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Welfare status and psychosocial adjustment among 100 Hmong refugees.

Although the mental health of recently employed persons has been well studied, the mental health of welfare recipients is not well understood. Among our increasing refugee population, many receive welfare benefits at some point. The Hmong are among those who are highly represented among welfare recipients in several areas of the United States. Do psychiatrists have anything to contribute toward the resolution of high welfare rates? This question is especially relevant in refugee populations who are at increased risk for several psychiatric disorders, including depression, paranoia, and adjustment disorders. This study was undertaken among 100 Hmong refugees who had been in the United States for 8 years. Indices of mental health included two rating scales (the Zung Depression Scale and the SCL-90), five-axis DSM-III diagnoses, Hamilton Anxiety and Depression Scales, Global Assessment Scale, Brief Psychiatric Rating Scale, Inpatient Multidimensional Scale, and Mini-Mental State Exam. These indices were compared with current welfare status and the duration of time on welfare. Other comparisons with welfare included demographic characteristics, material possessions, acculturation characteristics, health and social problems, and nonoccupation avocations. Results indicate that welfare recipients show lower acculturation and elevated psychiatric symptom levels. Suggestions for ameliorating this situation are extrapolated from studies in the literature on chronically unemployed persons.

Acculturation↗

Maternal sensitivity, posttraumatic stress, and acculturation in Vietnamese and Hmong mothers.

PURPOSE: To determine the extent of posttraumatic stress and acculturation in Vietnamese and Hmong mothers and identify their relationship to maternal sensitivity. DESIGN: Descriptive correlational research design. METHODS: A sample of 30 mothers was evenly divided between Hmong and Vietnamese who had lived in the United States 2 to 21 years, had healthy children under 30 months, and had varied education and literacy levels. Data were collected in the home using a script. The mother's sensitivity to her infant was measured by Ainsworth's Sensitivity vs. Insensitivity to the Baby's Communication, degree of acculturation by the Suinn-Lew Self-identity Acculturation Scale (SL-ASIA), and posttraumatic stress by the Hopkins Symptom Checklist-25 (HSCL-25). RESULTS: Depression and anxiety correlated highly with posttraumatic stress (PTS), and thus were substituted for PTS. Almost half (43%) were clinically depressed or anxious, with less acculturated mothers tending to be more anxious and depressed. One third had considered suicide in the previous week. Mothers found it difficult to communicate their distress to primary providers. In spite of high depression and anxiety rates, maternal sensitivity was high, and was not significantly correlated to any variable. CLINICAL IMPLICATIONS: Nurses should incorporate screening for depression and anxiety into routine assessments or discharge planning for foreign-born mothers, then refer stressed mothers to appropriate resources. It is important to not assume diminished sensitivity in depressed or anxious mothers and to consider the coaching role of the grandmother.

Acculturation↗

Hmong women: characteristics and birth outcomes, 1990.

Current demographic characteristics and pregnancy outcomes of immigrant Hmong women in a small town in southeastern United States were documented in a retrospective study. Interviews and review of existing records were used to determine prenatal practices and perceived problems. Sixteen health professionals and two women from the community were interviewed, and the labor and delivery records from 1985 to 1990 were reviewed for parity, child spacing, and health status of the women and newborns. The greatest concerns voiced by health caregivers were multiparity and the need for contraceptive compliance. Seventy-eight full-term infants were born to 64 women in five years, with 2 stillbirths. No eclampsia, diabetes, or Rh incompatibilities were noted. Evidence is limited that birth frequency or outcome for Hmong women is a problem. Their perinatal difficulties were thought to be sociocultural rather than medical. Further study of the effects of acculturation on maternal family position, perinatal risks, and birth outcomes is imperative as lifestyle and environment change for these immigrant women.

Adolescent↗

Hmong women in Wisconsin: what are their concerns in pregnancy and childbirth?

