless of citizenship or legal immigration status. A total of 1090 articles were identified in the search. A review of abstracts for inclusion criteria resulted in 118 articles for review. Seventy-one articles were excluded during the review process. A total of 47 articles met inclusion criteria and were evaluated. The review revealed that SDoHs, including education level, financial resources, access to health insurance, level of acculturation and level of social support, influenced cognitive status, depressive symptoms, health status and quality of life. These findings validate the need for interventions to address the social care needs of older Korean immigrants and can be used to identify the role of social workers in addressing the SDoHs that result in health disparities for older Korean immigrants.

Living/Eating Arrangement, Loneliness, and Mental Distress among Older Korean Immigrants: Gender Difference

Structural isolation such as living alone poses a mental health risk in diverse groups of older adults, including older immigrants. Given that those living with others might also be disengaged, the present investigation included eating alone as another source of isolation and examined the impact of the combination of living and eating alone. The proposes of the study were to examine (1) how living and/or eating alone would impact mental distress, (2) whether the impact would be mediated by feelings of loneliness, and (3) if there would be gender differences in the mediation effect. The data were drawn from the Study of Older Korean Americans (SOKA), which surveyed older Korean immigrants in five states during 2017−2018. The living/eating arrangement was classified into four-groups: living/eating with others (57%), living with others/eating alone (12.4%), living alone/eating with others (7.3%), and living/eating alone (23.1%). Using the PROCESS macro, we tested the mediation effect of loneliness and the moderation effect of gender in the relationship between the typology and mental distress controlling for background/health characteristics and social capital related variables. Two groups (living with others/eating alone and living/eating alone) had sociodemographic, health, and social capital disadvantages. Analyses demonstrated that mental distress was linked with living with others/eating alone and living/eating alone, of which relationships were mediated by loneliness only among women. Findings suggest that not only structural isolation (e.g., living alone) but also disengagement with others (e.g., eating alone) need to be considered to understand emotional well-being in older immigrant population and gender difference.

Sleep Disturbance Among Older Korean Immigrants

Little is known about sleep disturbance among older Korean immigrants living in the United States. In this exploratory study, we conducted focus groups with 6 and phone interviews with 22 older Korean immigrants to explore and understand their sleep experiences. Three members of the research team fluent in Korean independently coded each focus group and phone interview transcript to identify underlying themes. The following themes emerged: Daytime naps were acceptable behaviors, particularly among those who were retired or not employed. Many reported worry and anxiety rumination behaviors that interfered with their sleep. In addition, praying, reading the bible, and singing hymns often occurred while in bed, and smartphone or tablet use was a frequent activity as well. Drinking alcohol and taking sleeping pills were used as a last resort to help with sleep, particularly among those who lived alone. Internal (e.g., biological urge, snoring, medical conditions) and external distractions (e.g., noise) contributed to nighttime awakenings. Living alone and worrying about the future made it difficult for some to return to sleep after awakening. Seeking advice from peers was a common behavior but did not seem to help with sleep. Calming activities such as reading a book, taking a shower, watch television, or writing a diary were routinely performed before bedtime. These findings are consistent with unhealthy sleep behaviors shown in other racial/ethnic minority older adults with poor sleep. Sleep education programs in Korean-speaking churches may be used to target those who are socially isolated and may benefit older Korean immigrants.

The power of "altruistic" healthcare and its impacts on the health-seeking behaviour of Korean immigrants in New Zealand

