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PubMed1992

Causes and consequences of increase in child survival rates: ethnoepidemiology among the Hmong of Thailand.

The Hmong "hill tribe" minority in Thailand has much higher exposure to factors usually associated with risk of child mortality (high fertility, low status of women, low education, less use of modern medical care for births, exposure to warfare, economic and physical disruption, and poor hygienic conditions) than the rural ethnic Thai population. Nonetheless, infant mortality has declined from over 120 per 1000 to under 50 per 1000 live births among both these populations in the past 30 years. The reason for the rapid increase in child survival among the Hmong appears to be better access to and more use of modern curative and preventive medical care associated with road construction rather than major changes in social or hygienic conditions. Conventional wisdom suggests that high fertility is both a cause and a consequence of high infant and child mortality and that parents will not reduce fertility until they see that mortality has declined. Most Hmong parents recognize the decline in child mortality and attribute it to better access to modern medical care. Most Hmong parents also say that, if they were starting to have children now, they would want to have fewer children. Fear of child death is infrequently mentioned as a motive for having more children, and the perceived decline in child mortality is rarely mentioned as a reason for reduced fertility. Most Hmong parents explain their desired family size in terms of economic conditions rather than perceived risk of child mortality. Results of this study suggest that fertility and child mortality can vary independently of one another and that major reductions in child mortality can be accomplished without waiting for major social changes (e.g., improved education or status of women) or major reductions in fertility.

Child Health Services↗

PubMed1997

Critical thinking, health policy, and the Hmong culture group, Part II.

The Hmong are an Asian cultural group originating primarily in the northern hills of Laos. During the Vietnam conflict, they fought and died for the U.S. during a secret Laotian war. The U.S. gained their support in exchange for protecting them from their enemies in Laos regardless of the war's outcome. When North Vietnam took over Laos, hundreds of thousands of Hmong fled to Thailand's refugee camps; from there, over 100,000 Hmong refugees relocated to the U.S. (Heu, 1996). With them, the Hmong brought culture, language, and healthcare beliefs and rituals, as well as distinct challenges to U.S. communities, policy makers, and healthcare professionals. This article is the second in a two-part series on critical thinking and health policy and the Hmong culture group.

Acculturation↗

PubMed1996

Predominance of slow acetylators of N-acetyltransferase in a Hmong population residing in the United States.

Pharmacogenetics can be an important determinant of pharmacologic response. To learn more about interpopulation differences in drug metabolism between ethnically diverse populations of subjects cared for by an International Clinic, a study was conducted to describe the prevalence of fast or slow acetylators of N-acetyltransferase (NAT2) in a population of Hmong residing in Minnesota. Ninety-eight healthy Hmong refugees from Laos volunteered to take caffeine as an oral probe drug to establish acetylator phenotype. Participants were classified as either rapid or slow acetylators based on the urinary molar ratio of select metabolites of caffeine. Assignment of phenotype was based on results from analysis of urine collected subsequent to ingestion of caffeine. The ratio of 5-acetylamino-6-formylamino-3-methyluracil (AFMU) to the combined products of the 7-demethylation pathway of paraxanthine (AFMU, 1-methylxanthine (1X), and 1-methylurate (1U)] formed the basis for this determination. A probit plot of the data collected in our subjects qualified a metabolic ratio of 0.34 as an acceptable cut point for phenotype assignment. Participants with an AFMU/(AFMU + 1X + 1U) ratio of < 0.34 were classified as slow acetylators and all others as rapid acetylators. Analysis of the data suggested a bimodal distribution with an excess (74.5%) of slow acetylators in the population. The predominance of slow acetylators found in the Hmong contrast with the prevalence of slow acetylators seen in other ethnic groups. These findings may have important clinical implications given the large number of Hmong treated each year in our International Clinic and the increasing use of medications metabolized by NAT2 in this population.

