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At least 19 recordsLinked to original sources

PubMed2004

Stone disease in the Hmong of Minnesota: initial description of a high-risk population.

BACKGROUND AND PURPOSE: The Hmong are an ethically distinct refugee population from the highlands of Laos. Metropolitan Minneapolis-St. Paul, Minnesota is home to the largest population of Hmong ( 40,000) outside Asia. A clinical impression that the Hmong have a high rate of uric acid stone disease was evaluated. PATIENTS AND METHODS: A retrospective chart review was performed. All adult Hmong patients seen between January 1, 2000, and December 31, 2001, by a large urology group practice (N = 205) were compared with a similar number of non-Hmong patients (N = 204). RESULTS: Of these patients, 94 Hmong (46%) and 23 non-Hmong (11%) patients had stone disease (P < 0.001). After addition of 75 non-Hmong stone patients to create a suitable comparison group, a total of 86 Hmong and 88 non-Hmong stone patients had complete records. Sex (57% v 60% male) and mean age (47.9 v 47.3 years) were similar. Staghorn calculi were found in 21 Hmong (24%) and 0 non-Hmong patients (P < 0.001). Surgical treatments differed between Hmong and non-Hmong (P = 0.004): SWL (16 v 35), ureteroscopy (24 v 29), percutaneous nephrolithotomy (19 v 7), and nephrectomy (5 v 0). Treatment for staghorn calculi was refused by 9 Hmong patients (43%). Stone composition was available in 40 Hmong and 39 non-Hmong. Uric acid (>10%) was found in 50% of Hmong and 10% of non-Hmong stones (P < 0.001). CONCLUSIONS: Hmong patients who come to urologic attention tend to do so for stone disease and tend to have uric acid calculi. The frequent requirement for invasive therapy, including nephrectomy, in the Hmong is of concern.

Female↗

PubMed2002

Hmong shamanism. Animist spiritual healing in Minnesota.

Hmong cultural attitudes, values, and behaviors influence when, where, why, and with whom a Hmong person will use Western medicine. Understanding the practices and importance of Hmong healing traditions will help majority-culture physicians provide respectful and effective health care to Hmong patients. The foremost Hmong traditional healer is the shaman (tu txiv neeb, pronounced "too tse neng"). There is no equivalent health professional in Western biomedicine, and the scope of the shaman as a healer extends beyond the capacities and expertise of physicians. Despite 25 years of Hmong acculturation in the United States and conversion to Christianity, Hmong shamanism maintains its traditional role in health and healing. Many Hmong who see physicians also rely on shamans for restoring health and balance to their body and soul. Thus, the Hmong shaman can be considered a powerful complement to Western health care professionals. This article presents the results of semistructured interviews with 11 Hmong shamans (5 males, 6 females, ranging in age from 35 to 85) and 32 nonrandomly selected Hmong patients (14 males, 18 females ranging in age from 21 to 85). The shamans described their spiritual perspectives, training and skills, and professional activities. Patients described their beliefs about spiritual healing and health care. These interviews suggest that Shamanism is considered effective care by many Hmong, irrespective of age, gender, or degree of acculturation. The article also includes summary charts of Hmong healing practices and concludes with a set of questions designed to help practicing physicians access the assumptions and beliefs of their Hmong patients so that they can provide efficient, effective, and satisfactory care.

Acculturation↗

PubMed2004

Cervical cancer among Hmong women in California, 1988 to 2000.

BACKGROUND: The Hmong immigrated to the United States from Laos after the Vietnam conflict ended. Hmong encounter numerous readjustment issues, including health care. Traditional Hmong health beliefs and practices encompass more spiritual than biological etiologies. Hmong usually seek the first course of treatment from traditional healers, as they had in Laos. This practice delays early diagnosis and treatment of disease because biomedicine is used only as a last resort. This study examined cervical cancer incidence, mortality, and other tumor characteristics in the Hmong female population of California between 1988 and 2000. METHODS: Data from the California Cancer Registry were used to calculate annual average incidence, mortality, and age-specific rates for Hmong women diagnosed with cervical cancer. The population at risk was estimated with linear interpolation using data from the 1990 and 2000 censuses. RESULTS: Hmong women experienced incidence and mortality rates three and four times higher than Asian/Pacific Islander and non-Hispanic white women, respectively. Fifty-one percent of Hmong women chose no treatment, compared to 5.8% for Asian/Pacific Islander women and 4.8% for non-Hispanic white women. Hmong women aged >/= 40 years carried an unequal burden of cervical cancer. They were more likely to be diagnosed with cervical cancer at later stages and poorer histologic grades, and had a lower survival rate than younger Hmong females. CONCLUSIONS: Cervical cancer is clearly a public health issue that threatens the health and well-being of Hmong women. Culturally sensitive screening and prevention programs need to be developed to target older Hmong women using bilingual and bicultural Hmong women health educators using verbal communication.

