Copyright by Hyenam Hwang 2013 The Dissertation Committee for Hyenam Hwang certifies that this is the approved version of the following dissertation: IMPACT OF TRANSITIONING TO THE U.S. ON KOREANS’ HEALTH BEHAVIORS AND WELL-BEING Committee: Tracie C. Harrison, Supervisor Gayle J. Acton Sharon D. Horner Adama Brown Nestor P. Rodriguez IMPACT OF TRANSITIONING TO THE U.S. ON KOREANS’ HEALTH BEHAVIORS AND WELL-BEING By Hyenam Hwang, B.S.N., M.S.N. Dissertation Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy The University of Texas at Austin December 2013 Dedication This study is dedicated to my family, teachers, and friends for their unconditional support and encouragement, as well as to Korean immigrants and all immigrants who are struggling to integrate into a new country. Acknowledgements When I look back over the last few years of my life after coming to the U.S., I feel blessed because I have had many marvelous opportunities and have met many meaningful persons. I would like to express my deepest gratitude to my graduate mentor and dissertation director, Dr. Tracie C. Harrison, for providing me with the incredible guidance that broadens my research prospective. She is acknowledged for her efforts and times she spent assisting me, from planning research to the final touches of this study. She is also acknowledged for holding me to her highest standards and for believing in me when my self-confidence was running low. I also would like to thank my dissertation committee members. Dr. Gayle Acton offered critical insights and suggestions to improve my prose and ideas. Dr. Sharon Horner is acknowledged for her continued support through my entire graduate career. She taught me to recognize and stay focused on the important things. Also, I would like to acknowledge Dr. Nestor Rodriguez, who served as an outside member on my committee; he gave me thoughts about observing the other side of immigration. Dr. Adama Brown is acknowledged for always being there to assist with my many statistical questions. During my work as a Research Assistant for the last 8 semesters in the Cain Center, she was a good supporter and supervisor, as well as served as my committee member. I want to give thanks to Dr. Miyong Kim, who gave me an opportunity to join the community-participator research program. She is my supporter and encourager, and was my inspiration for pursing my future career. I also thank Dr. Eun-ok Im from the University of Pennsylvania, who holds a special place in my heart, having seen the v potential in me that others may have missed. Additionally, I give special thanks to Dr. Kwuy-Bun Kim, who believed in and supported me from S. Korea, from my undergraduate career until now. She always gives me a positive mentality for pursuing progressive works. I can’t forget her endless love, passion, and sacrifice to teach and care for her students. If it were not for my family and friends, the last four and a half years of my life would not have been among the best. Living in Austin, Texas, has allowed me to make the wonderful friends I have. My coworkers in the Cain Research Center, Tahryn Hughes, Charla Carrington, and Eunjin Lee, make my life worth living and they help me in numerous ways, which are too many to write down here. Other coworkers in the Community-Participatory Research Institute, Juyoung Lee and Jisook Ko, helped me keep my head up and were always there to keep my thoughts refreshed. To my friends in the Austin Presbyterian Church who pray for me and encourage me, I want to send special thanks. Also, to my generous friends, Veronica Walker, Tiffany Criswell, and Sook-Jung Kang, I am thankful because they help enrich my school life. For the confidence of my parents and parents-in-law in me, I thank them. Also, my brothers and sisters are thanked for always expressing to me just how proud they are of my family. To my husband, Sangyun Choi, goes the ultimate thanks for believing in my career and having constant enthusiasm about my work. Finally, my lovely daughter, Sunwoo Choi, is thanked for being a good friend and one of my top supporters during all of my time in the U.S. I am happy to be her mother. To my research participants and boundless love of the God, go the last and final thanks. vi Impact of Transitioning to the U.S. on Koreans’ Health Behaviors and Well-Being Hyenam Hwang, Ph.D. The University of Texas at Austin, 2013 Supervisor: Tracie C. Harrison Immigration transition may be an opportunity for physical, psychological, and social improvement, but the health of transitioning individuals may actually be at an increased risk for decline. In order to overcome negative influencing factors on the health of immigrants trying to integrate into a new society, examining the impact of transitioning immigration on the health of immigrants is important. Transition has complex and multidimensional patterns based on an individual’s social and cultural background. Korean immigrants in transitioning to the U.S. have experienced a specific and unique situation. Thus, the primary purpose of this study was to identify the impact of immigration transition, which is defined in the middle-range theory of transition, on the health-promoting behaviors and mental well-being of Korean immigrants in the U.S. A cross-sectional, descriptive correlational comparative design was used for examining a total of 192 Koreans: 105 in the U.S. and 87 in S. Korea, which were selected through matched age and gender controls with Korean immigrant participants in vii the U.S. The average ages were 46.8 (Median = 47, SD = 12.5) of Korean immigrants in the U.S and 46.2 (Median = 46, SD = 12.7) of 87 native S. Koreans. Korean immigrants had a low level of acculturation and limited English proficiency. The level of health-promoting behaviors of Korean immigrants was higher than that of S. Koreans, especially in subscales of health promotion, nutrition, and safety. Social resourcefulness was a key predictor of health-promoting behaviors and mental well-being among Korean immigrants. Also, self-control was a dominant mediator on the relationship between behavioral acculturation and mental well-being. Increasing acculturation and English ability for Korean immigrants, as well as increasing self-control, family functioning, and social resourcefulness were found to be important to improve integrating Korean immigrants into the U.S. These findings provide essential information that all health care professionals can use to increase their awareness of the importance of appropriately treating individuals with different cultural perspectives as well as diverse populations coming from varied countries. viii Table of Contents List of Tables·······················································································xiv List of Figures······················································································xvi CHAPTER 1: INTRODUCTION··································································1 Purpose of the Study········································································3 Background and Significance······························································4 Conceptual Framework·····································································7 Research Questions········································································11 Definitions of Terms······································································14 Assumptions················································································16 Study Limitations··········································································17 Summary····················································································18 CHAPTER 2: REVIEW OF THE LITERATURE·············································19 Part 1. Korean Immigrants································································19 Immigration History of Koreans to the U.S. ·································19 Characteristics of Korean Immigrants·········································21 Korean Cultural Values and Beliefs············································25 Summary of Part 1: Korean Immigrants·······································27 Part 2. Immigration Transition···························································29 Immigration Transition in the U.S. ············································29 Transition Theory for Immigrants··············································32 Summary of Part 2: Immigration Transition··································37 ix Part 3. Acculturation······································································41 Conceptual View of Acculturation in Present Study ························41 Acculturation and Health in Korean Immigrants·····························43 Acculturation and Demographic Characteristics····················47 Acculturation and Health-Promoting Behaviors·····················50 Acculturation and Mental Well-Being································55 Summary of Part 3: Acculturation··············································58 Part 4. Transition Conditions of Korean Immigrants·································59 Self-Control·······································································59 Family Functioning·······························································61 Social Resourcefulness···························································63 Summary of Part 4: Transition