<p>Immigrants’ health-seeking behaviours are reconstructed during their healthcare adapting process as a consequence of interaction with the host health services. How Korean immigrants, who came from a very different healthcare system, reconstructed their health-seeking behaviours by adapting in New Zealand, and the factors affecting their healthcare decisions and behaviours were the main concerns of the research. Korean immigrants’ experiences were explored and theorised in order to provide a theoretical understanding of their health-seeking behaviours. Glaser’s classic grounded theory was used to generate a conceptual theory with emergent fit. Forty-eight participants were recruited from Wellington and Auckland. The primary data were collected from unstructured face-to-face individual interviews (n=23), seven two-person interviews (n=14 [two people attended twice]), and four group interviews (n=14 [one person attended twice]). In order to develop a theory grounded in the participants’ experiences and perspectives, data were collected, coded and analysed congruently and iteratively with the constant comparison and theoretical sampling methods. The Healthcare Acculturation Theory that emerged from this research elucidated Koreans’ healthcare adapting process and provided insights into their health-seeking behaviours in New Zealand. Koreans’ health-seeking behaviours were largely categorised into four positions: “rejecting”, “attuning”, “attuning but negotiating”, and “rejecting but negotiating”. They were found to be in one of the four positions at any one point in time and each position reflected their responses toward the New Zealand healthcare system. Once a specific position was held, their healthcare decisions and behaviours were directed by the said position. As their healthcare experiences were ongoing, their chosen positions were not end-outcomes in themselves. When their existing perceptions and behaviours were challenged by new experiences their healthcare positions transitioned or reinforced, and these changes informed the Healthcare Acculturation Theory. When Korean immigrants, who came from a commercially driven healthcare system, experienced healthcare (emergency care rather than elective) at the public services in New Zealand they were deeply touched. The healthcare they received was caring, empathetic, and responsive care delivered in a person-centred way that they had never experienced before. This experience rendered a turning point in their healthcare adapting process. Participants who reached such a point experienced transitions, not only in their healthcare positions, but in their life beliefs and values as well, which went far beyond simply a shifting perspective but can be likened more to a “conversion”. It was conversion to a new understanding. This research articulates the major contributing factor to immigrants’ acceptance of healthcare, which was receiving care that Koreans perceived as “altruistic”. It is related to the ambience of health services that resulted in sincere and empathetic care, rather than the barriers to healthcare that immigrants face in the host country. This thesis makes an important contribution to the existing body of knowledge on acculturation demonstrating new knowledge and a theoretical understanding of health-seeking behaviour, in the development of a substantive theory based on the experiences of Korean immigrants in New Zealand.</p>

The power of "altruistic" healthcare and its impacts on the health-seeking behaviour of Korean immigrants in New Zealand

<p>Immigrants’ health-seeking behaviours are reconstructed during their healthcare adapting process as a consequence of interaction with the host health services. How Korean immigrants, who came from a very different healthcare system, reconstructed their health-seeking behaviours by adapting in New Zealand, and the factors affecting their healthcare decisions and behaviours were the main concerns of the research. Korean immigrants’ experiences were explored and theorised in order to provide a theoretical understanding of their health-seeking behaviours. Glaser’s classic grounded theory was used to generate a conceptual theory with emergent fit. Forty-eight participants were recruited from Wellington and Auckland. The primary data were collected from unstructured face-to-face individual interviews (n=23), seven two-person interviews (n=14 [two people attended twice]), and four group interviews (n=14 [one person attended twice]). In order to develop a theory grounded in the participants’ experiences and perspectives, data were collected, coded and analysed congruently and iteratively with the constant comparison and theoretical sampling methods. The Healthcare Acculturation Theory that emerged from this research elucidated Koreans’ healthcare adapting process and provided insights into their health-seeking behaviours in New Zealand. Koreans’ health-seeking behaviours were largely categorised into four positions: “rejecting”, “attuning”, “attuning but negotiating”, and “rejecting but negotiating”. They were found to be in one of the four positions at any one point in time and each position reflected their responses toward the New Zealand healthcare system. Once a specific position was held, their healthcare decisions and behaviours were directed by the said position. As their healthcare experiences were ongoing, their chosen positions were not end-outcomes in themselves. When their existing perceptions and behaviours were challenged by new experiences their healthcare positions transitioned or reinforced, and these changes informed the Healthcare Acculturation Theory. When Korean immigrants, who came from a commercially driven healthcare system, experienced healthcare (emergency care rather than elective) at the public services in New Zealand they were deeply touched. The healthcare they received was caring, empathetic, and responsive care delivered in a person-centred way that they had never experienced before. This experience rendered a turning point in their healthcare adapting process. Participants who reached such a point experienced transitions, not only in their healthcare positions, but in their life beliefs and values as well, which went far beyond simply a shifting perspective but can be likened more to a “conversion”. It was conversion to a new understanding. This research articulates the major contributing factor to immigrants’ acceptance of healthcare, which was receiving care that Koreans perceived as “altruistic”. It is related to the ambience of health services that resulted in sincere and empathetic care, rather than the barriers to healthcare that immigrants face in the host country. This thesis makes an important contribution to the existing body of knowledge on acculturation demonstrating new knowledge and a theoretical understanding of health-seeking behaviour, in the development of a substantive theory based on the experiences of Korean immigrants in New Zealand.</p>