Acetylation↗

PubMed2005

Preschoolers learning Hmong and English: lexical-semantic skills in L1 and L2.

Picture naming and picture identification tasks were used to investigate lexical-semantic skills in young children learning Hmong as a first language (L1) and English as a second language (L2). A total of 19 children, ages 3;4 (years;months)-5;2, participated in this study. Performance on lexical tasks was analyzed as a function of development (older and younger participants), language (Hmong and English), modality (receptive and expressive skills), and the nature of total or "composite" vocabulary scores (translation equivalents or singles, reflecting comparable forms in both languages as compared to concepts lexicalized into only 1 language). Older participants outperformed younger participants in English, but not Hmong, indicating a relative stabilization of L1 skills, alongside more robust growth in L2. The difference between expressive and receptive performance was also much greater in Hmong than English. Composite scores were always greater than single language scores and the proportion of translation equivalents increased with age.

Analysis of Variance↗

PubMed2003

Abortion--it is for some women only! Hmong women's perceptions of abortion.

In this article, I explore traditional Hmong explanations about abortion and the ethnomedical knowledge and practices that pertain to it. The article derived from in-depth interviews and participant observation with the Hmong who are now living in Melbourne, Australia. Hmong women are knowledgeable about indigenous fertility control methods including abortion. However, only women who are older and have had many children to ensure the continuity of the lineage have a right to abortion. Younger women do not have this right. Women may wish to control their fertility by means of abortion, but their wishes may be constrained by a societal norm that places a great deal of pressure on women to continue producing children. In a culture that values having many children, abortion is not easily accepted because it upsets the cosmological balance of the society. This has implications for younger Hmong women who may wish to control their fertility in Australia and elsewhere.

Abortion, Induced↗

PubMed2002

Mineral content of culinary and medicinal plants cultivated by Hmong refugees living in Sacramento, California.

Since the end of the American-Vietnamese War in 1975, more than 1.5 million refugees from Southeast Asia have resettled in the United States. Included among these displaced persons were the Hmong from Laos, a subsistence-based, shifting-cultivation, agricultural society. Hmong who resettled in urban areas have viewed vacant lots adjacent to urban dwellings as potential garden sites for production of familiar herbs and vegetables. In the present study exotic culinary and medicinal herbs grown by Hmong refugees in Sacramento, California were identified and analyzed for mineral composition. The herbs grown in these urban gardens were significant ingredients of Hmong recipes, and herb leaves, or infusions of steamed herb leaves were widely consumed as a component of pregnancy and post-partum diets. Six common species, Acorus gramineus, aff. Angelica, Dendranthema indicum, Eupatorium lindleyana, Sedum aff. sarmentosum, and Sedum aff. spectabile, were used in combination to season chicken. Polygonum odoratum, also widely cultivated, was used to season fish. Exotic culinary-medicinal species with highest mineral profiles included: Basella alba (Ca, Mg, Mn, Zn); Houttuynia cordata (Fe, Mg, Mn); Justica gendarussa (Ca, Mg, Zn); and Polygonum odoratum (Ca, Mg, Mn). While vacant lots sometimes are heavy metal contamination sites, we found no detectable levels of arsenic, cadmium, chromium, or lead in the samples analyzed.

Adult↗

PubMed2004

Genetic structure of Hmong-Mien speaking populations in East Asia as revealed by mtDNA lineages.

