Japanese American                       Health: the Canary in                           the MinesJAPANESE AMERICAN HEALTH ...
JA Health:    Who are theJapanese Americans?                      2
U.S. Census by Race/Ethnicity                                              Inclusive Population in Thousands              ...
0                                                 500,000                                                           1,000,...
What are the Disease Risksfor Japanese Americans?                             5
5 Leading Causes of Death Among AAPIsAll AAPIs,           % of           Men           % of          Women               %...
When It Comes to Cancer, AA/PICommunities Have Cause for Concern Between 1980 and 1993, the number of cancer deaths for AP...
J apanese American Data: Age-adjusted cancer rates (per 100,000)Incidence rates (per 100,000)                             ...
Differences between 1988-92 and 1999-2001Cancer                Mortality Rates for Men and Wom en20.010.0 0.0-10.0-20.0-30...
5 Most Common Cancers in California                MenBlack   White    Latino   Chinese   Japanese   Filipino   Korean   S...
11
5 Most Common Cancers in California                 WomenBlack    White         Latino   Chinese   Japanese   Filipino   K...
13
Breast Cancer in    Japanese American WomenIn Los Angeles County, CA  Japanese American women have thesharpest rising brea...
Female Breast Cancer            Five-Year Average Annual Age-Adjusted Incidence                 Rates per 100,000, Califor...
Relationship with Husbands of Chinese-, Japanese-  & European-American Breast Cancer Survivors Nature of marital relations...
Relationship with Husbands of Chinese-, Japanese-  & European-American Breast Cancer Survivors Sources of dissonance: Meet...
“Nure Ochiba” (wet leaves)                18
Colon and Rectum Incidence Rates          Six Highest Rates by Population and Sex, 1988-1992                              ...
Colon and Rectum Cancer Mortality             Rates         Six Highest Rates by Population and Sex, 1988-1992            ...
California is home to the largest Asian American population - ~37% of the 14 million AAPIs,       While colorectal cancer ...
Colorectal Cancer Incidence:Females in Los Angeles County                                22
Colorectal Cancer Incidence:Males in Los Angeles County                               23
Liver Cancer             Five-Year Average Annual Age-Adjusted Mortality Rates                        per 100,000, Califor...
Stomach Cancer        Five-Year Average Annual Age-Adjusted Mortality Rates                   per 100,000, California, 199...
Diabetes in Japanese AmericansJapan (Hiroshima)                     Age 40-59          9.8               4.8              ...
Diabetes in Japanese AmericansEnvironment  Studies show that rates of diabetes are higher in Japanese  Americans living in...
Alzheimer’s Disease         in Asian AmericansBetween 2000 and 2004, African-Americans and Asian/Pacific Islandersshowed t...
Alzheimer’s Disease Rates                            29
Mental and Emotional Health – (2009)Suicide:  10th leading cause of death for Asian  Americans  10th leading cause of deat...
It happens in  our  communities  too……  Parents  speaking out  to make a  difference….Jane andAlexanderNakatani1997       ...
Sociocultural Differences and Health      Some patients to endure severe discomfort and pain      since these symptoms may...
What You Can Do About Your Health  Stay active in ways you enjoy!  Maintain a diet high in fiber, with plenty of  fruits a...
Summary   The key to understanding critical health issues   for JAs is knowledge and understanding of   census and demogra...
