Handbook of Psychology

548 Cultural Aspects of Health Psychology

cultures. For example, a study by Thridandam, Fong, Jang,
Louie, and Forst (1998) indicates that the prevalence of both
tobacco and alcohol use is lower for San Francisco•s Chinese
population than for the general population.

Diet. There are complicated scenarios related to diet and
acculturation among Asian Americans. For example, accul-
turation has been found to affect dietary patterns of Korean
Americans. Korean Americans who were more acculturated
ate more •American foodsŽ such as oranges, low-fat milk,
bagels, tomatoes, and bread mostly during breakfast meals
(S. Lee, Sobal, & Frongillo, 1999). In contrast, there may be
lost health bene“ts for Asian Americans who opt to change to
American-style diets rather than more traditional Asian diets.
For example, there is evidence that Japanese diets may re-
duce the prevalence of diabetes (Huang et al., 1996) and that
soy intake among Asians may be related to a reduction in the
risk of breast cancer (Wu, 1998).

Physical Activity. As in other minority groups, there is
evidence that physical activity serves as a protective factor
against chronic illness among Asian Americans. Research on
Japanese American men who participated in the Honolulu
Heart Program study suggests that physical activity is associ-
ated inversely with incident diabetes, coronary heart disease
morbidity, and mortality (Burch“el et al., 1995a, 1995b;
Rodriguez et al., 1994).

Sexual Behavior. Nationally, the incidence of AIDS is
increasing at a higher rate among Asian and Paci“c Islander
American men who have sex with men than among
Caucasians (Choi, Yep, Kumekawa, 1998). It has been re-
ported that the rate of new AIDS cases among API men who
have sex with men increased by 55% from 1989 (4.0%) to
1995 (6.2%; Sy, Chng, Choi, & Wong, 1998). However, most
of the discussions have focused on the relatively low preva-
lence of APIs with AIDS in the United States (Sy et al.,
1998). Underestimating the risk of HIV may increase unsafe
sex practices and subsequently increase AIDS cases in this
population.

AlcoholAbuse. Cheung (1993) suggests that a review of
the literature “nds consistently low levels of alcohol con-
sumption and drinking problems among the Chinese in
America. Previous research has attempted to explain these
low levels using two theories: (a) The physiological explana-
tion attributes the light alcohol use among the Chinese to their
high propensity to ”ush, which protects them from heavy
drinking or; (b) a cultural explanation that suggests Chinese
cultural values emphasize moderation and self-restraint,

which discourages drinking to the point of drunkenness.

Cheung•s (1993) review of the existing research shows that

neither theory seems to provide an adequate explanation of

the current empirical “ndings.

Social Support. The role of social support as a factor in

health among minorities is also evident among Asian

Americans. In an examination of the nature of social support

for Asian American and Caucasian women following breast

cancer treatment, Wellisch et al. (1999) found differences in

the size, mode, and perceived adequacy of social support that

favored Caucasians. This is not to imply social support does

not promote health among Asian Americans but that social

support does not appear to be as prevalent for Asian

Americans as for Caucasians.

Major Biobehavioral Risk Factors

The impact of stress on health is also a biobehavioral risk fac-

tor in American Asians. Research suggests that most newly

arrived Amerasians experience acculturative stress in areas of

spoken English, employment, and limited formal education

(Nwadiora & McAdoo, 1996). The impact of this stress on

biomedical indicators of health has yet to be examined

empirically.

Latino(a) Americans

Morbidity and Mortality

While most of the research on ethnic minorities and CVD

risk factors has focused on African Americans, some stud-

ies suggest that there are also higher prevalence rates of ex-

cess weight, diabetes, untreated hypertension, cigarette

smoking, and low-density lipoprotein cholesterol in Mexican

Americans compared to Caucasians (Kuczmarski, Flegal,

Cambell, & Johnson, 1994; Sundquist & Winkleby, 1999).

Studies have also shown that the incidence and rate of CVD

mortality are higher for Hispanic women compared to

Caucasians (Kautz, Bradshaw, & Fonner, 1981). When age

differences are taken into account, Mexican-American men

and women also have elevated blood pressure rates compared

to Caucasians (NCHS, 2000).

As in other populations, Latinos/Latinas experience higher

age-adjusted stroke rates compared to Caucasians (e.g.,

Karter et al., 1998). Sacco et al. (1998) found that Hispanics

had a twofold increase in stroke incidence compared with

Caucasians. Furthermore, Haan and Weldon (1996) found

that among community-dwelling elderly Hispanics and

Caucasians, Hispanics experienced greater levels of disability