Adolescent↗

PubMed2006

Sexual exploitation of very young Hmong girls.

PURPOSE: Recent increases in Hmong girls referred to a Midwest hospital-based child advocacy center prompted this comparison of abuse experiences for Hmong extra-familial sexual abuse cases versus peers. METHODS: Retrospective chart review of all girls, aged 10 to 14 years, with extra-familial sexual abuse 1998-2003 (n = 226). Fourteen percent of cases were Hmong (n = 32). Demographics, risk behaviors, abuse experiences, physical findings and legal outcomes were compared for Hmong (H) and Other (O) girls using chi-square. Multivariate logistic regressions explored differences in gynecologic findings and sexually transmitted disease (STD) results. RESULTS: Hmong girls were more likely to be runaways (90% H vs. 8% O), truant (97% H vs. 13% O), self-mutilating (38% H vs. 10% O), and suicidal (41% H vs. 21% O). Seventy-seven percent of Hmong reported gang rape, prostitution, or multiple assaults versus 16% Others; most had 5+ perpetrators (69% H vs. 2% O) and 5+ assaults (75% H vs. 24% O, both p < .001). Gynecologic findings were more prevalent among Hmong girls (63% H vs. 21% O). Controlling for penetration, number of partners/assaults, and acuity at examination, Hmong ethnicity predicted gynecologic findings (adjusted odds ration [AOR] = 6.57). Hmong girls were more likely to have a positive chlamydia screen (36% H vs. 4% O, p < .001), but only number of perpetrators was an independent predictor (AOR = 15.09). Most cases were prosecuted, but Hmong had higher prosecution rates (83% H vs. 57% O, p < .001). CONCLUSIONS: Hmong girl assault experiences were markedly more severe than peers. Health care providers need appropriate knowledge of Hmong culture to conduct forensic examinations. Abused Hmong girls need culturally sensitive, developmentally appropriate after-care that helps connect them back with families and school.

Adolescent↗

PubMed2003

Use of the North American guidelines for children's agricultural tasks with Hmong farm families.

This literature review synthesizes available studies on Hmong agricultural practices, patterns of childhood growth and development of Hmong children in the context of injury prevention, and potential application or adaptation of the North American Guidelines for Children's Agricultural Tasks (Lee and Marlenga, 1999) for Hmong children working in the U.S. Data from qualitative interviews, focus groups, case studies, and surveys were collected, categories were determined, and themes were identified. Field tools and practices, gender roles, and reasons for farming were examined, as well as physical and cognitive development of Hmong children and Hmong parenting techniques to describe factors related to farm task assignment of children. Current agricultural practices of Hmong in the U.S. can be described as generally small-scale operations that use mainly hand tools, manual labor, and local direct-marketing techniques. Specific practices include thinning, weeding, and hoeing; carrying tools, buckets, or baskets; setting plant supports; and watering. Hmong children appear to be given greater amounts of responsibility at earlier ages than North American children. Hmong parenting practices, as would be used in task assignment, are somewhat more authoritarian-based and lead to psychosocial skills that are more group-oriented than individual-oriented. Hmong children were found to be shorter than children in the U.S. of the same ages. This review suggests that the NAGCAT cannot be literally translated and disseminated to Hmong farming families as an injury prevention intervention. Further information is needed about what farm tasks Hmong children do and how Hmong parents assign those tasks to children.

Accidents, Occupational↗

PubMed2005

Cancer incidence in the Hmong in California, 1988-2000.

