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PubMed1998

A comparison of Caucasian and Southeast Asian Hmong uterine fundal height during pregnancy.

BACKGROUND: Fundal height measurement is a standard clinical assessment tool used in prenatal care. This study compared the fundal heights growth curves of two ethnically distinct groups of pregnant women. We were motivated by our clinical experience with one group where fundal heights seemed 'small for date' and by the reluctance of this group to undergo further testing, especially ultrasound. METHODS: A prospective cohort study compared the fundal heights growth curve of 48 Caucasian and 40 Hmong women from two clinics in central Wisconsin (USA). RESULTS: Southeast Asian Hmong women were found to have a slower rate of fundal height growth than Caucasian women (significantly different average slopes of .88 vs. .95, respectively). An expectation of linear growth appeared more valid for Caucasian than Hmong women. At 40 weeks, regression based estimates overestimated the Caucasian sample by 1.3 weeks and the Hmong sample by 2.7 weeks. ANCOVA procedures remained significant while controlling for group differences in height. Fundal height measurements were moderately predictive of birth weight for the Hmong sample but not the Caucasian sample (multiple r=.39). CONCLUSIONS: Considerable differences emerged between fundal height measures for the Hmong and Caucasian samples. The improved ability to differentiate groups following control of variance due to height as well as the ability to predict birth weight from fundal height curve in the Hmong group argue for value of normative development using more homogeneous groups. Clinicians should consider the applicability of fundal height norms to their clinical populations and may be able to have more confidence in using fundal height as an evaluative tool with more appropriate norms.

Asia, Southeastern↗

PubMed2006

Verified predominance of slow acetylator phenotype N-acetyltransferase 2 (NAT2) in a Hmong population residing in Minnesota.

Southeast Asians known as the Hmong have a high prevalence of tuberculosis and select cancers. The slow acetylation (SA) phenotype for N-acetyltransferase 2 (NAT2) has been associated with toxicity from the anti-tuberculosis drug, isoniazid and in increased risk of select cancers. Previous research indicates a 74.5% prevalence of SA in Hmong which differs from other Asian populations including the Japanese and Thai (range: 7%-45%). Given this contrast, the purpose of this study was to confirm or refute this unexpected predominance of the SA phenotype in Hmong. Unrelated, Minnesota Hmong between 18 and 65 years of age consented and participated by ingesting caffeine as the probe for NAT2. A urinary caffeine metabolic ratio AFMU/1X (<0.6) was used to classify subjects as slow acetylators. Among 51 analysable samples provided by 61 enrollees (27 male, 33 female, 1 sex unknown, age 30+/-11 years [mean+/-SD]) there were 47 (92.2%) slow and 4 (7.8%) rapid acetylators. The prevalence of the SA phenotype (92.2%) from this study exceeds the 74.5% (p<0.02 by chi-square test) previously noted in Minnesota Hmong (n=98). The predominance of the SA phenotype within Minnesota Hmong is confirmed. Further studies evaluating this unexpected prevalence, its genetic basis and potential clinical relevance to drug toxicity and disease are warranted.

Acetylation↗

PubMed2003

Cancer in the Minnesota Hmong population.

BACKGROUND: The Hmong are an isolated, agrarian people who settled in the mountainous regions of what today are Vietnam, Cambodia, and Laos. After the Vietnam War, many Hmong were relocated to the U.S. Minnesota has the second largest population (after California) of Hmong individuals. The objective of this study was to examine cancer incidence in this population, because it may indicate areas for targeted surveillance and intervention. METHODS: The Minnesota Cancer Surveillance System database was screened for Hmong surnames, and proportional incidence ratios (PIRs) were calculated for the period 1988-1999. RESULTS: Compared with all Minnesotans, the Hmong population had increased PIRs for nasopharyngeal cancer (PIR, 39.39; 95% confidence interval [95% CI], 21.01-66.86), gastric cancer (PIR, 8.70; 95% CI, 5.39-13.25), hepatic cancer (PIR, 8.08; 95% CI, 3.88-14.71), and cervical cancer (PIR, 3.72; 95% CI, 2.04-6.20) and had decreased PIRs for prostate cancer, breast cancer, Hodgkin disease, and melanoma. CONCLUSIONS: The current observations have implications for cancer control interventions. In particular, an increased incidence of cervical cancer might be addressed in part by targeting culturally sensitive screening programs in the Hmong population.

