PI’s: Drs. Patricia Gonzalez, Jung-Wong Lim & Ming Wang Students: Suirong Li & Mee Yon Yum

1. The Role of Cultural Health Beliefs on Health Behaviors among Chinese, Korean, & Mexican American Breast Cancer Survivors PI’s: Drs. Patricia Gonzalez, Jung-Wong Lim & Ming Wang Students: Suirong Li & Mee Yon Yum Advisor: Dr. Kimlin Ashing-Giwa December 11, 2008

2. Background • Breast cancer (BC) is the most frequently diagnosed cancer in Asian-and Latina-American women. • Favorable survivorship outcomes for women with BC may be attributed to lifestyles and behavioral factors. • Given the growing ethnic minority populations in the U.S., and emerging health disparity issues in cancer outcomes, cultural factors of ethnic minorities need to be considered

3. Overall Goal • Examine the relationships among cultural health beliefs, health behaviors, and factors influencing them among Chinese, Korean and Mexican breast cancer survivors (BCS). • Explore the differences and/or similarities in cultural health beliefs & health behaviors among Chinese-, Korean- & Mexican-American BCS.

4. Phase I Specific Aims 1. Examine how acculturation is related to cultural health beliefs 2. Examine whether cultural health beliefs are related to treatment-related decisions, doctor-patient relationships, and health behaviors. 3. Examine whether treatment-related decisions and doctor-patient relationships mediate the relationship between cultural health beliefs and health behaviors. 4. Examine the differences and/or similarities in acculturation, cultural health beliefs, treatment-related decisions, doctor-patient relationships, and health behaviors among Chinese-, Korean-, and Mexican-American BCS.

5. Phase II Specific Aims 1. Explore the cultural health beliefs and health behaviors among Chinese-, Korean-, and Mexican-American BCS. 2. Explore the factors (e.g., acculturation, doctor- patient relationships) influencing health behaviors among Chinese, Korean, and Mexican BCS.

6. Phase I: Overall Framework Treatment Decision H2 H5 Health behavior Acculturation Cultural health beliefs H1 H4 H6 Doctor-patient Relationship H3

7. Research Method Sample Measures • N = 237 • Chinese (N=85), Korean (N=29), • Mexican (N=123) • Age > 18 • Stage 0-III • CCSP, Hospital registries • Community agencies Health behaviors: Self-report health behavior instrument (5-items)  Diet, exercise, alternative medicine, stress management Cultural health beliefs: The Multidimensional Health Locus of Control (4-items) + 3 new items Acculturation: Short Acculturation scale (7-item) Methods • Cross-sectional • Population-based • Mixed Methods • Culturally Responsive Model Doctor-patient relationship: The Adherence Determinant Questionnaire (6-items) Treatment-related decision (1-item) Secondary data analyses

8. Data Analyses • Descriptive statistics • Pearson product-moment correlations • T –Tests • ANOVAs • Chi-Squares

9. Table 1. Acculturation and cultural health beliefs(Aim1: H1) *p<0.05, **p<0.01, ***p<0.001

10. Table 2. Cultural health beliefs and doctor-patient relationship(Aim2: H2) *p<0.05, **p<0.01

11. Table 3. Cultural health beliefs and health behaviors (Aim2: H3) *p<0.05

12. Mediating effects of treatment-related decision and doctor-patient relationship (Aim 3: H5) Treatment decision Doctor-patient relationship Health behavior Cultural Health belief Treatment-related decisions and doctor-patient relationship did not mediate the relationship between cultural health beliefs and health behaviors. Thus, findings did not support the hypothesis.

13. Table 4. Acculturation & Doctor-patient relationship by Ethnicity & Language (Aim 4: H6) *p<0.05, **p<0.01, ***p<0.001

14. Table 5. Treatment-related decisions by ethnicity (Aim4: H6) **p<0.01

15. Table 6. Health behavior changes by ethnicity(Aim 4: H6) * P < 0.05

16. Conclusions • This research is the first study to compare health behaviors and cultural health beliefs across Chinese, Korean- and Latina BCS. • The diverse sample provides a unique opportunity to begin exploration health behaviors and health belief issues. • Results suggest that cultural context must be considered when understanding health behaviors among BCS.

17. Limitations • Participants may have provided socially acceptable responses • Self report data are subject to recall bias • Certain health behavior information was not included • Korean-American sample size was small

18. Activities to Date • Phase I • Identified variables based on research hypotheses • Secondary data analyses and interpretation • Findings reported / Manuscript Development • Phase II • Focus Group Protocol and procedure preparation • Questionnaire • Contacted community agencies for recruitment • Two Chinese focus groups conducted • One Korean focus group conducted

19. Activities to Date(cont.) • Abstracts and Manuscripts • Two Poster presentations • One Oral presentation • One manuscript in press (Supportive Care in Cancer) • Two in preparation • Student research assistants recruited • Training and learning

20. Timeline & Tasks CompletedIn process Target Schedule

21. Acknowledgements Research Assistants: Ann Lee Suirong Li Mee Yon Yum Ariel Bianca Moreno Dr. Ashing-Giwa: Mentor Dr. Susan Kane & Dr. Jamil Momand Funding Source: NIH: 1P20CA118783-01A1 & 1P20CA118775-01A