2. Introduction
• People‟s Republic of China
• One of oldest civilizations in the world
• Second Largest Country in the World (Russia the
first)
• Population- Over 1.3 Billion
• Vast and Diverse Landscape
• Languages- Mandarin &
Cantonese (Southern China)
• Religion- Buddhism, Taoism, Islam
(McCabe, 2012)
3. Introduction
Ethnic Groups in China
• Han 91.59%
• Zhuang 1.28%
• Manchu 0.84%
• Hui 0.78%
• Miao 0.71%
• Uyghur 0.66%
• Tujia 0.63%
• Other 3.51%
http://www.globaled.org/curriculum/china/ethnic.htm
4. Introduction
• Immigration to the United States
- Gold Rush- Mid 1800‟s
• Chinese Exclusion Act
• Repealed in the early 1940‟s
• In 1960- population under 100,000
• Today- over 1.8 million foreign born Chinese
• California- 36%- FBC (Jones, 2012, p. 11)
(McCabe, 2012)
5. Health and Nutrition Beliefs
• Traditional Chinese Medicine
-For minor illnesses
• Herbs- To treat side effects
• Acupuncture- Most common of TCM in US
(restores Qi/Ch‟i)
• Coining or Pinching
(Chinese American Outreach Guide, 2009)
6. Health and Nutrition Beliefs
• Western Medicine- Viewed as “Too Strong” and
saved for major illnesses
• Nutrition- Not as concerned as Western Culture
• More concerned with flavor, texture, color, and
aroma of foods
• Believe diet is related to illness- Hot & Cold theory
(Lin, 2012)
7. Health and Nutrition Beliefs
Yin & Yang Foods
• Yin- Negative energy “Cold Foods”
- Eaten in excess = stomach aches, diarrhea,
dizziness, and weakness
• Yang- Positive energy “Hot Foods”
- Eaten in excess = skin rashes, hives, nose
bleeds, gas, indigestion, constipation, sore
throat, eye redness
• Balance = Good Health & Happiness
(Lin, 2012)
8. Typical Foods Eaten in China
• Rural China- Foods are very fresh
-Include- Fresh meat, live seafood, fresh
fruits and vegetables purchased at local
markets or raised/grown on farms
- Typically consume smaller portions of meat
- More plant based foods
- Chinese Tea
• Urban China- More likely to consume fast
food
(Lin, 2012), (Gong, 2005)
9. Typical Foods Eaten in US
• Rice
• Chicken
• Beef and Pork
• Seafood
• Vegetable- Bok Choy or whatever is available in
Market and more affordable
• Dim Sum- Meaning “Touch the Heart”
• Cuisine from other Asian cultures
• Younger generation- More likely to eat fast food
10. Food Customs
• Table is round- Lazy Susan Holds courses
• Family style
• Guest of honor- Right of host
• All dishes should be eaten with chopsticks
• To consume rice- bring bowl close to your mouth
and scoop in rice with chopsticks
• Serve others before serving yourself- Elders First
• Wait for host or oldest member to begin
• Keep conversation light
http://www.sccfsac.org/manners.html , (Gong, 2005)
11. Special Events- Weddings
• An elaborate celebration
• Adopt some Western customs
• Planned out ten to twelve months in advanced
• Banquet-style- Usually serves nine courses
• Banquet menu includes a cold appetizer platter
with a variety of meats and seafood
• Shark „s fin or bird‟s nest soup- A Chinese Delicacy
(Gong, 2005)
12. Holiday‟s- Chinese New Year
• A fifteen day celebration
• Falls between January 19 and February 23
• Begins on the day of the first lunar moon and ends
when the moon is full
• New Year‟s Eve dinner- banquet-style, eight
courses
• New Year Parade- Oldest and largest in San
Francisco
(Gong, 2005)
13. Chinese New Year- Symbolic
Foods
• Candied Coconut- Togetherness
• Chinese Black Mushrooms- Wishes Fulfilled
• Fat Choy (sea moss)- Prosperity
• Fish- Abundance
• Green Onions- Smart
• Long Noodles- Long Life
• Red Dishes- Good Luck
• Lotus Seeds- Children, long continuous lineage
(Gong, 2005, p. 25)
14. Mid-Autumn Festival
“Moon Festival”
• Celebrated on the eight lunar month- September
• In old rural China- Celebrates a bountiful
harvest
• Banquet-style meal at home or restaurant: five,
seven or nine dishes prepared
• Moon cakes- filled with duck egg yolk
• Symbolic Foods
-Taro- a starchy root vegetable
-Pomelo- ward off evil and promote good health
-Snails- A reminder of earth‟s wealth
(Gong, 2005)
15. Communication Styles
• Older generation- Very private
• Greeting- A simple handshake is acceptable
• Small talk- Ask how day is going
• Eye contact is okay- Staring would be impolite
• Do not touch on the head or slap on the back