Adolescent↗

PubMed2004

Genetic polymorphisms in the Hmong population: implications for cancer etiology and survival.

BACKGROUND: The Hmong, an isolated, agrarian people from southern China, migrated to the mountainous regions of what are today Vietnam, Cambodia, and Laos. Minnesota has the second largest Hmong population in the United States. The authors compared frequencies of common genetic polymorphisms believed to influence risk of malignancy to determine whether frequencies in the Hmong are different from those in other Asian populations and in white Minnesotans. METHODS: Genotyping for glutathione S-transferase micro1 (GSTM1), glutathione S-transferase theta1 (GSTT1), myeloperoxidase (MPO) (C(-)463T), nicotinamide adenine dinucleotide phosphate:quinone oxidoreductase (NQO1) (C609T), 5,10-methylenetetrahydrofolate reductase (MTHFR) (C677T), MTHFR (A1298C), methionine synthase reductase (MTRR) (A66G), X-ray repair cross complementing 1 (XRCC1) 194 (Arg194Trp), XRCC1 280 (Arg280His), and XRCC1 399 (Arg399Gln) alleles was performed by TaqMan analysis using DNA isolated from newborn heel-stick spots provided by the Minnesota Department of Health. RESULTS: The Hmong had significantly higher frequencies of the NQO1 T allele and the XRCC1 Trp polymorphism (Arg194Trp) and had significantly lower frequencies of the G allele in MTRR (A66G) and the T allele in MTHFR (C677T) compared with white Minnesotans. The Hmong also were significantly more likely to lack the GSTM1 and GSTT1 genes compared with whites (82% vs. 54% and 61% vs. 18%, respectively). Genotype frequencies were similar for MTHFR (A1298C), MPO (C(-)463T), and XRCC1 (Arg280His, Arg399Gln). Genotype frequencies at these loci also were compared with those reported for other Asian populations and showed notable differences between the Hmong and Chinese/Taiwanese, Korean, and Japanese populations. CONCLUSIONS: The genetic differences identified have implications for both cancer etiology and prognosis in this unique population.

Asia↗

PubMed1985

Health of Hmong in Thailand: risk factors, morbidity and mortality in comparison with other ethnic groups.

Demographic and health conditions among Hmong in Thailand were examined in comparison with other ethnic groups which closely resemble the ethnic origins of Southeast Asian refugees in the U.S. Thailand Hmong have very large extended family households, very high birth rates, low use of contraception, very young age at first marriage, and, compared with other highland minorities, relatively low infant and crude mortality rates. Hmong use of tobacco and alcohol and other stimulants is lower than other ethnic groups, and is much more frequent among men than among women. Opium was used by 15% of the men in the surveyed village, lower than among another highland group, but higher than in surveyed lowland villages. Fewer illnesses were reported by Hmong in the 7 days prior to survey than in other rural groups. Relatively low Hmong morbidity and mortality as compared with other highland ethnic groups may be associated with low use of tobacco and alcohol, and with the sharing of child care responsibilities within the large Hmong extended family households.

Adolescent↗

PubMed1993

Demographic variables in fetal and child mortality: Hmong in Thailand.

Conventional theories would not predict the 60% decline of infant mortality which has occurred among the Hmong population of Thailand, from 123/1000 in the mid-1960s to 48 in the mid-1980s. The Hmong population in northern Thailand has sustained high fertility and low use of modern health services. Most Hmong live in relatively remote rural villages and earn their living by self-employed farming. They have low levels of education, especially for women. They live in multi-generational patrilineal-patrilocal extended family households. Women's status is low. These characteristics contrast strongly with the majority ethnic Thai population, among whom a comparable mortality decline has been accompanied by widespread use of family planning, rapidly declining fertility, widespread use of modern health facilities, rapidly increasing levels of education for both sexes, rapid economic development, and a predominance of nuclear-based family households. Distributions of Hmong pregnancies by birth order and maternal age have remained relatively constant while fetal and young child death rates have declined for each level of parity and all maternal ages in recent cohorts. As predicted by conventional theories, infant mortality rates are highest among higher order births and for births to mothers of the highest ages, however there is relatively little effect on risk of infant mortality of first order pregnancies, or births to very young (10-14 year old) women. Fetal and infant mortality have declined steadily in recent cohorts at each parity level and all maternal ages. Modern medical care and decline in a surplus of female deaths associated with low status of women might explain the declines in fetal and child deaths regardless of parity or maternal age. Use of modern medical care for delivery is recent and accounts for less than 10% of all recent Hmong births, but survival rates are not consistently or significantly higher for children born with a modern birth attendant. Sex-specific mortality rates calculated from reproductive histories show no surplus of female deaths in the past, but females have benefitted more from recent mortality declines than males. Ethnographic evidence suggests that Hmong have customs which act to protect the health of mother and child ('chicken soup theory'), and that they are predisposed to accept innovations (including use of modern medicine) which they see as beneficial. This may allow them to respond especially quickly to small opportunities for improving their children's survival, as compared with other ethnic groups.

