20424_KAISER_iccc_covers.qxd 8/15/03 4:37 PM Page 4 A Provider’s Handbook on CulturallyCulturally CompetentCompetent CareCare Asian and Pacific Islander Population 2nd Edition Kaiser Permanente National Diversity Council and the Kaiser Permanente National Diversity Department 20859_KAISER_ccc_api_guts.qxd 8/13/03 10:58 AM Page 1 A PROVIDER’S HANDBOOK ON CULTURALLY COMPETENT CARE ASIAN AND PACIFIC ISLANDER POPULATION 2ND EDITION Kaiser Permanente National Diversity Council And the Kaiser Permanente National Diversity Department 20859_KAISER_ccc_api_guts.qxd 8/13/03 10:58 AM Page 2 Asian and Pacific Islander Handbook Table of Contents INTRODUCTION .......................................................................................................1 DEMOGRAPHICS ......................................................................................................2 Introduction .........................................................................................................2 Language..............................................................................................................4 Racism..................................................................................................................4 Families................................................................................................................4 Education, Income and Occupation Patterns....................................................5 Education.......................................................................................................5 Income...........................................................................................................5 Occupation Patterns......................................................................................5 Health Care Coverage ........................................................................................6 Implications for Kaiser Permanente Care Providers .........................................6 HEALTH BELIEFS AND BEHAVIORS.......................................................................7 Introduction .........................................................................................................7 Asian American View of Health and Illness......................................................8 Buddhism.......................................................................................................8 Confucianism.................................................................................................8 Ayurveda........................................................................................................8 Taoism............................................................................................................9 Naturalistic Theory ......................................................................................10 Animism.......................................................................................................10 Pacific Islander View of Health and Illness ....................................................10 Native Hawaiians.........................................................................................10 Samoans.......................................................................................................11 Traditional Medical Treatments ........................................................................11 Health Care Decision-Making Processes .........................................................13 Implications for Kaiser Permanente Care Providers .......................................14 RISK FACTORS ........................................................................................................15 Diet and Nutrition .............................................................................................15 Introduction .................................................................................................15 Traditional Diets ....................................................................................16 East Asians and Southeast Asians ........................................................16 Indians ...................................................................................................16 Filipinos .................................................................................................16 Samoans and Native Hawaiians ...........................................................16 Strengths of Traditional Diets.....................................................................16 Weaknesses of Traditional Diets ................................................................16 Effects of Westernization on Health...........................................................17 20859_KAISER_ccc_api_guts.qxd 8/13/03 10:58 AM Page 3 Obesity.........................................................................................................18 Implications for Kaiser Permanente Care Providers .......................................19 Substance Use....................................................................................................19 Tobacco Use ................................................................................................19 Asian Youth ...........................................................................................21 Alcohol Use .................................................................................................21 Chinese ..................................................................................................21 Japanese.................................................................................................21 Korean ...................................................................................................22 Southeast Asian .....................................................................................22 Indian.....................................................................................................23 Alcohol Use in the United States ...............................................................23 Illicit Drug Use ............................................................................................24 Drug Use in the United States..............................................................24 Social and Economic Risk Factors ...................................................................25 Language......................................................................................................25 Economic/Immigration Status.....................................................................25 Implications for Kaiser Permanente Care Providers .......................................26 MAJOR DISEASES....................................................................................................27 Introduction .......................................................................................................27 Research Constraints ...................................................................................27 Diabetes .............................................................................................................27 Thalassemia .......................................................................................................31 Cardiovascular Diseases....................................................................................32 Hypertension ...............................................................................................32 Cerebrovascular Disease.............................................................................34 Coronary Heart Disease..............................................................................34 Cancer ................................................................................................................36 Liver Cancer.................................................................................................36 Colorectal Cancer ........................................................................................37 Gastric Cancer .............................................................................................38 Lung Cancer.................................................................................................39 Nasopharyngeal Cancer ..............................................................................40 Prostate Cancer............................................................................................40 Summary of API Population Risks for Specific Cancers...........................41 Implications for Kaiser Permanente Care Providers .......................................41 INFECTIOUS DISEASES ..........................................................................................42 Introduction .......................................................................................................42 Parasitic Infestations..........................................................................................43 Tuberculosis.......................................................................................................43 Hepatitis B .........................................................................................................44 HIV/AIDS ...........................................................................................................45 Implications for Kaiser Permanente Care Providers .......................................47 20859_KAISER_ccc_api_guts.qxd 8/13/03 10:58 AM Page 4 SPECIAL AREAS OF CLINICAL FOCUS..................................................................47