Childbirth in different cultures is treated as a traumatic life crisis and a time of vulnerability for the mother and infant. This qualitative descriptive study explored specific concerns related to pregnancy and childbirth in 52 Hmong women living in central and northeastern Wisconsin. Women were questioned using a semistructured interview about 4.6 months after childbirth. They described concerns related to breastfeeding, contraception, touch, communication with health caregivers, and procedures performed during childbirth. Women preferred bottle-feeding over breastfeeding. They reported difficulty practicing birth control because of cultural expectations of male and female roles, but were aware of the need for education about methods of contraception. Fear of miscarriage if they were touched by doctors and nurses resulted in delayed prenatal visits. The women believed that invasive procedures such as episiotomies and circumcisions are not natural, and they preferred natural tearing and healing. It is important for health caregivers to be culturally sensitive and understanding of Hmong practices and beliefs when touching and communicating with these women and when educating them about breastfeeding, contraception, and medical procedures during hospitalization.

Adolescent↗

Afterbirths in the afterlife: cultural meaning of placental disposal in a Hmong American community.

Interviews were conducted with 94 Hmong Americans in California's Central Valley to explore attitudes regarding placental disposition and the cultural values that affect those attitudes. Research indicated a persistence of the traditional belief that placentas should be buried at home. The placenta is perceived to be essential for travel by the soul of the deceased into the spirit world to rejoin ancestors. Older respondents (older than age 35) and those who self-identified as animists were most likely to believe in the importance of home placental burial. Comments by respondents indicated some reluctance on the part of Hmong patients to ask health care providers for permission to take placentas home. Incorporating non-Western patients' traditional health care practices into Western health care delivery may be facilitated by an awareness of the reluctance of some patients to verbalize their wishes.

Adult↗

Designing culturally and linguistically appropriate health interventions: the "Life Is Precious" Hmong breast cancer study.

Cancer is the number one cause of death for Asian American women, yet they have the lowest rates of cancer screening. Contributing factors, particularly for Hmong women, include the lack of culturally and linguistically appropriate educational interventions. This study aimed to develop a culturally and linguistically appropriate intervention to improve the breast cancer screening rates among Hmong women in Fresno and San Diego, California. Intervention elements included the development of a flipchart, brochure, and video that presented basic breast health and screening information, along with the targeting of not only women but men to support their wives' breast cancer screenings. Analyses of pre- and post workshop surveys showed increases in knowledge and more positive attitudes among all participants, behavioral intentions for clinical breast examinations and mammograms among women, and support for such exams and possible cancer treatment among men. Implications for further research and practice are discussed.

Asian↗

Hmong immigrants' views on the education of their deaf and hard of hearing children.

The study investigated the attitudes, perceptions, and feelings of parents of 7 Hmong families that included a deaf or hard of hearing child attending a U.S. public school. The findings indicate that many Hmong parents value education and want to be involved in their deaf or hard of hearing child's learning. However, the parents in the study did not know how to become involved, and needed the support of the school. Although they accepted their deaf or hard of hearing children unconditionally, they had lower academic expectations of that child than of their hearing children. Most of the parents reported limited knowledge of the policies, procedures, practices, and organizational structures of special education, and all cited communication barriers as impediments to involvement in their child's education. Most of the parents expressed strong satisfaction with their child's educational program. The findings suggest several areas for further research.

Child↗

Paragonimiasis in the United States. A report of nine cases in Hmong immigrants.

Nine cases of paragonimiasis have been encountered in Laotian Hmong immigrants from Camp Ban Vinai in Thailand. Symptoms included cough, hemoptysis, and fever. Chest x-ray films showed segmental infiltrates and pleural effusions, often bilateral. The clinical presentation mimics tuberculosis. All Hmong patients with chronic infiltrates and pleural disease in whom tuberculosis has not been proven should have parasitologic and serologic evaluation to exclude paragonimiasis.

Adolescent↗

Measles, Hmong, and metaphor: culture change and illness management under conditions of immigration.

When 19 Hmong families and three healers in St. Paul, Minnesota, were interviewed regarding their understanding of measles and the ways in which they cared for children with the disease, their responses spanned the range between Hmong animistic cosmology and Western theories of disease. The metaphors of growth that were used to describe the disease link language, cosmology, causation, body processes, and illness management practices. This study discusses the themes of cyclical time, disease-causing spirits, the natural/supernatural dichotomy, and agricultural metaphors as applied to disease, as well as the growing adaptation to, use of, and interpretation of Western medicine by these immigrants.

