Transcript traditional food habits

Southeast Asians
and
Pacific Islanders
Chapter 12
Introduction
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Tropical regions
Markedly different
cultures
Chinese
Spanish in the
Philippines
French in Vietnam
Newest, youngest,
fastest growing
population in the US
Includes
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SE Asians
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Filipinos
Vietnamese
Cambodians
Laotians
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Pacific Islanders
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Native Hawaiians
Samoans
Guamanians
Tongans
History of SE Asians in the US:
Immigration
Filipinos immigrate to the US for
educational and economic opportunities
 SE Asians have come to the US since
the 1970s as refugees
 Phillipines immigration increased after
1898 when it became a US territory
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◦ Young men came to Hawaii to work in the
sugar cane fields
◦ US nationals
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Very slow from 1924 - 1965
History of SE Asians in the US
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Filipinos could become US citizens after
WWII
Many came to the US after 1965 as
professional or technical workers
Vietnamese immigration in the 1970s due to
political and economic reasons
3 distinct waves
When South Vietnam fell to the North in 1975
1975-77 – left for political/economic reasons
1978 – Ethnic Chinese fled because of China
invading North Vietnam
History of SE Asians in the US
Cambodian and Laotians occurred
from 1976 – 1979 when the US
granted asylum to refugees
 Many were of tribal populations from
the mountains
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 The Hmong and Mien (ethnic Chinese)
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Many refugees in numerous refugee
camps were of concern
Current Demographics and
Socioeconomic Status: Filipinos
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Population more than doubled since 1980
Half live in California
Heterogeneous group
Citizenship rates higher than other Asian
groups
Educational attainment is high
Family median incomes above national
average
Poverty rates half that of the general US
population
Current Demographics and
Socioeconomic Status: Vietnamese
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Population has more than doubled since
1990
Relocated to western and Gulf states
First wave were well educated and spoke
English
Second group not as prepared
Assimilated quickly
Education highly valued
High rates of employment
Median family income lower than US average
Poverty rates higher than US average
English may not be spoken at home
Current Demographics and
Socioeconomic Status: Cambodian
Over 90% have arrived since 1990
 Half in California
 Adjustment difficult
 Came from rural regions where they
were farmers
 High unemployment rate
 Income below national average
 30% below poverty level
 Low levels of educational attainment
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◦ More than half do not have a HS education
Current Demographics and
Socioeconomic Status: Laotians
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3 groups
◦ Non-tribal Laotians in CA, TX, MN, WA
◦ Hmong in MN and CA
◦ Mien in CA, OR, WA, AK
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Poor fluency in English
Low education levels
◦ Over 60% have not completed HS
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Laotians have low rates of poverty
Hmong have lowest median family
income of all immigrants
◦ Poverty rates 3x the national average
Worldview: Religion
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SE Asians often believe in spirits and
ghosts, especially of ancestors
◦ Guard against misfortune
◦ Cause harm and suffering
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Filipinos are primarily Roman Catholic
◦ Accept one’s fate as supernatural forces
control the world
◦ Time and providence will solve all
problems
Worldview: Religion
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Vietnamese
◦ 70% Buddhists
◦ 30% Roman Catholic
◦ Consider themselves part of a greater
force in the universe
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Cambodian
◦ Theraveda Buddhism
◦ Great emphasis on reaching spiritual
perfection
Worldview: Religion
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Laotian
◦ Theraveda Buddhists
◦ Must devote some time being a monk
◦ Hmong
 About half are Christian
 May still practice ancestor worship
 Other half practice animism, shamanism and
ancestor worship
 Two spheres of the world – the visible and
invisible
Worldview: Family
Interpersonal relationship are
emphasized
 SE Asians share common values
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High esteem for family
Respect for elders
Interdependence among family members
Behavior that would bring shame avoided
Avoid direct expression of conflict
Social acceptance and smooth
Worldview: Family
Filipino family highly structured
 Extended family at the center with
kinship extended to neighbors, etc.