The Hmong represent a unique new Southeast Asian immigrant group to the U.S. Approximately 169,000 Hmong reside in the U.S., primarily in California, Minnesota, and Wisconsin. Previous studies of cancer in this population have indicated that Hmong experience an elevated risk of gastric, hepatic, cervical, and nasopharyngeal cancers and experience a reduced risk of breast, prostate, lung, and colorectal cancers. Approximately 65,000 Hmong live in California, where there has been a population-based cancer registry since 1988, and the authors used these data to calculate age-adjusted cancer incidence rates and to examine disease stage and tumor grade at diagnosis. Changes in rates during the period studied also were evaluated. These rates and proportions were compared with rates among the non-Hispanic white (NHW) and Asian/Pacific Islander (API) populations of California. Between 1988 and 2000, a total of 749 Hmong in California were diagnosed with invasive cancer, and the age-adjusted rate of cancer for the Hmong was 284 per 100,000 population, compared with 362.6 and 478 per 100,000 in the API and NHW populations, respectively. The age-adjusted incidence rates of cancer in the Hmong were elevated for hepatic, gastric, cervical, and nasopharyngeal cancers and for leukemia and non-Hodgkin lymphoma (NHL). Rates were lower in the Hmong for colorectal, lung, breast, and prostate cancers. For gastric cancer and lung cancer, age-adjusted rates increased between 1988 and 2000 in the Hmong, although breast cancer incidence declined. Cervical cancer incidence increased, rates of NHL were declining, and rates for colorectal cancer remained steady between 1988 and 2000. The Hmong experienced later disease stage at diagnosis than other API and generally poorer grade of disease at diagnosis. Hmong experienced lower overall invasive cancer incidence rates than API or NHW populations in California. However, they experienced higher rates of hepatic, gastric, cervical, and nasopharyngeal cancers; and, for most types of cancer, they were diagnosed in a later disease stage.

Age Factors↗

PubMed2005

Gastric adenocarcinoma among Hmong in California, USA, 1988-2000.

BACKGROUND: This study examined gastric adenocarcinoma incidence, mortality, and tumor characteristics in the Hmong population of California, 1988-2000. Many Hmong relocated to the United States at the conclusion of the Vietnam War. Resettlement difficulties encountered by Hmong have included socioeconomic and healthcare issues. Hmong are wary of Western medicine and would resort to it as the last option, which may delay the diagnosis and treatment of diseases such as cancer. METHODS: Data from the California Cancer Registry were used to calculate incidence and mortality rates for Hmong, and were compared to these in Asian Pacific Islanders (API) and non-Hispanic whites (NHW). The population at risk was estimated through linear interpolation, using data from the 1990 and 2000 decennial censuses. RESULTS: Hmong experienced incidence and mortality rates of gastric adenocarcinoma several times higher than those of API and NHW. More than 97% of Hmong patients chose no treatment, compared to only 25.6% of API and 30.3% of NHW patients. Hmong were more likely to be diagnosed with cancer at later stages but at better histologic grades than API and NHW. CONCLUSIONS: Further investigations into Helicobacter pylori, Epstein-Barr virus, acid reflux, and dietary practices of Hmong living in the United States are needed before any firm conclusion can be made, as these risk factors may impact gastric cancer development. Hmong should also be encouraged to use traditional and Western medicines simultaneously, provided that traditional healthcare practices do not interfere with biomedicines.

Adenocarcinoma↗

PubMed2002

Cultural feeding practices and child-raising philosophy contribute to iron-deficiency anemia in refugee Hmong children.

OBJECTIVE: Iron-deficiency anemia is high in refugee Hmong toddlers attending Special Supplemental Food Program for Women, Infants, and Children (WIC) sites in St. Paul, Minnesota. We investigated social and cultural reasons for feeding practices of Hmong parents that result in excessive milk and inadequate food intake among infants and toddlers contributing to iron-deficiency anemia. DESIGN: In-depth interviews with community members. Focus-group interviews with caregivers. Discussions of results with a professional healthcare group. SETTING: St. Paul, Minnesota in 1997-1998. PARTICIPANTS: Eight Hmong and 7 non-Hmong community members. Thirty-two Hmong parents in focus groups. Thirteen Hmong and 11 non-Hmong healthcare professionals. MAIN OUTCOME MEASURES: Qualitative analysis identified themes from community and focus-group interviews. Professional group discussed meaning of results. RESULTS: To successfully adjust to American lifestyle demands, Hmong refugee families bottle-feed, rather than breast-feed, their infants. In the traditional demand pattern, bottle-feeding can cause infants to be given too much milk at the expense of solid food, and can teach them to prefer milk to food. As these infants become toddlers, caregivers have difficulty weaning them due to a child-raising philosophy of "hlu" that caters to children's desires. CONCLUSION: Hmong caregivers' child-raising philosophy of "hlu" coupled with feeding practices chosen to adjust to American society contribute to the high rate of iron-deficiency anemia in Hmong toddlers.

