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BACKGROUND: While it is recognized that social support can alleviate mental health symptoms, this relationship is not well-understood among Chinese pregnant and parenting immigrants in the United States. This study aims to bridge this gap by exploring the relationships between different types of social support and women's anxiety and depression, and examining how these associations vary with pregnancy status. METHODS: Data were obtained from a cross-sectional survey conducted in Simplified Chinese or Mandarin between March-June 2021 among 526 women who were pregnant and/or parenting a child under five years. The Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, and Social Support scales were used to measure anxiety, depression, and social support levels. Descriptive statistics, t-tests, chi-square tests, and Pearson's correlations were employed for analysis. Hierarchical regression was conducted to investigate the main and interaction effects of social support types and pregnancy status on mental health outcomes. RESULTS: Compared to non-pregnant women, pregnant women reported higher mean scores for anxiety (non-pregnant: 55, pregnant: 59, p < 0.01) and depression (non-pregnant: 54, pregnant: 56, p = 0.02). Instrumental support displayed a significant main effect in relation to anxiety (ß=-0.13, p = 0.01) and depression (ß=-0.16, p < 0.01); emotional support exhibited a significant main effect solely on depression (ß=-0.13, p = 0.01). Notably, the interaction effects between pregnancy status and both instrumental (ß=-0.28, p = 0.01) and emotional support (ß=-0.42, p < 0.01) were significant for anxiety. In contrast, informational support did not exhibit a significant impact on either anxiety or depression. CONCLUSIONS: The findings indicate that tailoring support to the cultural context is crucial, especially for pregnant women in this Chinese immigrant community, with instrumental and emotional support being particularly beneficial in mitigating maternal anxiety.

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BACKGROUND: Intimate partner violence (IPV) is a significant public health concern, particularly in vulnerable populations such as Chinese immigrant women. AIM: This study aimed to assess the feasibility and acceptability of an empowerment-based intervention integrated with relaxation and self-compassion techniques for Chinese immigrant women experiencing IPV. METHODS: The present study was a part of a pilot randomized controlled trial (RCT). A total of 50 Chinese immigrant women who had experienced IPV in the past year were recruited online and randomized to either the intervention or the control group. The intervention group engaged in seven weekly sessions delivered with a phone call and a mobile application. Quantitative and qualitative data were collected through surveys and interviews to evaluate intervention adherence, participants' perceptions, and areas for improvement. RESULTS: 64% of the participants completed each weekly session, demonstrating favorable intervention adherence. The intervention was perceived to be helpful by most participants, with reported decreases in stress, anxiety, fatigue, pain, and family conflicts, and with reported improvements in emotion regulation and self-compassion. However, technical issues with the mobile platform and lack of personalization were identified as limitations. CONCLUSION: This study demonstrates the feasibility and acceptability of the intervention for Chinese immigrant women experiencing IPV and warrants a full-scale RCT to determine its efficacy. It will be essential to personalize the intervention and reduce any barriers to participation.

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Chinese patients face higher risks of gastrointestinal (GI) cancers and greater cancer-related deaths than Canadian-born patients. The older population encounters barriers to quality healthcare, impacting their well-being and survival. Previous studies highlighted Chinese immigrant perceptions of not requiring healthcare support. During the COVID-19 pandemic, their underutilization of healthcare services garnered attention. The present study explores the experiences of older Chinese cancer patients to improve culturally sensitive cancer care. A total of twenty interviews carried out in Cantonese and Mandarin were conducted with Chinese immigrants, aged 60 or above, diagnosed with Stage 3 or 4 GI cancer. These interviews were transcribed verbatim, translated, and subjected to qualitative descriptive analysis. Among older Chinese immigrant patients, a phenomenon termed "Premature Acceptance: Normalizing Death and Dying" was observed. This involved four key themes: 1. acceptance and letting go, 2. family first, 3. self-sufficiency, and 4. barriers to supportive care. Participants displayed an early acceptance of their own mortality, prioritizing family prosperity over their own quality of life. Older Chinese patients normalize the reality of facing death amidst cancer. They adopt a pragmatic outlook, acknowledging life-saving treatments while willingly sacrificing their own support needs to ease family burdens. Efforts to enhance health literacy require culturally sensitive programs tailored to address language barriers and differing values among this population. A strengths-based approach emphasizing family support and practical aspects of care may help build resilience and improve symptom management, thereby enhancing their engagement with healthcare services.