 Patriarchal
 Children indulged until age 6
 Women may not be encouraged to
attend school as beyond family
supervision
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Worldview: Family
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Vietnamese family in US adapted to
American norms
Larger than typical US family
Family will live nearby
Family values are in transition
Father has been head of household, now
becoming les prevalent
American-style dating common
Divorce uncommon
High levels of intergenerational conflict
Old age not as valued as it had been before
Worldview: Family
Cambodian families are large and extended
 Children are treasures
 Men provide for families, women take care of
the budget
 Has been difficult to maintain traditional
family structure due to many female-headed
households
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◦ Men killed in conflicts in Cambodia
Cambodian women can have formal
education
 Differences in the US can be very great
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Worldview: Family
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Laotians an agriculturally based family in
Laos
Men represented the family
Women ran the home
Great significance is given to the site of
the family’s home
Extended families still important, but
nuclear families the norm in the US
Women have nearly equal status to men
in the US
Low divorce rate
Worldview: Family
Hmong American families are the
youngest and largest in the US
 Nuclear families of about 6 members
 Extended family often live nearby
 Men heads of household but women
held in high regard
 Men assume a larger role in childcare in
the US
 Children are the heart of the home
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◦ At age 5 are expected to act as adults
Worldview: Family
Teenage runaways common among
the Hmong
 Some Hmong customs in direct
conflict with US laws
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◦ Polygamy
◦ Kidnapping of young women and forced
marriage
Conversion to Christianity has split
many families
 Much conflict over marriage traditions
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Traditional Health Beliefs and
Practices
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In SE Asia origins of illness focus on
supernatural world
◦ Intervention of malevolent spirits
◦ Ghosts of angry ancestors
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Chinese medical practices often used
Mexican hot/cold theory more prevalent
in the Philippines
Health requires personal harmony and
fulfilling obligations
Illness is defined by cause, not
symptoms
Traditional Health Beliefs and
Practices:
Filipinos
 Adhere to the concept of bahala na
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◦ Life is controlled by the will of God and by
supernatural forces
◦ Rewarded with health in this life and
eternal life after death
◦ Illness a punishment for transgressions
against God
◦ Religious medals worn for protection from
evil
Traditional Health Beliefs and
Practices: Filipinos
Supernatural illness due to unhappy ghosts
of ancestors
 Witchcraft or animal spirits may be involved
 Evil eye (usog) common
 Undesirable traits or conditions can be
transferred magically through contact with
person or object
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◦ Pregnant women will try to look on beautiful
objects
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Forces do not apply in the US as spirits and
ghosts cannot cross the ocean or survive in
noisy cities
Traditional Health Beliefs and
Practices: Filipinos
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3 practices produce balance (timbering)
◦ Heating
 Warm body prevents illness
 Exposure to elements OR hot/cold foods
 Imbalance causes illness
◦ Protection
 Layer of fat needed to protect body from cooling
 Wind of great concern
 Through pores or any wounds or drafts
◦ Flushing
 Cleanse from impurities or evil forces
 Perspiration, flatulence, vomiting, or menstrual
blood
Traditional Health Beliefs and
Practices: Filipinos
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Traditional healers
◦ Midwives
◦ Masseurs
◦ Curers
 Evaluate pulse and diagnose
◦ Arbularyos
 Herbalists
◦ Shamans
◦ Faith healers
 Gaining in popularity
Traditional Health Beliefs and
Practices: Vietnamese
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Health related to personal destiny
◦ How one behaved in past lives, number of
good deeds performed by one’s
ancestors determine experiences in this
life
◦ Also Current behavior
Pregnant women avoid funerals, ugly
objects, leaving home between noon
and 5 pm when malevolent spirits walk
 Use divination to predict how a person
might expect his life to proceed
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Traditional Health Beliefs and
Practices: Vietnamese
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Believe there are 3 separate souls
◦ One encompasses the life force
◦ One represents intelligence
◦ One embodies emotions
9 vital spirits provide assistance to the
souls
 Soul loss can cause illness and death
 Strong feelings, especially fright, can
cause the soul to leave the body
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Traditional Health Beliefs and
Practices
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Chinese medical system used by
ethnic Chinese
◦ Some Vietnamese
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Balance yin/yang
◦ Diet
◦ Treatment of disease
◦ Filipinos may do this
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Filipinos and Hmong will be concerned
with wind or air
Traditional Health Beliefs and Practices:
Cambodian, Laotian, Hmong
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Spiritual intervention
Laotians identify 32 spirits who oversee
the 32 body organs
Laotian baci rituals to bind soul to body