Understanding Korean Immigrants and Major League Baseball Fandom

Currently, there are more than 40 million immigrants in the United States, and immigrant sports consumers have been considered a significant niche market in the sport industry. In particular, Major League Baseball (MLB) teams have realized that Korean immigrants, along with Japanese immigrants, are among the most attractive Asian immigrant MLB markets in the U.S., because of their large populations in the U.S. and the popularity of baseball in their native countries (Kim & Jeon, 2008). However, there has been limited research regarding Asian immigrants’ team identification with MLB teams. The theoretical framework of this study is drawn from acculturation theory (Berry, 1997) and social identity theory (Tajfel, 1982). Berry defines acculturation as “the general processes and outcomes (both cultural and psychological) of intercultural contact” (Berry, p. 8). Acculturation theory has been widely used to explain the adaptation patterns of immigrants to a new society. This theory further explains not only how immigrants evolve in new cultural contexts resulting from migration, but also how they retain their original cultural contexts and beliefs while in their new society (Berry, 1997). According to Berry (1980), there are four types of acculturation strategies: integration, assimilation, separation, and marginalization. These four acculturation strategies differ according to immigrants’ efforts to adapt to new cultural contexts as well as the extent of their relationships with their new as well as with their old societies. Social identity theory (Tajfel, 1982) is a useful theoretical framework for team identification. Social identity is defined as “the part of the individual’s self-concept which derives from their knowledge of their membership in a social group together with the value and emotional significance attached to that membership (p.2)”. Team identification research has been developed based on social identity theory and identity theory (Kwon, Trail, & James, 2007). Team identification is an extension of self-identity that results from a sports fan’s psychological connection to a team (Fink, Trail, & Anderson, 2002). The purpose of this study is to understand the Major League Baseball fandom of Korean immigrants by exploring factors associated with recent Korean immigrants’ team identification with MLB teams in the U.S.

How stress, discrimination, acculturation and the gut microbiome affect depression, anxiety and sleep among Chinese and Korean immigrants in the USA: a cross-sectional pilot study protocol

IntroductionAlthough a considerable proportion of Asians in the USA experience depression, anxiety and poor sleep, these health issues have been underestimated due to the model minority myth about Asians, the stigma associated with mental illness, lower rates of treatment seeking and a shortage of culturally tailored mental health services. Indeed, despite emerging evidence of links between psychosocial risk factors, the gut microbiome and depression, anxiety and sleep quality, very few studies have examined how these factors are related in Chinese and Korean immigrants in the USA. The purpose of this pilot study was to address this issue by (a) testing the usability and feasibility of the study’s multilingual survey measures and biospecimen collection procedure among Chinese and Korean immigrants in the USA and (b) examining how stress, discrimination, acculturation and the gut microbiome are associated with depression, anxiety and sleep quality in this population.Method and analysisThis is a cross-sectional pilot study among first and second generations of adult Chinese and Korean immigrants in the greater Atlanta area (Georgia, USA). We collected (a) gut microbiome samples and (b) data on psychosocial risk factors, depression, anxiety and sleep disturbance using validated, online surveys in English, Chinese and Korean. We aim to recruit 60 participants (30 Chinese, 30 Korean). We will profile participants’ gut microbiome using 16S rRNA V3-V4 sequencing data, which will be analysed by QIIME 2. Associations of the gut microbiome and psychosocial factors with depression, anxiety and sleep disturbance will be analysed using descriptive and inferential statistics, including linear regression.Ethics and disseminationThis study has been approved by the Institutional Review Board at Emory University (IRB ID: STUDY00000935). Results will be made available to Chinese and Korean community members, the funder and other researchers and the broader scientific community.