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Chinese immigrant survivors of men's violence experience both significant mental health impacts from abuse and barriers to formal services. Therefore, we examined the preliminary efficacy of an innovative mobile-based empowerment-based intervention (self-compassion, health, and empowerment; SHE) that specifically focuses on abused Chinese immigrant women in the US. This pilot study used a two-arm randomized controlled design with repeated measures. A convenience sample (N = 50) of Chinese immigrant women who experienced past year intimate partner violence (IPV) were recruited online and randomly assigned to the intervention or control group (25 per group). We assessed IPV exposure, safety behaviors, depressive symptoms, anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms, and self-compassion at baseline, post-intervention, and 8-week follow-up. Of 95 eligible participants, 50 (52.6%) agreed to participate and completed baseline data collection; intervention completion rate was 64%. We found a significant group and time interaction for self-judgment (a self-compassion component), with a significant reduction seen in the intervention group compared to the control group. Despite no other significant group differences observed over time, the intervention group showed consistent trends toward improvements in most outcome measures, including specific types of IPV (i.e., negotiation, psychological aggression, and sexual coercion), depressive and PTSD symptoms, self-compassion, and certain components of self-compassion (i.e., isolation and over-identification) when compared to the control group. Our findings suggest that the SHE intervention shows promise in improving the mental health well-being of Chinese immigrant survivors. However, a fully powered randomized controlled trial is warranted to determine its efficacy. Our intervention has the potential to be translated in the Chinese immigrant populations with the necessary organizational support.

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This study presents novel and compelling evidence of the disparities in factors influencing the beliefs and aspirations for higher education among mainstream and immigrant youth in Hong Kong, particularly those who are underprivileged. We developed and validated a psychometric questionnaire, known as the Post-Secondary Education Pursuit Instrument (PSEPi), which was administered to 4,850 students aged between 15 and 18 years old from 23 secondary schools. The objective of this study was to explore the factors that impact students' choices and plans for higher education. The results of the one-way Multivariate Analysis of Variance (MANOVA) analysis deepen our understanding of the differential effects of success and obstacle factors on students' higher education pursuits across various cultural groups. The underprivileged mainstream, Chinese immigrant, and ethnic minority South Asian youth reported a perceived glass ceiling effect associated with their ethnic backgrounds, as well as financial aid barriers, while pursuing higher education, in contrast to their average Hong Kong mainstream counterparts (mean Cohen's d = 0.40). The direct effects and multiple mediation analyses demonstrated that significant others' influence, particularly the influence of parents, and locus of control are prime determinants of the perceived usefulness of higher education for all student groups. The implications are that educational policies should be implemented to level the playing field in higher education admissions for both privileged and underprivileged youth in Hong Kong and other international countries. Overall, this study provides robust empirical evidence that can be utilized to enhance educational policies and practices to bridge the gap between mainstream and underprivileged immigrant youth in their pursuit of higher education.

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Background: Although the etiology of women's cancer has been extensively studied in the last few decades, there is still little evidence comparing the temporal pattern of these cancers among different populations. Methods: Cancer incidence and mortality data from 1988 to 2015 were extracted from the Changle Cancer Register in China, and cancer incidence data for Los Angeles were extracted from Cancer Incidence in Five Continents plus database. A Joinpoint regression model was used to analyze the temporal trends of incidence and mortality for breast, cervical, corpus uteri and ovarian cancers. The standardized incidence ratios were applied to compare the cancer risk across populations. Results: An increasing trend of incidence rate for breast, cervical, corpus uteri and ovarian cancer was observed in Changle, although the rate leveled off for breast and cervical cancer after 2010, although not statistically significant. The mortality rate of breast and ovarian cancer was slightly increased during this period, while we found a decreased mortality of cervical cancer from 2010. The mortality of corpus uteri cancer showed a decreasing and then increasing trend. The incidence of breast, corpus uteri and ovarian cancer in Chinese American immigrants in Los Angeles was significantly higher than indigenous Changle Chinese and lower than Los Angeles whites. However, the incidence of cervical cancer in Chinese American immigrants shifted from significantly exceeding to lower than Changle Chinese. Conclusion: The incidence and mortality of women's cancers in Changle were generally on the rise, and this study concluded that environmental changes were important factors affecting the occurrence of these cancers. Appropriate preventive measures should be taken to control the occurrence of women's cancers by addressing different influencing factors.