Hmong recognize the world of the
invisible
◦ Ancestor spirits especially important
◦ Soul loss very important cause of illness
◦ Ceeb is “fright illness”
 Typically in children
 From accidents, chased by a dog, startled by a
noise, plunged into cold water
Traditional Health Beliefs and
Practices
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Sudden Unexpected Nocturnal Death
Syndrome (SUNDS)
When a healthy person dies in their
sleep
Prevalent among Cambodians, Laotians,
Hmong
Was leading cause of death among
Hmong men ages 25 – 40
Nightmare spirit dab tsog enters room at
night and crushes the victim by sitting on
their chest
Traditional Health Beliefs and
Practices
Hmong traditional healers
 Hmong herbalists
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◦ Treat natural disorders
◦ Use teas and poultices
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Hmong shamans
◦ Treat spiritual disorders
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May be treated by anyone with healing
experience
◦ Always in the home first
Traditional Health Beliefs and
Practices
Botanical remedies popular
 Herb gardens maintained
 Prepared as teas, broths, steam
inhalants, balms
 Physical therapies include massage,
cupping, moxibustion, coining,
scratching or pinching therapies
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◦ Releases bad wind or excess heat and
restores balance
Traditional Health Beliefs and
Practices
Religious rituals also intervene on
behalf of ill person
 Hmong soul callers
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◦ “Mandate of Life” ceremony
◦ Return a lost soul
Mien appeal to ancestor spirits
 May include animal offerings
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◦ Its soul offered in exchange for the
victim’s missing soul
Traditional Health Beliefs and
Practices
In Vietnam small shrines constructed
to appease ancestor spirits or souls of
premature infants who have died
 Catholic Filipino & Vietnamese appeal
to Virgin Mary
 Christian Hmong may avoid use of
traditional practitioners
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◦ May still use herbals
TRADITIONAL FOOD HABITS:
INGREDIENTS AND COMMON
FOODS
Staples and Regional Variations:
Filipino
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Blended cuisine
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Malaysian
Polynesian
Spanish
Chinese
Ingredients similar
 Food prep methods,
meal patterns reflect
foreign culture
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◦ Vietnamese – French
◦ Filipino – Spain
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Use strongly flavored
fish sauces and pastes
Three principles of Filipino cooking
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Never cook any food by itself
Fry with garlic in olive oil or lard
Foods should have a sour-cool-salty
taste
◦ Ex: Adobo combines marinated chicken,
pork, fish/shellfish fried in garlic in lard,
braised in soy sauce, vinegar, garlic, chili
peppers, bay leaf, and peppercorn with
plantains, potatoes, greens or bamboo
shoots
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Clay pots are traditional but woks are
used now
Staples and Regional Variations:
Filipino
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Rice foundation of diet
◦ Steamed or fried
◦ Pan de sal from rice flour
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Amount of meat depends
on economic status
◦ Pork, chicken, fish
◦ Lumpia
 Filipino egg rolls
◦ Chicken relleno
 Whole stuffed chicken
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Use all parts of the animal
Balut - partially developed
duck soft-boiled and served
warm by street vendors
Staples and Regional Variations:
Filipino
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Dairy products available
◦ Cow’s milk used infrequently
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Evaporated milk commonly used
Water buffalo (carabao) milk used
◦ Used to make cheese called Kesong puti
◦ Popular in desserts like ice cream, flan
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Fermented fish paste used as seasoning
Sour ingredients marinate and pickle raw
foods including fruits and vegetables
Staples and Regional Variations:
Filipino
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Coconut is a principle food in many
Pacific Islands
◦ Dried kernels for oil extraction
◦ Export
◦ Beverages
 Coconut juice or water
◦ Cooking liquids
 Coconut cream and milk
◦ Vegetables
 Hearts of palm or palmetto cabbage
◦ Alcoholic beverages
 Coconut palm blossom sap fermented to produce
tuba, distilled to form lambanog
Staples and Regional Variations:
Filipino
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Fruits consumed
include
◦ Bananas
◦ Durian
 Strong odor
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Jackfruit
Mango
Papaya
Pineapples
Staples and Regional Variations:
Filipino
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Divided into four regions
◦ Luzon
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Home of Manila, the capital
Various ethnic groups
Strong Spanish influence
Fish in the north
Boiled or steamed foods
Rice grown here
Stir-frying is common
Coconuts and tropical fruits
Staples and Regional Variations:
Filipino
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Bicolandia
◦ Ethnically homogeneous
◦ Malaysian and Polynesian influence
◦ Spicy hot with chile peppers
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Viscayan Islands
◦ Seafood
◦ Dessert specialties due to sugarcane plantations
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Mindanao
◦ Heavy influence from Indonesia and Malaysia
◦ Heavily Muslim so little pork consumed
◦ Sauces from peanuts, chiles, curries, spicy
dishes
Staples and Regional Variations:
Vietnamese, Cambodian, and Laotian
Indigenous fish and seafood, tropical