Adult↗

Sudden death in sleep of Laotian-Hmong refugees in Thailand: a case-control study.

A syndrome of sudden and unexpected death during sleep occurs among adult Southeast Asian refugees in the United States. Surveillance for sudden deaths was conducted among Laotian-Hmong refugees in the Ban Vinai refugee camp in northeastern Thailand to determine if a similar cause of death occurs there. Sixteen sudden and unexpected deaths associated with sleep were found that were similar to the sudden deaths noted among Southeast Asian refugees in the United States. A case-control study in Ban Vinai revealed associations between sudden death in sleep and membership in the Green-Hmong subgroup, a family history of sudden death, and previous non-fatal sleep disturbances. Sudden and unexpected death during sleep of young adults is a regional phenomenon within Asia and occurs in populations that are culturally and genetically distinct. Migrants from affected populations in Asia carry with them the susceptibility to sudden death in sleep.

Adolescent↗

Hmong children and their families: consideration of cultural influences in assessment.

Occupational therapists assessing young Hmong children with developmental problems must consider their families' cultural beliefs as they affect the design of assessment procedures and practices. Choices that families make about health and educational services are influenced by their beliefs. Developmental status can be affected by unresolved medical problems and the child's general health condition. Assessment components based on cultural awareness may improve the effectiveness of early identification of Hmong children with developmental delay. Appropriate use of interpreters, creation of the most beneficial assessment environment, parental report, and observation of functional skills and play provide needed information when determining the child's eligibility for early intervention services. The author has found that trained interpreters provide the most reliable communication between family members and the therapist. Assessments in the home environment are encouraged due to the child's age and the need for family support and interaction. Parents are an excellent source of information about the child's current and past functional abilities. Observations of the child's interaction with family members, with objects and toys during play, and during functional daily living activities provides the therapist with valuable information about the child's need for intervention.

Attitude to Health↗

Use of imported folk remedies and medications in the Wisconsin Hmong community.

The Marathon County Health Department and the Wisconsin Division of Public Health evaluated several imported drugs and folk remedies that were being used by 2 Hmong families. These included a powdered blend of folk remedies that had been purchased in California and 5 packets of medication that had been imported from Thailand. The powdered folk remedy contained arsenic sulfide as a principal ingredient. The drug packets contained acetyl aspirin, acetaminophen and chloramphenicol. The purity of these drugs was not assessed, and their dates of manufacture could not be determined. To discourage use of folk remedies and imported drugs, the county health department issued a press release that was published in a Hmong community newsletter. Despite these efforts, many Asian immigrants may continue to use these products.

Arsenic Poisoning↗

The prevalence of viral hepatitis among the Hmong people of northern Thailand.

Sera from 269 Hmong people (102 males and 167 females, with mean age 35.4 years, range 16-63 years) were examined in order to determine the seroprevalence of hepatitis virus infection. The seroprevalence rates for HAV (hepatitis A virus), HBV (hepatitis B virus), HCV (hepatitis C virus), HDV (hepatitis D virus), HEV (hepatitis E virus), HGV (hepatitis G virus) and TTV (TT virus) infection were 87.8% (n=140), 76.0% (n=150), 2.0% (n=150), 0.7% (n=150), 6.5% (n=139), 5.3% (n=94) and 25.6% (n=121) respectively. The rate for carriers of HBV (HBsAg) was 13.8% (20.5% in males and 9.6% females) with a peak prevalence in the 21-40 year age group. A high rate of HAV seropositivity was found among the younger subjects. The rate of HEV seroprevalence was low. The prevalence of TTV-DNA was high with no difference between the sexes. HGV-RNA prevalence was low and seen primarily in males. This study indicates that the Hmong people are endemically infected with HAV and HBV infection and should be considered for targeted vaccination. The role of TTV and HGV in producing illness and hepatic disease has yet to be determined in this population.

Adolescent↗

Risk prevalence for type 2 diabetes mellitus in adult Hmong in Wisconsin: a pilot study.