Birth Order↗

PubMed1997

Cancer incidence in the Hmong of Central California, United States, 1987-94.

The Hmong are an ethnic minority in China, some of whom migrated to the mountainous areas of North Vietnam, Laos, and Thailand in the 19th and 20th centuries. Because of their support for the United States during the Vietnam war, many Laotian Hmong fled to Thailand and eventually were re-settled in the US after the end of that conflict. Approximately 100,000 Hmong currently live in the US, of whom about half reside in the Central Valley of California. The purpose of this study was to measure cancer incidence in this unique new immigrant population. Using the resources of the Cancer Registry of Central California (CRCC), a population-based cancer registry, cancer incidence in the Hmong was evaluated by calculating age-adjusted incidence rates as well as by calculating proportional incidence ratios. Compared with all races combined, elevated rates of cancer in the Hmong were observed for the following sites: nasopharynx, stomach, liver, pancreas, leukemia, and non-Hodgkin's lymphoma. Cervical cancer incidence overall was elevated, but more noteworthy, invasive cervix cancer rates were much higher than expected. Lower cancer rates were found for breast, prostate, and colorectal cancer. Hmong also experienced advanced stage and grade of disease at diagnosis for many cancer sites in addition to cervical cancer, which may be explained by cultural factors, including avoidance of Western medical care and low rates of participation in screening programs. This population should be followed closely and monitored for patterns of cancer incidence in the future since it provides a natural laboratory for studies of cancer etiology as this population gradually becomes acculturated to the Western lifestyle.

Adolescent↗

PubMedDate not supplied

Cancer screening, reproductive history, socioeconomic status, and anticipated cancer-related behavior among Hmong adults.

In the United States, breast, cervical, colorectal and prostate cancer screening rates are low or non-existent in the Hmong population compared to non-Hispanic Whites. No Hmong adults report ever participating in prostate (male only) and colorectal cancer screening. US-born Hmong women, those living in the US 20 years, and those 39 years old are more likely to be screened for breast and cervical cancer than other women. The Hmong, in general, are a young population (median age = 34 years) with low socioeconomic status. As a function of these characteristics, 52% of Hmong women reported having their first child at 15-19 years old and continued to bear children until 40-54 years old. The combination of young age at first pregnancy and multiparity probably protects Hmong women from breast cancer but elevates cervical cancer risk.

Adolescent↗

PubMedDate not supplied

Perinatal needs of immigrant Hmong women: surveys of women and health care providers.

The Hill People of Laos in Southeast Asia, who are called the Hmong, are from a primitive culture which has had a written language for only 31 years. By 1980, about 3,000 of them were living in Colorado, one of 9 States to which they had migrated. In an effort to determine whether or not local health care service was accessible and acceptable to child-bearing families, a pilot survey was conducted in the Denver area. The survey consisted of interviews of the Hmong women themselves and questions of area health care providers. The interviews proved to be both difficult and illuminating. They were difficult because of the language barrier, which required exclusive use of interpreters, and because of the diffidence of the women themselves, especially in discussing matters of sex and childbearing. Illumination came from learning Hmong customs and culture and some of the benefits of their version of self-care. It also came from whatever value may lie in applying this knowledge to other immigrant ethnic groups with comparable problems. Responses to questionnaires from the health care providers disclosed that, from their viewpoint, principal Hmong concerns were family planning and nutrition. They also revealed surprisingly few maternal or child deaths among the Hmong. There still exists a need for both cross-sectional and longitudinal studies to document the effect of migration on the Hmong.

Attitude to Health↗

PubMed1984

Splenomegaly in Hmong refugees.