Standingon theshouldersof ourancestors            35
Yonsei from George and Lil Kagawa                                    36
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Japanese American Health Seminar, Gardena California

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Japanese American Health Seminar, Gardena California

  1. 1. Japanese American Health: the Canary in the MinesJAPANESE AMERICAN HEALTH CONDITIONS: Where we have been - Where we are - What you can do about your health March 2, 2013 Gardena Valley Japanese Cultural Institute Marjorie Kagawa Singer Ph.D., MA, MN, RN Professor UCLA School of Public Health and Asian American Studies Department 1
  2. 2. JA Health: Who are theJapanese Americans? 2
  3. 3. U.S. Census by Race/Ethnicity Inclusive Population in Thousands 2000 and 2004 300,000 293,655.4 2000 2004 281,424.6 250,000 Population in Thousands 231,436.3 200,000 197,840.8 150,000 41,322.1 39,232.5 37,105.0 35,306.3 100,000 13,956.6 12,006.7 4,225.1 4,409.4 50,000 976.4 906.8 0 US Total Non-Hispanic Latino / African Am/ Asian AI/AN NHOPI White Hispanic Black American AI/AN = American Indian/Alaska Native; NHOPI = Native Hawaiian and Other Pacific IslanderU.S. Census: Race and Hispanic Origin in 2004, Population Profile of the United States:Dynamic Version http://www.census.gov/population/pop-profile/dynamic/RACEHO.pdf. 3
  4. 4. 0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000Ch Asi in an ese Ind (n o ia n t Ta iw a 3,183,033 ne s e) 2,734,841 Fi li pi n o V ie tna 2,364,815 me se 1,737,433 K or ea n Jap 1,706,822 ane se P ak 1,304,286 ista ni Ca mb 409,163 odi an Hm 276,667 on g 260,073 Tha i 237,583 La o ti an Tai 232,130 wa nes Ban e 230,382 g la des hi In d 147,300 2010 Census Alone and In Combination on e sia n S ri 94,970 L an kan 45,381 Asian Alone Ma l ay si a n In Combination 26,179 SELECTED ASIAN GROUPS 4
  5. 5. What are the Disease Risksfor Japanese Americans? 5
  6. 6. 5 Leading Causes of Death Among AAPIsAll AAPIs, % of Men % of Women % ofAll Ages total total total1. Cancers 27.0 1. Cancers 26.8 1. Cancer 27.22. Cardiovascular 23.2 2. 24.0 2. 22.3diseases Cardiovascular Cardiovascular diseases disease3. 7.9 3. 6.6 3. 9.2Cerebrovascular Cerebrovascular Cerebrovasculardiseases diseases diseases4. Accidents 4.8 4. Accidents 5.6 4. Diabetes II 4.15. Diabetes II 3.8 5. Diabetes II 3.6 5. Accidents 3.8National Center for Health Statistics. Health, United States, 2010: With SpecialFeature on Death and Dying. Hyattsville, MD. 2011. (Data from 2007) 6
  7. 7. When It Comes to Cancer, AA/PICommunities Have Cause for Concern Between 1980 and 1993, the number of cancer deaths for API men and women increased 290% and 240%, respectively – the highest percentage increase for all U.S. racial/ethnic populations. National Center for Health Statistics/Centers for Disease Control & Prevention (NCHS/CDC): Health, United States, 1995 While heart disease remains the leading cause of death for all U.S. groups (all ages), cancer has been the number one killer of API females since at least 1986 and males since 2004. NCHS/CDC: Health, United States, 1995; Health, United States, 2002 API women were the only U.S. population group who experienced no decrease in cancer incidence and an overall increase in cancer mortality for all cancers combined between1990 and 1997; these trends continue. Wingo PA, et al: Cancer incidence and mortality, 1973-1995: A report card for the U.S. Cancer, 1998; Annual Report to the Nation on the Status of Cancer : Wingo PA, et al, 1999; Ries LAG, et al., 2000; Howe HL, et al., 2001; Edwards BK, et al., 2002; Weir HK, et al., 2003; Jemal A, et al., 2004; Edwards BK, et al., 2005. 7
  8. 8. J apanese American Data: Age-adjusted cancer rates (per 100,000)Incidence rates (per 100,000) J apanese Non-hispanic whites male female male femalecolon/rectum 64.4 50.2 59.1 42.8lung 41.1 22.8 77.9 57.6prostate 103.7 159.9s tomach 27 14 9.5 3.8liver 9.3 8.1 6.8 2.5breas t (only female data given) 102.8 152.9Mortality rates (per 100,000) male female male femalecolon/rectum 27.1 15.1 21.3 15.7lung 36 19.5 64 44.9prostate 15.1 27s tomach 18.1 11.6 5 2.6liver 8.3 7.8 6 2.7breas t (only female data given) 17.1 27.4S ource: D ata taken from Tab le 3 of A C ancer J ournal for C linicians. Age-Adjusted cancer rates (per 100,000). C ancer Incidence, Mortality and 8associated risk factors among Asian Americans E thnic Groups, C A 2000 to 2002, C alifornia C ancer R egistry.