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Spousal bereavement poses considerable challenges to adults in late life. Some populations, such as older immigrants, may experience heightened negative outcomes as a consequence of spousal bereavement, due to migratory stress and social isolation. Spousal bereavement is culturally embedded as it is related to cultural beliefs and attitudes concerning death and family relationships. However, studies on spousal bereavement or widowhood among older immigrants are extremely limited. This study aims to fill the gap by exploring, via a phenomenological approach, the lived experiences of widowed older Chinese immigrants in Calgary and responding to the question: What are the lived experiences of widowed Chinese older immigrants in coping with their spousal bereavement? With the data drawn from 12 in-depth qualitative interviews, findings were categorized into individual, family, community and societal levels. Study participants experienced long-lasting grief that was private and impacted by their culture and immigration status. Although family and ethno-cultural communities provided various types of supports during participants' widowhood, they did not directly assist them in coping with spousal loss. Most participants did not access social services for bereavement support, more often relying on cultural rituals and faith practices. Findings suggest the need for culturally appropriate bereavement supports and family/community involvement for older immigrant adults who have experienced spousal loss.

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BACKGROUND: Older adults are vulnerable to social exclusion and its detrimental health outcomes. However, few existing studies focus on the social exclusion of older adults as immigrants and ethnic-minority individuals. To fill the gap, drawing on the conceptual framework of old-age vulnerability, this study explored the multi-dimensional experience of social exclusion for older Chinese immigrants in the U.S. and investigated how old age and immigration exacerbated older adults' experiences of social exclusion. METHOD: The study included 24 in-depth face-to-face individual interviews in Los Angeles and employed thematic analysis on the qualitative data. Themes were identified until consensus was reached among the research-team members. Triangulation of multiple analysts was used to avoid analytic bias. FINDINGS: Findings showed that older Chinese immigrants experienced social exclusion in the following dimensions: basic services; material and financial resources; social relations and activities; socio-cultural aspects; and neighborhood/territory/community. In addition to age-related factors, immigration-related factors, including changes in physical and socio-cultural environments and legal status, also contributed to older immigrants' extra vulnerabilities to social exclusion. CONCLUSIONS: This study provides useful information and strategies for human and healthcare service providers to find ways to overcome social exclusion and enhance older Chinese immigrants' social inclusion in the U.S.

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Chinese immigrant survivors of intimate partner violence (IPV) in the United States have been overlooked and underserved. The purpose of this study was to explore their perceptions of resources for assistance as well as their priority needs. We conducted phone interviews with 20 Chinese immigrant women who had experienced IPV in the past year. The women expressed their needs for emotional support, culturally specific services, a variety of online resources to meet different demands, being empowered, raising the Chinese community's awareness about IPV, and batterer intervention programs. These women's testimonies shows that greater effort should be directed toward addressing those needs in order to reduce IPV and its impacts on health in this vulnerable group of women.

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The concept of "Aging in place" has not been fully validated among older immigrant groups living in diverse cultures. The study used a qualitative research approach and interviewed Chinese immigrant older adults across three Chinese enclave communities in New York City to identify whether Chinatowns are a place for Chinese immigrants to age and explore their experience of aging in Chinatowns. The findings showed that Chinese immigrants did consider Chinatown as the place, which conveyed practical, linguistic, social, emotional and cultural meaning. Aging in Chinatown, older adults sought independence, security, and autonomy through various social resources. However, older adults, especially newly arrived immigrants, have faced obstacles that undermine their aging experience. Older immigrants' unique aging experience has provided profound insight in understanding migration and AIP, which help develop proper policies and programs to support the AIP initiative.