We review asymptomatic splenomegaly in Indochinese refugees and provide recommendations for evaluation of the problem. Prevalence of splenomegaly in newly arrived Indochinese refugees was 2.5%, three times more prevalent in the Hmong than in the non-Hmong refugees. Male Hmong refugees aged 15 to 29 years had the highest prevalence (10%). For the 50 Hmong refugees studied, there was no evidence that their splenomegaly was caused by clonorchiasis, schistosomiasis, tuberculosis, syphillis, lymphoma, tropical splenomegaly syndrome, or clinical malaria. Cases were more likely to have hepatomegaly, hepatitis B surface antigen positivity, and a low mean corpuscular volume than a reference population of Hmong refugees. Malaria antibody titers were elevated in all but one of the 41 cases (98%) tested.

Adolescent↗

PubMed1992

Indications of early obesity in low-income Hmong children.

OBJECTIVE: To determine if there is evidence of obesity in low-income Hmong children. DESIGN: Cross-sectional survey. SETTING: Women, Infants, and Children clinics in Minneapolis, Minn. PARTICIPANTS: 271 US-born Hmong children, ages 1.00 through 4.99 years. SELECTION PROCEDURES: Consecutive sample of all Hmong children seen in two clinics between September and December 1989. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Heights and weights were measured and converted to National Center for Health Statistics z scores of weight for age, height for age, and weight for height. Relative to National Center for Health Statistics reference data, mean height-for-age z scores decline progressively after age 2 years to--1.2 z at age 4.5 years. Mean weight-for-height z scores exceeded the National Center for Health Statistics reference significantly at ages 3 and 4 years, and there was more than a fourfold excess of Hmong children beyond the 95th percentile in weight for height at these ages. CONCLUSIONS: There is evidence of early obesity in Hmong children, an ethnic group heretofore considered to be a low risk for obesity.

Asia, Southeastern↗

PubMed2005

Effectiveness of a community-based advocacy and learning program for hmong refugees.

The effectiveness of a community-based advocacy and learning intervention for Hmong refugees was assessed using a comprehensive, multi-method strategy, which included a within-group longitudinal design with four data collection points and in-depth qualitative recruitment and post-intervention interviews. The intervention's impact on five aspects of refugee well-being was examined: Participants' psychological well-being, quality of life, access to resources, English proficiency, and knowledge for the U.S. citizenship exam. Twenty-eight Hmong adults and 27 undergraduate students participated together in the intervention, which had two major components: (1) Learning Circles, which involved cultural exchange and one-on-one learning opportunities for Hmong adults, and (2) an advocacy component that involved undergraduates advocating for and transferring advocacy skills to Hmong families to increase their access to resources in their communities. Undergraduate paraprofessionals and Hmong participants worked together for 6-8 hr per week for 6 months. Growth trajectory analysis revealed promising quantitative findings. Participants' quality of life, satisfaction with resources, English proficiency, and knowledge for the U.S. citizenship test increased and their levels of distress decreased over the course of the intervention. Mediating analyses suggested that participants' increased quality of life could be explained by their improved satisfaction with resources. Qualitative data helped to support and explain the quantitative data, as well as providing insight into other outcomes and processes of the intervention. Policy, practice, and research implications are discussed.

Adolescent↗

PubMedDate not supplied

Pesticide exposures among Hmong farmers in Thailand.

Highland Hmong farmers in Thailand have abandoned shifting cultivation of subsistence crops and turned to chemical-intensive cultivation of non-narcotic permanent field cash crops. Three highland communities and Hmong in urban Chiang Mai were studied. Most rural study participants applied chemicals, primarily to control insects, weeds, and fungus, by backpack and machine sprays and by hand. Hmong women have less Thai language skill than men and less information concerning hazards of exposure or use of protective clothing. Most Hmong know of the health hazards, but many fail to use adequate protective clothing to prevent exposure. Screening showed 20-69% of 582 Hmong adults with risky or unsafe levels of cholinesterase inhibition, an indicator of exposure to organophosphate and carbamate pesticides. Exposure rates are as high among those who do not actually apply pesticides as among those who do, suggesting exposure by routes in addition to direct contact associated with application.

Adolescent↗

PubMed1991

A Hmong Adaptation of the Beck Depression Inventory.