Acculturation↗

PubMed1996

Growth of Hmong children.

OBJECTIVE: To investigate the growth of a group of young Hmong children. DESIGN: In this descriptive, comparative study, length and weight measures of Hmong children were abstracted from medical charts for each previous clinic visit (newborn to most recent visit) where both measures had been recorded, and measures were compared with National Center for Health Statistics (NCHS) standard percentiles. Visits occurred from 1988 to 1994. PARTICIPANTS AND SETTING: Participants were 579 Hmong children, ages 0 to 5 years, who were active patients at a family practice residency clinic. MAIN OUTCOME MEASURES: Length and weight. RESULTS: This group of Hmong children showed lengths similar to those of the NCHS reference population for the first 6 to 12 months of life, after which they lagged behind reference lengths. By the 24th month, median length for Hmong girls and boys was less than the NCHS 25th percentile. The Hmong children's average weight was slightly higher than the NCHS median until about 8 months of age, after which the distributions were similar. CONCLUSIONS: Compared with children who comprise the NCHS reference population, the Hmong children in this study were slightly heavier in the first several months of life, and shorter thereafter. Therefore, in general, the Hmong children were proportionately heavier than other children of similar height.

Anthropometry↗

PubMed2000

Nyo dua hli--30 days confinement: traditions and changed childbearing beliefs and practices among Hmong women in Australia.

OBJECTIVE: To examine traditional and changed beliefs and practices related to the puerperium of Hmong women in Melbourne, Australia. DESIGN: An ethnographic study of reproductive health among Hmong women in Australia. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 27 Hmong women, three shamans, two medicine women and one magic healer who are now living in Melbourne. FINDINGS: In the Hmong tradition, the first 30 days after birth is seen as the most dangerous period for a new mother. There are several beliefs and practices which women must observe in order to regain strength and avoid poor health in the future. Lying near the fire in the first three days is one such belief. The woman's body during the puerperium is considered polluted. Hence, there are several rules to restrict the woman and the substance of her body. It appears the Hmong continue to observe their post-birth confinement practices regardless of their new environment. Most women mentioned that this is to avoid ill health and misfortune in the future. There are only a few customs which they have to modify due to changes in their living situations in a new country. IMPLICATIONS FOR PRACTICE: Hmong cultural beliefs and practices concerning the puerperium in particular, and childbearing in general, have specific implications for midwifery care. Since midwives will continue to encounter many traditional beliefs and practices of the Hmong when providing birthing care to Hmong women, it is essential that their cultural beliefs and practices be taken into account. This will not only help to avoid misunderstanding, but also result in culturally appropriate and sensitive care for immigrant women.

Adult↗

PubMed1995

Comparison of the prevalence of the poor metabolizer phenotype for CYP2D6 between 203 Hmong subjects and 280 white subjects residing in Minnesota.

Genetic polymorphism of the P450IID6 (CYP2D6) enzyme system can be an important component of the variability in response to drug therapy. Interpopulation differences in the prevalence of deficiencies of drug-metabolizing enzymes may be clinically important in the selection and dosage of drug therapies for patients. Since 1980, the State of Minnesota has had more than a 1000% increase in population of Hmong refugees from Laos. The Hmong are frequently treated in our institution's international clinic with virtually no systematically acquired knowledge about the ability of this relatively ethnically pure population to metabolize commonly used Western medications. To further our knowledge of drug metabolism in this population, we identified the prevalence of the poor metabolizer phenotype for CYP2D6 in a sample population of Hmong subjects and compared this prevalence to that in a sample population of white subjects. Urine collected after ingestion of dextromethorphan in 237 healthy Hmong and 280 healthy white volunteers was analyzed by HPLC. Based on probit plots of the metabolic ratios (dextro-methorphan/dextrorphan), 8.9% of Hmong subjects and 6.1% of white subjects were assigned the poor metabolizer phenotype (difference not significant). Weak associations were found between body surface area and metabolic ratio for both Hmong and white men and between smoking status and metabolic ratio for white subjects only. We conclude that the prevalence of poor metabolizers for the CYP2D6 enzyme system is similar between Hmong subjects and white subjects residing in Minnesota and that an antimode of 0.3 for metabolic ratio appears to be reasonable for the populations studied.