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This study delves into the heritage language experiences of Australian-born Chinese immigrant children under the framework of family language policy. Storytelling as a narrative inquiry method is used to reveal the lived experiences of the protagonists in relation to heritage language and culture. The three family stories involved for case studies reveal different levels of parent agency in Chinese immigrant families regarding their children's home language use and heritage language education. It is noted that the level of child agency corresponds with the level of their parent agency. Where parents strongly advocate and practice heritage language maintenance, stronger agency is observed in their children to continue the use and learning of their heritage language. In addition, maintaining harmony while parents are implementing family language policies and providing children with formal instruction in heritage language are conducive to heritage language development, particularly in terms of its literacy.

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INTRODUCTION: Smoking rates remain disproportionately high among Chinese immigrants in the US, particularly in males. Community-based smoking cessation services and quitlines have low engagement rates. Social media and text messaging programs can be effective in promoting quit rates and improving treatment engagement. This study examined Chinese immigrant smokers' barriers to accessing available smoking cessation services and patterns of using social media platforms and mobile phone text messaging. METHODS: We conducted in-depth interviews (n=30) and a brief survey (n=49) with adult Chinese immigrant smokers leaving in New York City in 2018. Qualitative interviews explored smokers' challenges with smoking cessation, barriers to accessing and using smoking cessation services, and experience using social media and text messaging. The quantitative survey assessed smoking and quitting behaviors, and social media and text messaging use patterns. RESULTS: Qualitative data revealed that participants faced various barriers to accessing cessation services, including the lack of awareness about services, skepticism about treatment effects, reliance on willpower for cessation, and time constraints. WeChat was mainly used to maintain social networking and acquire information. Participants rarely used text messaging or other social media platforms. Quantitative data showed that 55% of participants had no plan to quit smoking. Among those who reported past-year quit attempts (45%), 55% used cessation assistance. WeChat was the most frequently used platform with 94% users. CONCLUSIONS: WeChat has potential to serve as an easily accessible platform for delivering smoking cessation treatment among Chinese immigrant populations. Research is warranted to explore the feasibility and efficacy of employing WeChat in smoking cessation treatment.

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Adequate nutrition during infancy and early childhood is essential for ensuring the growth, health, and development of children so that they can reach their full potential. There is a current void of data on infant and young child feeding practices (IYCF) in ethnic minority communities in the UK; specifically, it is difficult to find accurate Chinese IYCF data in the UK because survey data often includes Chinese in the category of 'Chinese or other ethnic group', further contributing to health inequalities. This mixed methods study aimed to explore the cultural influences on IYCF beliefs among new Chinese immigrant mothers. A total of 31 mothers of infants aged 6-23 months were recruited from informal community organizations. All 31 mothers were born in Mainland China, the mean length of their stay after immigrating to the UK was 10 years (range = 1-21 years), and their mean age was 29 ± 3.40 years. When using the Infant Feeding Style Questionnaire (IFSQ) to investigate IYCF beliefs, the highest score was obtained for responsive attention, with a value of 4.28 ± 0.92, indicating that parents were very attentive to child hunger and satiety cues; lower scores were obtained for indulgence soothing (1.82 ± 1.01), indulgence coaxing (2.11 ± 1.18), indulgence pampering (1.90 ± 0.95), and pressuring to soothe (1.92 ± 0.86), indicating lesser maternal indulgence and pressuring/controlling beliefs. A sub-sample (n = 14) participated in semi-structured interviews in order to understand the balancing sources of information and cultural preferences, the influence of traditional Chinese medicine, and language difficulties in accessing health services. The mothers reported barriers of IYCF beliefs and the introduction of solid foods earlier than the NHS guidelines. This study can promote optimal IYCF in Chinese immigrants and show health services the need to reconcile differences between the perceptions of British and Chinese health beliefs.