Hmong-Mien (H-M) is a major language family in East Asia, and its speakers distribute primarily in southern China and Southeast Asia. To date, genetic studies on H-M speaking populations are virtually absent in the literature. In this report, we present the results of an analysis of genetic variations in the mitochondrial DNA (mtDNA) hypervariable segment 1 (HVS1) region and diagnostic variants in the coding regions in 537 individuals sampled from 17 H-M populations across East Asia. The analysis showed that the haplogroups that are predominant in southern East Asia, including B, R9, N9a, and M7, account for 63% (ranging from 45% to 90%) of mtDNAs in H-M populations. Furthermore, analysis of molecular variance (AMOVA), phylogenetic tree analysis, and principal component (PC) analysis demonstrate closer relatedness between H-M and other southern East Asians, suggesting a general southern origin of maternal lineages in the H-M populations. The estimated ages of the mtDNA lineages that are specific to H-M coincide with those based on archeological cultures that have been associated with H-M. Analysis of genetic distance and phylogenetic tree indicated some extent of difference between the Hmong and the Mien populations. Together with the higher frequency of north-dominating lineages observed in the Hmong people, our results indicate that the Hmong populations had experienced more contact with the northern East Asians, a finding consistent with historical evidence. Moreover, our data defined some new (sub-)haplogroups (A6, B4e, B4f, C5, F1a1, F1a1a, and R9c), which will direct further efforts to improve the phylogeny of East Asian mtDNAs.

Asia, Southeastern↗

PubMed2005

Chronic illness and Hmong shamans.

Among the challenges health care personnel in California's central valley face has been finding ways to help Hmong Americans manage chronic illness. Interviews were conducted with 11 Hmong shamans diagnosed with diabetes or hypertension and were qualitatively analyzed to ascertain respondents' understanding and management of their illnesses. Hmong shamans are influential individuals within their communities and are often the resource persons to whom patients turn for information on health. Understanding the shamans' perspective on chronic illness was seen as a gateway to understanding how the broader Hmong American community perceived these conditions. The concept of chronic illness was not well understood, resulting in sporadic medication and dietary regimens, limited awareness of potential complications, and a persistent impression that these illnesses could be cured rather than managed. Suggestions for patient educators include family and community involvement in care regimens and the use of descriptive terminology to identify the disease.

Adaptation, Psychological↗

PubMed2006

Chronic confusion and memory impairment in Hmong elders: Honoring differing cultural beliefs in America.

The Hmong began arriving to the United States as refugees in the mid 1970s and constitute a growing number of the population. Little is known about the prevalence and care of dementia in Hmong elderly individuals. The purpose of this article is to discuss the traditional beliefs and treatment of tem toob (memory impairment) within the Hmong culture. This includes a discussion of the authors' encounters with Hmong herbalists in open-air markets during a journey in Laos and Thailand. A story cloth is then featured to discuss a shamanic healing ceremony for an elderly woman with tem toob. Nursing implications are discussed.

Aged↗

PubMed2006

The relationship between maternal child-feeding practices and overweight in Hmong preschool children.

OBJECTIVE: Maternal child-feeding practices have been linked to overweight in several studies. Overweight is a prevalent condition in Hmong preschool children in the United States, therefore, the purpose of this study was to determine whether maternal child-feeding attitudes and practices were associated with overweight in Hmong preschool children. DESIGN: The Child-Feeding Questionnaire (CFQ) was revised and administered to Hmong mothers with normal-weight and overweight children. SETTING: Women, Infant, and Children Supplemental Food Program (WIC) clinics and community centers in the Minneapolis-St. Paul metropolitan area. PARTICIPANTS: Hmong mothers of normal-weight (n=45) and overweight (n=35) children. MAIN OUTCOME MEASURES: Relationships between maternal perceptions of child's weight, practices in child feeding, including monitoring, restriction, and pressure to eat, and overweight status in children. RESULTS: No association was found between maternal attitudes and practices in child feeding and body mass index (BMI) of the child except for mother's perception of her child's weight. Mother's perception of her child's weight was also associated with maternal restriction of certain foods. Mother's education and children's weight status were weakly positively associated. Mothers with more education tended to be younger and to work outside the home. CONCLUSION: The lack of a relationship between maternal child-feeding practices and children's weight status may be due to factors such as mother's education, role of other caregivers, and cultural factors.

Adolescent↗

PubMedDate not supplied

Can NCAST and HOME Assessment Scales be used with Hmong refugees?