  9. 9. Differences between 1988-92 and 1999-2001Cancer Mortality Rates for Men and Wom en20.010.0 0.0-10.0-20.0-30.0-40.0 White T otal API Chinese Filipino Japanese Nat. Haw. AI/AN Hispanic 9 Chu, K. 2004
  10. 10. 5 Most Common Cancers in California MenBlack White Latino Chinese Japanese Filipino Korean S Asian VietnamProst Prost Prost Prost Prost Prost Lung Prost LungLung Lung Colo Colo Colo Lung Stom Colo ProstColo Colo Lung Lung Lung Colo Colo Lung LiverStom Melan NHL* Liver Stom NHL* Prost NHL ColoNHL* NHL* Stom Stom NHL* Liver Liver Bladder Stom 10 *Non Hodgkin lymphoma
  11. 11. 11
  12. 12. 5 Most Common Cancers in California WomenBlack White Latino Chinese Japanese Filipino Korean S Asian VietnamBreast Breast Breast Breast Breast Breast Breast Breast BreastColo Lung Colo Colo Colo Colo Colo Colo ColoLung Colo Lung Lung Lung Lung Stom Uterus LungUterus Uterus Cervix Stom Uterus Uterus Lung Ovary CervixPanc Melan Uterus Ovary Stom Thyroid Liver Lung Liver 12
  13. 13. 13
  14. 14. Breast Cancer in Japanese American WomenIn Los Angeles County, CA Japanese American women have thesharpest rising breast cancer rates overwomen from all other population groups inLos Angeles County; believed to havesurpassed BC incidence rates for non-Hispanic White counterparts. Deapen D, Liu L, Perkins C, et al: Int JCancer 99:747, 2002 14
  15. 15. Female Breast Cancer Five-Year Average Annual Age-Adjusted Incidence Rates per 100,000, California, 1997-2001 Rate per 100,000 S. Kwong, 2004120 105.5100 97.4 80 71.9 72.9 60 54.9 49.1 40 20 0 Chinese Filipino Japanese Korean South Asian Vietnamese 15
  16. 16. Relationship with Husbands of Chinese-, Japanese- & European-American Breast Cancer Survivors Nature of marital relationship Domain Japanese- Chinese- Euro-Americans A. Mutual emotional give Same for the three groups and take Intimacy B. Harmony and Harmony rather than intimacy predominates v. Intimacy predominates harmony Direct and Non-Verbal verbal C. Communication - Inshin denshin in Japanese communication - Zhih Yi in Chinese is valued Wife’s role clearly differentiated Ability to be D. Role as emotional nurturer and dependent on expectations husband as source of security husband Kagawa-Singer and Wellisch, 2002 Psycho-Oncology 16
  17. 17. Relationship with Husbands of Chinese-, Japanese- & European-American Breast Cancer Survivors Sources of dissonance: Meeting needs Domain Japanese- Chinese- Euro-Americans A. Empathy Expectations of wives not met by husbands “cut a little No time out B. Recognition Invalidation of slack” but from ongoing of individuality individuality ‘abandoned’ to stress in own resources relationship C. Perceived Pragmatic problem-solving assistance and tangible types of aid – driving, housecleaning, also reassurance and support from H calm Daughters/ D. Sources of Friends/co- Husbands Family support for W workers (3) (15) (husband) (6) 17 Kagawa-Singer and Wellisch, 2002 Psycho-Oncology
  18. 18. “Nure Ochiba” (wet leaves) 18
  19. 19. Colon and Rectum Incidence Rates Six Highest Rates by Population and Sex, 1988-1992 67.4 39.5 Women 45.5 Alaska Nativ e 39.2 33.6 √ Japanese 30.5 Black 79.7 Non-Hispanic White 64.1 Men 60.7 √ Chinese 57.6 44.8 √ Haw aiian 42.4 0 20 40 60 80 100Rates are "average annual" per 100,000 population, age-adjusted to 1970 U.S. standard.Miller BA, et al: Racial/Ethnic Patterns of Cancer In the United States 1988-1992, 1996 19
  20. 20. Colon and Rectum Cancer Mortality Rates Six Highest Rates by Population and Sex, 1988-1992 20.4 24.0 Women 11.4 Black 15.6 12.3 Alaska Nativ e 10.5 √ Haw aiian 28.2 Non-Hispanic White 27.2 Men 23.7 √ Japanese 23.4 20.5 15.7 √ Chinese 0 10 20 30Rates are "average annual" per 100,000 population, age-adjusted to 1970 U.S. standard.Miller BA, et al: Racial/Ethnic Patterns of Cancer In the United States 1988-1992, 1996 20
  21. 21. California is home to the largest Asian American population - ~37% of the 14 million AAPIs, While colorectal cancer (CRC) rates are decreasing in Blacks, Latinos, and non- Hispanic Whites, they are increasing among all Asian American groups. Japanese American men and women have the highest rectal cancer incidence rates, and Japanese American men have the highest rectal cancer mortality rate.Miller BA, et al: Racial/Ethnic Patterns of Cancer In the United States 1988-1992, 1996;Cancer Incidence and Mortality in California, Trends by Race/Ethnicity 1988-2001 21