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BACKGROUND: While exclusive breastfeeding is recommended to 6 months of age, just 15% of mothers in Australia achieve this. The rate appears to be even lower among mothers born in China, where 90% have introduced infant formula by this time. This study aimed to examine infant feeding patterns in the first 12 months of life and the factors associated with exclusive breastfeeding at 4 months of age and infant formula introduction by 1 month of age among Chinese Australian mothers. METHODS: Chinese Australian women with a child aged 1 to 4 years born in Australia were recruited through social media and asked to complete an online survey. Chinese ethnicity was defined as the mother or her parents having been born in mainland China, Taiwan or Hong Kong. Infant feeding practices since birth and a range of psychosocial and cultural factors were assessed. A total of 289 Chinese Australian mothers completed the survey. The relationships between exposure variables and exclusive breastfeeding at 4 months or infant formula use by 1 month were examined using multivariable logistic regression. RESULTS: Almost all (93%) mothers initiated breastfeeding, however by 1 month of age exclusive breastfeeding rates reduced to 44%, with a further decline to 33 and 18% at 4 and 6 months respectively. Concurrently, 7% of parents reported infant formula feeding at birth increasing to 55 and 63% at 1 and 6 months of age respectively. The rates of any breastfeeding were 81% at 6 months and 50% at 12 months of age. Breastfeeding intention, self-efficacy and awareness of the infant feeding guidelines were key factors associated with sustained exclusive breastfeeding to 4 months. CONCLUSIONS: While Chinese Australian mothers had comparable exclusive breastfeeding rates at 6 months to the general Australian population, twice as many had introduced infant formula by 1 month of age. There is an urgent need to support Chinese Australian mothers in the perinatal period to strengthen their knowledge, intention and confidence to delay early introduction of infant formula and promote exclusive breastfeeding in the early postpartum period.

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Children who experience transnational separation (TS) from their parents, often referred to as "satellite babies," endure a relatively common but underdiscussed experience. To date, no evaluations of clinical interventions to specifically support transnationally separated families have been described. This column describes implementation of a group therapy pilot program for parents to address parenting and emotional concerns related to TS at a social services agency in Boston's Chinatown. Parent and therapist interviews indicated increased skills in negotiating parental feelings of guilt, shame, and regret caused by TS. These insights can guide practitioners and researchers who wish to address family separation in their communities.

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In the U.S. and Canada, Traditional Chinese Medicine (TCM) use has become increasingly common; Chinese immigrants have particularly high rates of TCM use. In this study, we used a cross sectional survey study design to assess the specific types of Traditional Chinese Herbal Medicine (TCHM) used, the concurrent use of TCHM and conventional cancer treatment, and communication with providers about TCHM use, among Chinese immigrant cancer patients in New York City (NYC). We surveyed 114 patients from several community and clinical settings in NYC. The mean age was 63, 59% were female, and 83% originated from mainland China. Breast (18%) and lung (21%) cancer were the most common cancer diagnoses, and 60% were receiving conventional cancer treatment at the time of the survey. 75% reported ever using TCHM since their most recent primary cancer diagnosis. 68% of those who used herbs reported concurrent use of TCHM with conventional cancer treatment. Only 13% of those who used herbs reported sharing TCHM use with a provider, and only 19% reported that a provider had ever discussed TCHM use with them. Our findings demonstrated an alarmingly high rate of concurrent use of TCHM and conventional cancer treatment and low rate of communication with providers about TCHM use. A wide variety of herbs were used, including those with potentially negative interactions with conventional treatment. This study highlights the urgent need for the development of interventions to assist providers and patients in improving communication around this important topic.

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CONTEXT: Many in the rapidly growing Chinese-American population are non-English-speaking and medically underserved, and few engage in advance care planning (ACP). Evaluating culturally-determined factors that may inhibit ACP can inform programs designed to increase ACP engagement. OBJECTIVES: To describe attitudes and beliefs concerning ACP in older, non-English-speaking Chinese Americans in a medically-underserved urban region. METHODS: Patients were consecutively recruited from a primary care practice in New York City to participate in a cross-sectional survey. Attitudes and beliefs were measured using an ACP Survey Tool and the validated Traditional Chinese Death Beliefs measure. Exploratory analyses evaluated associations between these two measures and between each measure and sociodemographics, primary dialect, acculturation (using the Suinn-Lew Asian Self Identity Acculturation Scale), and health status (using the Short Form-8 Health Survey). RESULTS: Patients (n = 179) were 68.2 years on average; 55.9% were women, and 81.0% were non-English speaking (42.8% Cantonese, 15.2% Mandarin, 19.3% Toisanese, and 19.3% Fuzhounese). Most had low acculturation (mean 1.7/5.0) and highly-rated physical and mental health (mean 70.1/100 and 81.5/100, respectively). Few patients (15.1%) had an advance directive and 56.8% were unfamiliar with any type; 74.4% were willing to complete one in the future. Thirty-two percent "agreed" that "talking about death in the presence of a dying person would accelerate death". The analyses revealed no significant associations. CONCLUSION: These Chinese-American older adults had low acculturation and very limited knowledge of, or engagement in, ACP. Factors that may predict culturally-determined attitudes and beliefs about ACP were not identified. Further research can inform efforts to improve ACP engagement in this population.