OBJECTIVE: To quantify the proportion that may be at risk for developing type 2 diabetes among a convenience sample of Hmong adults in Wisconsin using the 2000 American Diabetes Association (ADA) Clinical Practice Recommendations for community screening. METHODS: Design was a cross sectional survey. One hundred forty-four participants completed the survey, which consisted of a demographic questionnaire and the ADA Risk Test. Casual capillary whole blood glucose values, blood pressure, height, weight, and waist and hip circumference measures were also recorded. Predictors of positive casual capillary whole blood glucose value (> 140 mg/dl) were identified using logistic regression. RESULTS: Forty-one percent demonstrated positive blood glucose screens on survey. Waist-to-hip ratio was a stronger predictor of a positive screen (Odds Ratio = 3.2 [95% CI: (1.5, 6.2)]) than the ADA Risk Test (Odds Ratio = 2.7 [95% CI: (1.4, 5.1)]). CONCLUSIONS: Hmong adults in Wisconsin demonstrate an increased risk for type 2 diabetes. Present findings are consistent with studies demonstrating increased disease risk in newly arrived populations of industrialized countries.

Adult↗

Hepatitis B knowledge and vaccination levels in California Hmong youth: implications for liver cancer prevention strategies.

Although chronic infection with hepatitis B virus (HBV) is one of the major risk factors for liver cancer, the level of knowledge about liver cancer risk factors and HBV transmission, as well as vaccination have not been assessed in this population. We interviewed Hmong youth living in Fresno, California about liver cancer risk factors. General knowledge of HBV was common, but knowledge of specific modes of transmission was low. For example, only 49% knew that HBV was transmitted by sexual intercourse. We also observed very low prevalence of HBV vaccination (12%), although a majority reported knowing that shots can prevent disease (68%). Liver cancer prevention and control methods targeted to Hmong youth are needed.

Adolescent↗

Horizontal transmission of hepatitis B virus infection to United States-born children of Hmong refugees.

There is evidence that hepatitis B virus (HBV) transmission continues among Southeast Asian refugees after resettlement. To determine the prevalence of HBV infection (hepatitis B surface antigen [HBsAg] positive or core antibody positive) and modes of transmission in Hmong refugee households in Wisconsin, results of serologic tests were reviewed for 429 US-born children not previously vaccinated with hepatitis B vaccine and 754 of their Asian-born household members. The prevalence of HBV infection was 14% (62/429) among all US-born children, 30% (21/69) among children whose mothers were HBsAg-positive, and 11% (41/360) among children whose mothers were HBsAg-negative. Among children whose mothers were HBsAg-negative, the prevalence of HBV infection increased with increasing age (chi 2 test for trend = 5.6, P = .02) and was related to the household presence of HBsAg-positive sibling(s) (relative risk = 4.0; 95% confidence interval = 1.5, 9.3; P less than .001). Of the 62 infected children, 13 (21%) lived in households with no HBsAg-positive household members. US-born children of Hmong refugees apparently acquire HBV infection through both horizontal and perinatal transmission. These findings emphasize the importance of routinely integrating hepatitis B vaccine doses into the childhood vaccination schedule for all infants whose parents are from areas where HBV infection is highly endemic. In addition, the findings support the need for pediatricians to consider vaccinating older children (up to age 7 years) whose parents are from HBV-endemic areas.

Adult↗

Hmong folk remedies: limited acetylation of opium by aspirin and acetaminophen.

The traditional folk medicine of the Hmong and other Southeast Asian refugees has accompanied them during their immigration in this country over the past two decades. In two recent cases involving Hmong defendants, unknown solids, resembling charcoal in consistency and purported to be "backache remedies," were analyzed and found to be complex mixtures of aspirin, acetaminophen, caffeine and partly acetylated opium. In particular, significant amounts of acetylacetaminophen, 3-O-acetylmorphine, 6-O-acetylcodeine, 6-O-acetylmorphine, and heroin were identified by gas chromatography/mass spectrometry. Heating approximately equal weights of solid opium, aspirin, and acetaminophen at 130 degrees C for several hours produced a mixture of compounds showing a similar acetylation pattern.

Acetaminophen↗

Ethnic-sensitive work with Hmong refugee children.

This article examines three distinguishing characteristics of Hmong culture, and gives examples of the problems these differences can create in serving Hmong children and their families.

Acculturation↗