This descriptive study of a convenience sample of 32 recently settled, preliterate Hmong families tested the applicability of the NCAST and HOME assessment tools in the Hmong refugee population. The sample means on the Nursing Child Assessment Feeding Scale (NCAFS), Nursing Child Assessment Teaching Scale (NCATS), and the Home Observation for Measurement of the Environment (HOME) were compared to a randomly selected sample of white (n = 60), African American (n = 60), and Hispanic (n = 60) families from the University of Washington NCAST (Nursing Child Assessment Satellite Training) normative data bank. The NCAFS and NCATS Hmong total means were not significantly different when compared to the combined normative sample total means. However, when the ethnic groups were compared using ANCOVA with ethnicity and education as covariates, the parent, child, and scale total means were found to be significantly different (p < .05). Hmong HOME total means were significantly lower when compared to the combined normative sample (p < .05) and with separate ethnic group comparisons (p < .05). Although lower for this population lacking formal education, scores were not significantly different when compared to the combined normative sample means. Findings suggest that the NCAST tools should be used with respect for the impact of ethnicity and education on total scores. Findings do not support the use of the HOME scale with this population except as a teaching guide.

Adolescent↗

PubMedDate not supplied

Hmong healing practices used for common childhood illnesses.

Central California has become a place of refuge and settlement for Southeast Asian Hmong immigrants over the past 20 years. The resulting assimilation of this new cultural group into American society has produced the need for multi-ethnic understanding and culturally sensitive health care interventions. Knowledge regarding the health care practices of Hmong parents provides the foundation for this understanding and an integrated and meaningful model of child care. This study of Hmong parents describes (a) their indigenous healing practices, (b) the purposes of these health care practices, (c) their beliefs about western medical care, and (d) their views on seeking western pediatric health care. A one-group descriptive design was used. Interview data from Hmong parents (N = 21) describes illness causation, healing rituals, herbal remedies, and other health care traditions.

Adolescent↗

PubMed1996

Predictors of English fluency among Hmong refugees in Minnesota: a longitudinal study.

The objective of this study was to assess factors associated with later acquisition of English language fluency among Hmong refugees in Minnesota. Fluency in a society's lingua franca is a critical skill in psychosocial adaptation and mental health. A longitudinal study design was used, in which premigration and early postmigration factors were related to subsequent English fluency. The first group of 102 Hmong refugees located in Minnesota by the Immigration and Naturalization Service participated, and were interviewed in their homes. Hmong research assistants collected data using a questionnaire format at 1.5 years following resettlement in the U.S. Eight years later, two measures of English language competence were obtained: a self-assessment and an objective measure of English language fluency. Self-assessed fluency and performance on a brief English test showed good correlation. Greater English fluency on both measures was predicted by the following: younger age, male gender, education or vocational training in Laos prior to migration, occupation in Laos requiring literacy, study of English while in Asia, less proximity to other Hmong households in the U.S., any educational involvement in the U.S. (except English as a second language or ESL training), and not receiving welfare. Self-assessment of English fluency appeared to be a valid measure of competence in English. Demographic characteristics, certain premigration experiences, and early postmigration experiences predicted English fluency after 10 years in the U.S. ESL training was not associated with eventual English fluency on either self-assessment or objective testing. Recommendations are made to enhance English fluency, and hence the psychosocial adaptation of refuguees and other immigrants to the U.S.

Adolescent↗

PubMed1994

Ethnomedical pathogenesis and Hmong immigrants' sudden nocturnal deaths.

Scores of seemingly healthy Hmong immigrants have died mysteriously and without warning from what has come to be known as Sudden Unexpected Nocturnal Death Syndrome (SUNDS). To date medical research has provided no adequate explanation for these sudden deaths. This study is an investigation into the role of powerful traditional beliefs in illness causation. In Stockton, California, 118 Hmong men and women were interviewed regarding their awareness of and personal experience with a traditional nocturnal spirit encounter. An analysis of this data reveals that the supranormal encounter acts as a trigger for Hmong SUNDS.