Adolescent↗

PubMed1986

Two self-rating scales for depression in Hmong refugees: assessment in clinical and nonclinical samples.

An exploratory cross-cultural study was undertaken of two widely used self-rating scales: the Zung and the Depression Scale on the 90 Item Symptom Checklist, or SCL-Depression. Both scales were translated into Hmong and tested in two samples of Hmong refugees in the U.S.A. One sample (n = 86) consisted of a field survey of all Hmong people living in Minnesota. Of the 86, 15 sought treatment and were diagnosed as having major depression during the year following their self rating, so that a comparison of patients' scores with nonpatients' scores was possible. The other sample consisted of another 51 Hmong psychiatric patients with major depression. This second group was also assessed by four psychiatric rating scales (i.e. Hamilton Depression Scale, brief Psychiatric Rating Scale, Inpatient Multidimensional Rating Scale, and Nurse's Observation Scale for Inpatient Evaluation) and two measures of treatment intensity (i.e. number of visits, duration of treatment). In the general Hmong population (n = 86), both self-rating scales were highly intercorrelated, and strongly associated with patient status. In the patient sample (n = 51), only the SCL-Depression showed any correlations with psychiatric rating scales or with treatment variables. This is contrary to the anticipated outcome, as it had been expected that the Zung would perform better than the SCL-Depression. In addition, duration of treatment was inversely correlated with the SCL-Depression, also opposite to our prediction. Probable causes for these unexpected results are presented. An item analysis was undertaken, comparing 71 Hmong survey subjects who were not treated for depression with 51 Hmong psychiatric patients who were treated for depression. Most Zung and SCL-Depression items showed significantly higher symptom levels in the depressed patients. However, non-depressed controls unexpectedly reported significantly higher symptom levels on certain items. No significant differences were observed on several Zung and SCL items. These unexpected findings are discussed in light of the refugee's adjustment and experience.

Cross-Cultural Comparison↗

PubMed2005

Nasopharyngeal cancer in the California Hmong, 1988-2000.

Although previous studies document elevated nasopharyngeal cancer incidence in the American Hmong, a descriptive analysis is lacking. The present case-series aims to identify important features of head and neck cancers in the California Hmong, specifically nasopharyngeal cancer. We assessed incident head and neck cancers identified by the California Cancer Registry from 1988-2000 for incidence, mortality and descriptive comparisons between the Hmong, non-Hispanic Whites (NHW) and Asian/Pacific Islanders (API). Nasopharyngeal cancer was the most frequent Hmong cancer (39 of 51 cases) with incidence 23 times greater than in NHW. Nasopharyngeal cancer mortality rates for Hmong, NHW and API were 10.4, 0.2 and 1.7/100,000 respectively. Hmong were more likely to be diagnosed with remote tumors and less likely to receive treatment. A public health disparity clearly exists regarding nasopharyngeal cancer in the Hmong. Education on culturally appropriate healthcare and efforts to encourage diagnosis and treatment are necessary to reduce this disparity.

Adult↗

PubMed2000

Baby, souls, name and health: traditional customs for a newborn infant among the Hmong in Melbourne.

In this paper, I discuss childrearing beliefs and practices in Hmong culture. In particular I focus on issues related to souls and ceremonies for a newborn infant in Hmong society. The Hmong believe that each living body has three souls. For a newborn infant, the first soul enters his or her body when he or she is conceived in the mother's womb. The second soul enters when the baby has just emerged from the mother's body and taken its first breath. The third soul, however, will have to be called on the third morning after birth, as will be discussed in this paper. If all three souls are secured in the infant's body, he or she will be healthy and hence thrive well. On the contrary, the infant may become ill and eventually die if all three souls do not reside in his or her body. This, therefore, makes a soul calling ceremony on the third morning after birth essential in Hmong culture. I will show that for Hmong society to survive, the Hmong strongly adhere to their cultural beliefs and practices related to a newborn infant. These beliefs and practices tie the Hmong with not only their family and their society at large, but also the supernatural world.