• Don‟t point index finger or snap fingers
• Nodding means listening, not agreeing
http://www.sccfsac.org/manners.html , per interviewee
16. Nutrition Related Health Problems
• Chronic Diseases
- Hypertension
- Hyperlipidemia
- Heart Disease
- Gout
- Diabetes- 12-21% Chinese Americans
- Hepatitis B- May cause liver cancer
- Overweight/Obesity- Possibly related to
acculturation and Westernized diet
Per interviewee, (Sun, 2011)
17. Nutrition Related Health Problems
Current Research
• Small pilot study on older diabetic Chinese
Americans (65 years and older)
• Interviewed over the course of 3-4 weeks
• Participants from two Chinese senior care centers
in Southern California
• Lived in US average of 15 years
• Purpose- To explore self-care practices with type 2
diabetes and to identify risk factors related to
lifestyle, attitudes and health beliefs
(Fang, Letzkus, &Washington, 2009)
18. Current Research Results
• Results based on two reoccurring themes
1. Self –care management, diet, exercise, and
medications
2. Health beliefs- attitudes, lifestyle, and health
practices
• Self Care practices were important for overall
health, not for T2DM
• Diet- realized importance to maintain good health
• Exercise- no cardiovascular reported
• Medications- one or more diabetes medications,
herbs
(Fang, Letzkus, &Washington, 2009)
19. Current Research Results
Continued
• Health beliefs- good health = no suffering of
physical or emotional pain, independence, ability
to eat, drink, and sleep well.
• Lifestyle- reported that T2DM did not change
lifestyle, did not think T2DM is serious, more
concerned about other diseases, stressed
importance of accurate information from health
care providers
• Attitudes- self reliance is very important, don‟t
want to burden family, overall health management
is more important than focusing on one disease
(Fang, Letzkus, &Washington, 2009)
20. Current Research Results
• Bottom Line
- Self-care is very important in T2DM management
- Self-care is affected by age, low socioeconomic
conditions, education, access to healthcare
- Self-care management is more effective when
- It‟s accurate
- Suitable
- Culturally sensitive
(Fang, Letzkus, &Washington, 2009)
21. Impact on Dietitians
• For clients- focus on age, acculturation, education level,
language, and socio-economic status
• Focus more on health benefits of foods
• Respect special holiday‟s and events
• Provide accurate information- clients will respect this
• Provide educational materials/handouts in Chinese
• Don‟t overwhelm- small changes
• If working with the elderly- empower them
• Involve family members- be mindful
• Respect communication styles
22. Impact on Dietitians
• According to Gail, Ming, and Wang (2009), “When
working with Chinese Americans with T2DM,
Interventions should involve:
- Self- reliance
- Hopefulness and Optimism
- Focus more on strengths of their community and
less on behavior change” (Gail et al., 2009, p. 318)
24. References
• http://www.chinatoday.com/general/a.htm
• http://sun.menloschool.org/~mbrody/ushistory/angel/exclusion_act/
• http://www.migrationinformation.org/USfocus/display.cfm?ID=876
• http://en.wikipedia.org/wiki/Dim_sum
• http://www.sccfsac.org/manners.html
• http://www.globaled.org/curriculum/china/ethnic.htm
• Chinese American Outreach Guide (2009).
• Retrieved from http://www.caringinfo.org/files/public/outreach/chinese_american_outreach_guide.pdf
• Gong, Rosemary (2005). Good Luck Life, The Essential Guide to Chinese American Celebrations and Culture. New York, New
York: Harper Collins Publishers
• Jones, Nicholas A. (2012). The Asian population in the United States: results from the 2010 census. Retrieved from
http://www.census.gov/newsroom/releases/pdf/2012-05-02_nickjones_asianslides_2.pdf
• Lin, Kathy (2012). Chinese food cultural profile. Retrieved from
http://ethnomed.org/clinical/nutrition/chinese_food_cultural_profile
• McCabe, Kristen (2012). Chinese immigrants in the United States. Retrieved from
http://www.migrationinformation.org/USfocus/display.cfm?ID=876
• Sun, Angela, PhD, MPH (2011). Challenges and barriers in diabetes management among Chinese Americans. Retrieved from
http://www.cchrchealth.org/downloads/Challenges%20and%20Barriers%20in%20Diabetes%20Management%20Among%20
Chinese%20Americans.pdf