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BACKGROUND: Chinese immigrant mothers have been found to hold cultural-specific beliefs about children's weight and use cultural-specific feeding practices when feeding their children. However, current measurements of child feeding, including the widely used Child Feeding Questionnaire (CFQ), do not capture these cultural-specific beliefs and practices. Thus, the present study examined the underlying factor structure of the original CFQ (7-factor model) and the modified CFQ with additional Asian cultural-specific feeding items (8- and 9-factor model) and assessed the validity of the CFQ among U.S. Chinese immigrant mothers. METHOD: First-generation Chinese immigrant mothers (N = 216, Mage = 38.31, SDage = 4.34) with young children (Mage = 5.14, SDage = 1.49; 47.70% females) completed the CFQ (Birch et al., 2001), with two additional items capturing Asian cultural-specific feeding beliefs and practices. Children's and parents' body mass index and mothers' perceptions of their children's body size were also assessed. RESULTS: Our findings revealed that the 9-factor model, which included the cultural-specific feeding items, was the most optimal model to represent the factor structure of feeding beliefs and practices among U.S. Chinese immigrant mothers of young children. Mothers' feeding beliefs and practices were associated with children's and mothers' body mass index and mothers' perceptions of their children's body size. CONCLUSIONS: The present study highlighted the importance of cultural-specific beliefs and practices when examining parents' feeding perceptions, beliefs, and practices.

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OBJECTIVE: This study explores the contributions of Chinese immigrant mothers' parenting cognitions and parenting practices to their children's social skills. DESIGN: We used a cross-sectional design to examine the mediating role of authoritative parenting in associations between Chinese immigrant mothers' parenting attributions and their children's social skills. Chinese immigrant mothers (N = 208, M age = 37.36 years) reported their attributions regarding successes and failures in their daily caregiving experiences, authoritative parenting practices, and demographic information. Their preschool children's (M age = 4.51 years, 46.2% females) social skills in school were rated by their teachers. RESULTS: Maternal attributions of successful events to uncontrollable causes and unsuccessful events to controllable causes were associated with more authoritative parenting. In turn, more authoritative parenting was associated with more competent social skills in children. In contrast, maternal attributions of successful events to controllable causes and unsuccessful events to uncontrollable causes were associated with less authoritative parenting, which in turn was associated with poorer social skills in children. CONCLUSIONS: Promoting Chinese immigrant mothers' attributions that preserve positive efficacy during daily parenting tasks may enhance their engagement in warm, autonomy-promoting and regulatory parenting, which in turn may facilitate their children's social skills.

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Guided by the "opportunity-propensity" (O-P) framework, this study explores how immigrant status might affect students' civic knowledge through an antecedent factor (socioeconomic status [SES]), opportunity factors (civic learning at school and civic participation at school), and propensity factors (perceived open classroom climate, perceived student-teacher relationship, and perceived importance of conventional citizenship). The data were taken from the International Civic and Citizenship Education Study (ICCS) 2016. The sample comprised 2,544 eighth graders from Hong Kong. Results of two-level path analysis showed that, at the student level, mainland Chinese immigrant grant students had a higher level of civic knowledge. Although perceived open classroom climate and perceived importance of conventional citizenship were found to be two positive mediators and family SES (via civic learning at school) was a negative mediator, the mediation effects at the student level were quite small. In contrast, quite a large amount of variance was explained at the school level: School-aggregated immigrant status was positively linked to school-aggregated civic knowledge and negatively via school-aggregated students' family SES via school-aggregated civic learning.

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