Factors Promoting Health and Preventive Health Behaviors Among Older Chinese Americans in California

Background. Efforts to reduce health disparities among Chinese American elderly in the U.S. are significantly hampered by the lack of disaggregated epidemiological and behavioral data. A more sophisticated understanding of culture is required to move towards addressing health disparities in older ages. Research with immigrant populations needs to be better at addressing cultural influences on health behavior and healthcare use. Intragroup variation must be accounted for before generalizations are made concerning the beliefs, values, and practices of population groups. This study applied the Andersen Model of Health Care Utilization to analyze the relevance of different measures of acculturation and identify consistent patterns of predisposing enabling, and need factors that predict preventive health activities and self-reported health for older Chinese Americans. Objectives. Since the California Health Interview Survey (CHIS) provides several ways to operationalize acculturation, different proxy measures for acculturation were explored to see if different acculturation measures were more relevant to different types of preventive health activities and health outcomes than others. Methods. Statistically significant focal relationships between predisposing, enabling and need factor variables with: self-reported health (SRH), walking for transport/exercise, having an annual flu shot, ever having a colorectal cancer (CRC) exam, being current with mammogram, and number of annual doctor visits. Significant (p<0.05) variables were entered into logistic regression analyses in blocks according to Andersen's model to identify which variables grouped under each category played a significant factor in participation in the outcome variables. Results. After controlling for confounders, acculturation was a significant predictor for walking, ever having CRC screen, and SRH. Two different measures of acculturation provided the best model fit in the final statistical models. Chinese Americans who were English only speakers were less likely (OR=0.65, p< 0.05) to walk for leisure/transportation, and increased percent life spent in the U.S. was positively related with the likelihood of CRC screening (p<0.01) and reporting very good/excellent health (p < 0.005). Discussion. Acculturation is not consistently found to be a factor for health service use among older Chinese Americans. Part of the inconsistency may be attributed to the fact that acculturation is not measured the same across studies. I hypothesized that the inconsistency of the contribution of acculturation may also be due to the fact that a particular acculturation measurement may be more relevant to an outcome variable than other proxy measures. Four different proxies for acculturation were compared.