Adult↗

PubMed1999

"The heart still beat, but the brain doesn't answer". Perception and experience of old-age dementia in the Milwaukee Hmong community.

The purpose of this exploratory and descriptive study was to examine old-age dementia in the Hmong community of Milwaukee, Wisconsin. Formal and informal Hmong leaders were interviewed to determine the prevalence of dementia in the Hmong community and how it is perceived and experienced. Interviews revealed few cases of dementia among the Hmong. Dementia was perceived as a natural part of the life cycle, rather than as a devastating disease that robs individuals of their autonomy. Treatment is not sought for dementia. Some of the common manifestations of dementia, such as wandering and combativeness, were rare or non-existent in the Hmong community. Individuals with dementia are cared for in their sons' homes. Nursing home placement in advanced dementia was only acceptable if sanctioned by the entire extended family. Further research on the Hmong perception of and experience with dementia needs to be conducted in other Hmong communities to validate the generalizability of these results.

Aged↗

PubMed2002

Hmong health beliefs and experiences in the western health care system.

This ethnographic study was conducted to determine Hmong perspectives and beliefs that influence the Hmong experience in Western medical situations. Hmong perspectives regarding the body as well as descriptions of Hmong experiences within the American medical system were explored using participant observation and interviews over a 2-year time frame. Two focus groups were conducted to confirm findings. Data indicates that the Hmong language lacks terms that translate biomedical body physiology and anatomy. Medical terms and diagnoses lack direct translation and require extensive nondirect terms to approximate meaning. Differences between Hmong traditional beliefs and Western biomedical beliefs create a lack of understanding. Negative health care experiences result in Hmong community members' mistrust and fear of Western medicine.

Attitude to Health↗

PubMed1999

When the baby falls!: the cultural construction of miscarriage among Hmong women in Australia.

In this paper, traditional Hmong explanations about miscarriage and the ethnomedical knowledge and practices which pertain to it are explored. They are derived from in-depth interviews and participant observation with the Hmong who are now living in Melbourne, Australia. The loss of pregnancy creates considerable anxiety in Hmong society. This is not only because it calls for a socially justifiable explanation for a family's failure to extend their lineage, but also reduces the venue for a soul to be re-born into the family. This is a threat for Hmong society since it means the extinction of the family, clan and lineage and hence Hmong society. The cultural construction of the causes of miscarriage among the Hmong surrounds two main categories: the natural world which is related to the woman's body and her behaviour; and the supernatural world. These explanations point to the influence that individuals, both living and dead, have on pregnancies. In traditional Hmong society, health is perceived as a harmony between the social, and religious or supernatural realm. A woman being unable to bring forth an offspring because of miscarriage indicates disharmony with the living and/or between the living and the dead.

Abortion, Spontaneous↗

PubMed2002

Childrearing practices and child health among the Hmong in Australia: implications for health services.

This study of cultural beliefs and practices related to childrearing and child health among the Hmong in Melbourne, Australia, used in-depth interviews and participant observation of 27 Hmong mothers and some Hmong traditional healers between 1993 and 1998. Traditional Hmong beliefs and practices include: taking notice of the birth date and time, placing a silver necklace on the newborn, not praising the newborn, not taking the infant out during the first 30 days, breastfeeding, the infant's sharing a bed with the parents, and a soul-calling ceremony on the third day after birth. All Hmong mothers follow cultural beliefs and practices to prevent the ill-health or death of their newborn infants, but some aspects of these practices have had to be modified to suit the new living environment in Australia. Health care professionals need to acknowledge the different ways of caring for a young child among the Hmong so as to avoid misunderstandings and to provide sensitive care. Hmong beliefs and practices also have implications for health promotion campaigns and can be a valuable source of ideas in the efforts to promote infant health and reduce infant deaths in Australia and elsewhere.

Adult↗