  22. 22. Colorectal Cancer Incidence:Females in Los Angeles County 22
  23. 23. Colorectal Cancer Incidence:Males in Los Angeles County 23
  24. 24. Liver Cancer Five-Year Average Annual Age-Adjusted Mortality Rates per 100,000, California, 1997-2001 Rate per 100,00060 S. Kwong, 2004 Male Female5040 32.230 22.1 20.720 10.9 11.4 9.410 5.6 6.4 6.5 3.1 2.4 2.1 0 Chinese Filipino Japanese Korean South Asian Vietnamese 24
  25. 25. Stomach Cancer Five-Year Average Annual Age-Adjusted Mortality Rates per 100,000, California, 1997-2001 Rate per 100,00060 S. Kwong, 2004 Male Female5040 34.63020 17.8 14.5 12.3 12.4 11.110 7.0 8.0 5.2 3.1 1.5 1.4 0 Chinese Filipino Japanese Korean South Asian Vietnamese 25
  26. 26. Diabetes in Japanese AmericansJapan (Hiroshima) Age 40-59 9.8 4.8 Age 60-96 21 10.3 Age and sex adjusted 6.5Hawaii and Los Angeles Age 40-59 10.1 2.9 Age 60-96 19.4 7.6 Age and sex-adjusted 13.9Seattle Nisei Age 45-74 20 16Prevalence of diabetes among Nisei Japanese Americanmen and women in Seattle, WAMen 20Women 16 Source: Chapter 33 Diabetes in Asian and Pacific Islander Americans, 1995. Wilfred Y Fujimoto, MD 26
  27. 27. Diabetes in Japanese AmericansEnvironment Studies show that rates of diabetes are higher in Japanese Americans living in the U.S. compared to Japanese living in Japan, pointing to environment and lifestyle as an important contributing factor.Genetics On the other hand, second and third generation Japanese Americans, who are well acculturated in the mainstream American lifestyle, still have higher diabetes rates compared with Caucasians, suggesting a strong role of genetics in the development of diabetes. This complex interaction between genetics and lifestyle necessitates more extensive research. Source: http://aadi.joslin.org/content/asian/why-are-asians-higher-risk-diabetes 27
  28. 28. Alzheimer’s Disease in Asian AmericansBetween 2000 and 2004, African-Americans and Asian/Pacific Islandersshowed the greatest increase in reporteddeaths due to Alzheimer’s disease.Asian/Pacific Islanders living withAlzheimer’s disease will triple between2008 and 2030. 28
  29. 29. Alzheimer’s Disease Rates 29
  30. 30. Mental and Emotional Health – (2009)Suicide: 10th leading cause of death for Asian Americans 10th leading cause of death for White AmericansOlder Asian American women have the highestsuicide rate of all women over age 65 in theUnited StatesThe rate of serious psychological distressincreases with lower levels of income, as withmost other ethnic populations. 30
  31. 31. It happens in our communities too…… Parents speaking out to make a difference….Jane andAlexanderNakatani1997 31
  32. 32. Sociocultural Differences and Health Some patients to endure severe discomfort and pain since these symptoms may have a different meaning for them; Some patients to ignore a potential disease for as long as possible, if having or treating that disease may cause difficulty or hardship on the family. Different cultural beliefs about the etiology of disease (e.g., retribution, evil spirits, Karma) may preclude some patients from seeking or following through with treatment.Intercultural Cancer Council: Pain & Cancer (iccnetwork.org); President’s Cancer Panel: Voices of a BrokenSystem: Real People, Real Problems, 2002; Heng L. Foong, PALS for Health (www.palsforhealth.org) 32
  33. 33. What You Can Do About Your Health Stay active in ways you enjoy! Maintain a diet high in fiber, with plenty of fruits and vegetables. Ask questions of your health care providers. Understand your health conditions and medications. Get the cancer screenings and other tests appropriate for your age group. 33
  34. 34. Summary The key to understanding critical health issues for JAs is knowledge and understanding of census and demographics, immigration, and a myriad of sociocultural variables. JA cancer and other health data collected and reported in the “API” aggregate are virtually meaningless; aggregate data obscure the reality of diseases in this group. Better education and outreach in theJapanese American community toinform us of our health risks – we haveunique risks and protective factors –but few know about them….. 34
  35. 35. Standingon theshouldersof ourancestors 35
  36. 36. Yonsei from George and Lil Kagawa 36

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