We developed the Hmong Adaptation of the Beck Depression Inventory (HABDI) and evaluated the instrument's psychometric characteristics. Also examined was the relationship between depression and demographic variables such as age, sex, length of stay in America, English-speaking ability, and social support in Hmong refugees. One hundred twenty-three Hmong living in Fresno County, between the ages of 18 and 66, participated in the study. The new measure demonstrated a high coefficient alpha (.93), and test-retest reliability (.92), and a significant mean score difference between the nondepressed and the depressed groups. Individual items were distributed evenly and correlated highly with the total depression score. The HABDI correctly identified 94% of depressed and 78% of nondepressed in the Hmong sample. The results suggest that quality of social support and years of education play important roles in buffering Hmong refugees against depression, whereas length of stay in America and number of social supports do not.

Acculturation↗

PubMed1995

Hopkins Symptom Checklist-25, Hmong version: a screening instrument for psychological distress.

The Hopkins Symptom Checklist (HSCL-25; Mattsson, Williams, Rickels, Lipman, & Uhlenhuth, 1969) was translated into the Hmong language and administered to 159 Hmong adults, 73 nonclinical and 86 mental health clients. The instrument demonstrated internal consistency of .97 and had a split-half coefficient of .92 and test-retest reliability of .90. Mental health clients produced scores that were significantly higher than those of nonclinical participants on the Anxiety, Depression, and Total scores. Consistent with expectations, Hmong more intensely affected by the casualties of war, those currently unemployed, those older, and those with less education tended to report more symptoms of anxiety and depression. The Hmong version of the HSCL-25 provided a sensitivity of 100%, specificity of 78%, and overall accuracy of 89%, demonstrating that it is a useful screening tool for assessing general distress and anxiety problems in Hmong people.

Adolescent↗

PubMed2005

Group visits for Hmong adults with type 2 diabetes mellitus: a pre-post analysis.

Hmong refugees with type 2 diabetes mellitus (DM2) have poor glycemic control. For Hmong adults with DM2, group visits were instituted at a community health center and evaluated for their influence on diabetes management. Pre- and postintervention measures of physical health, mental health, and behavior were collected on 39 participants (64% participation rate). Baseline characteristics and clinical outcomes of 39 group visit participants were compared with 22 Hmong DM2 adults who refused to participate and 216 nonparticipating Hmong DM2 adults from a local diabetes registry. Baseline characteristics were similar among the three groups. Although participants received good medical services and their mental health improved (p < 0.05), clinical outcomes did not significantly improve. Although group visits are feasible for providing medical services for Hmong adults with DM2, clinical outcomes remain outside of recommended targets. Addressing mental health in this population may be necessary before people can institute behavioral changes that improve diabetes management.

Adult↗

PubMed1992

Pregnancy among the Hmong: birthweight, age, and parity.

OBJECTIVES: The influx of Southeast Asians into the United States allows for the study of this special population and contributes to a broader understanding of reproductive health. METHODS: We used information on birth certificates to identify 1937 Hmong children born 1985 through 1988 in California, and we compared birthweight and reproductive factors as related to these children with the same factors as related to 3776 White, non-Hispanic children born in the same period. RESULTS: Mean birthweight among Hmong children (3311 g) was significantly lower (P less than .05) than among White children (3452 g), but the proportion of births under 1500 g was higher for Whites. Hmong women were of much higher parity and were more likely to deliver at both a young (less than 18 years) and an old (greater than 40 years) maternal age. At every age and every parity, however, Hmong women had cesarean sections at one-half to one-tenth the rate of White women. CONCLUSIONS: Despite a high proportion of births at high parity and advanced maternal age, Hmong women gave birth to very low-birthweight babies at essentially the same rates as White women. Their lower cesarean section rates, however, deserve further attention.

Adolescent↗

PubMedDate not supplied

Fright illness in Hmong children.

For the Hmong, illness may occur as the result of an intense emotional experience such as a frightening or upsetting event. Illness from fright (termed ceeb; pronounced "cheng") among refugee Hmong children entails culture-specific meaning, etiologies, responses, and treatment. In a focused ethnographic study, interviews with 18 Protestant Hmong parents and several community members living in a Midwestern community identified factors contributing to the onset of fright illness in Hmong children, its symptomatology, and treatment. Diagnostic and treatment methods for fright illness were discussed with a Hmong healer. Culture and religious change has influenced ideas and healing practices surrounding illness from fright. Nurses and other health care providers are often unaware of illnesses and treatments specific to culture groups different than their own. Elicting the patient's perspective on illness can provide insights that assist in providing culturally sensitive care.

Adolescent↗