Adult↗

PubMed2006

Promoting Hmong refugees' well-being through mutual learning: valuing knowledge, culture, and experience.

Refugees who resettle in a new country face numerous struggles, including overcoming past traumas and coping with post-migration stressors, such as lack of meaningful social roles, poverty, discrimination, lack of environmental mastery, and social isolation. Thus, in addition to needing to learn concrete language skills and gain access to resources and employment, it is important for refugees to become a part of settings where their experiences, knowledge, and identity are valued and validated. The Refugee Well-Being Project (RWBP) was developed to promote the well-being of Hmong refugees by creating settings for mutual learning to occur between Hmong adults and undergraduate students. The RWBP had two major components: (1) Learning Circles, which involved cultural exchange and one-on-one learning opportunities, and (2) an advocacy component, which involved undergraduates advocating for and transferring advocacy skills to Hmong families to increase their access to resources in their communities. The project was evaluated using a mixed quantitative and qualitative approach. This article discusses data from qualitative interviews with participants, during which the importance of reciprocal helping relationships and mutual learning emerged as significant themes.

Cooperative Behavior↗

PubMed1984

Urban lead levels in Minneapolis: the case of the Hmong children.

This study uses soil lead as a means of describing the urban lead levels in the metropolitan area of the Twin Cities, and assesses the soil lead levels next to homes of neighborhoods of the metropolitan area. Lead levels of rural soils are around 5 micrograms/g. Near the city limits they increase to 25-50 micrograms/g, and in the central business district they are around 500 to 1000 micrograms/g, or over 100 times greater than in the rural areas. Many Hmong children are suffering from undue lead absorption. The homes of the Hmong children were all located in inner-city neighborhoods. Soil around these homes was compared to soils around homes of a neighborhood away from the inner city. Fifty percent of the Hmong children with lead poisoning inhabit homes which have soil lead levels of 500-999 micrograms/g and 40% live in homes with lead levels of 1000 micrograms/g or more. One home of ten in the outer city has soil lead levels above 500 micrograms/g. The lead sources of the inner city include house paint and leaded gasoline from vehicle traffic. Raising children in high lead environments as found in the Minneapolis inner city has long-term implications because of mental and behavioral deficits that are known to result from chronic exposure to lead.

Body Burden↗

PubMed1995

Refugee stress and folk belief: Hmong sudden deaths.

Since the first reported death in 1977, scores of seemingly healthy Hmong refugees have died mysteriously and without warning from what has come to be known as Sudden Unexpected Nocturnal Death Syndrome (SUNDS). To date medical research has provided no adequate explanation for these sudden deaths. This study is an investigation into the changing impact of traditional beliefs as they manifest during the stress of traumatic relocation. In Stockton, California, 118 Hmong men and women were interviewed regarding their awareness of and personal experience with a traditional nocturnal spirit encounter. An analysis of this data reveals that the supranormal attack acts as a trigger for Hmong SUNDS.

Adult↗

PubMed1989

Ethnopharmacologic analysis of medicinal plants used by Laotian Hmong refugees in Minnesota.

Laotian Hmong refugees in the Twin Cities of Minneapolis and St. Paul, Minnesota, cultivate many plants and employ them as a first line of defense against illness and disease. Thirty-seven medicinal plants have been identified, phytochemical components catalogued through literature research, and potential pharmacological activities correlated with Hmong medicinal uses. Using western biomedical criteria of efficacy, 92% of the medicinal plants being cultivated were found to be potentially efficacious. The frequent use of these plants in diet (81%) suggests that they have served to mediate against illness and disease states in the cultural and natural environment in which the practices evolved. A listing of 37 plants with Hmong names, uses and potentially active constituents is provided.

Asian↗