fruits and vegetables and glutinous
rice are foundation of the diet
 Chinese and French influence
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◦ French bread a staple
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Malaysian and Indian influence as well
◦ Curries, coconut milk dishes
Staples and Regional Variations:
Vietnamese, Cambodian, and Laotian
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Short- and long-grain rice
◦ Noodles, paper, flour
◦ Paper used for egg rolls or wonton wrappers
Fried noodles
 Fish and shellfish main protein food
 Poultry, pork or goat in wealthier areas
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◦ Religious dietary restrictions may be an issue
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Few dairy products
◦ Soy milk and tempeh
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Fermented fish paste used to season
Staples and Regional Variations:
Vietnamese, Cambodian, and Laotian
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Vegetables consumed frequently
◦ Stir-fried, stews, uncooked, pickles
◦ Leaves may be used to wrap foods
◦ Fresh herbs and spices
 Spicy ground meat or fish
◦ French influence brought asparagus,
green beans, potatoes
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Many tropical fruits
Staples and Regional Variations:
Vietnamese, Cambodian, and Laotian
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Tea is the preferred beverage
◦ Before and after, not during
◦ Blended with flowers
Coffee popular in French-influenced areas
 Broth
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◦ Only beverage besides water available for most
Hmong
Beer and soft drinks in wealthier areas
 Soybean and fruit drinks common
 Rice wine or whiskey at special occasions
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Staples and Regional Variations:
Vietnamese
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Chinese influence in the north of
Vietnam is strong
◦ Hot pots, stir-fried, soup
◦ Presentation emphasized
◦ Seasonal cooking
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South is tropical
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Simpler cooking, stronger seasoning
Curries, peanut sauces
Coconut, caramel
Clay pot cooking
Staples and Regional Variations:
Cambodian
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Khmer cooking of Cambodia
◦ Elements of northern Indian, Malaysian,
Chinese
◦ Aromatic seasonings
◦ Spice like chile peppers with coconut milk
◦ Sweet –sour, salty-bitter
◦ Kroeung is a paste that is made fresh for
each dish with
◦ different spices and herbs
◦ Amok – fish coconut milk steamed in a
banana leaf
Staples and Regional Variations:
Laotian
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Prefer glutinous rice
Added vegetables and fish make up bulk
of diet
Eggs, poultry, beef as affordable
Game meat, grasshoppers, snakes
Meats usually grilled or stewed
Salty beef jerky prepared with nam pa
◦ A national specialty
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Spicy salads
Chinese and Vietnamese influences
seen
Staples and Regional Variations:
Hmong
Hmong shares some similarities with
Vietnamese
 Long-grain rice and vegetables are
base of diet
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◦ Stir-frying, steaming, and roasting are
common preparation methods
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May raise chickens, duck, pigeons,
pigs
◦ Supplement with game, fish, snails
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Use soy sauce and fish sauces
Meal Composition and Cycle:
Daily Pattern - Filipino
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3 meals a day
Breakfast is garlic fried rice with eggs or
broiled fish, coffee or hot chocolate
◦ Ensaymadas are cheesy, sweet rolls
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Lunch and dinner similar and usually large
◦ Soup, rice, crispy or chewy dish, salty dish, sour
dish, noodle dish and often an adobo dish with
fresh fruit for dessert
◦ Served in courses if Spanish-style, all together if
Filipino-style
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Snacks midmorning and late afternoon
◦ Never eat rice as a snack as it is reserved for
meals only
Meal Composition and Cycle:
Daily Pattern – Vietnamese and Others
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2 or 3 meals daily with number and
amount of meals dependent on income
Snacking uncommon
Do not associate particular foods with
specific meals
Soups consumed at every meal
Large breakfasts
Always includes rice
All items served at once and consumed
family style
Meal Composition and Cycle:
Daily Pattern – Cambodian
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Family style
Soups at every meal
Lunch and dinner with rice or rice
noodles with grilled or steamed fish and
seafood, salad with fruit as dessert
Tea, coffee, condensed meal
◦ Maybe fruit juices, soft drinks, beer, rice wine,
whiskey
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Chile pepper paste is standard
condiment
Etiquette
Use lazy Susan turntables
 No one starts eating until the eldest
male begins
 May use forks, knives, spoons, or no
knives
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◦ Chopsticks or fingers may be used
◦ Right hand used for dining with fingers
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Don’t take last food from plate
Etiquette
In Vietnam, low table with family sitting
cross-legged on mats
 Hands on table
 Limited conversation
 In Laos, there is lots of conversation
 Food served on rattan tray
 Men on one side, women on the other
 Each diner eats from the dishes as
desired
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Etiquette: Utensils
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Chopsticks used for most dishes in most of
Vietnam
Spoons /fingers appropriate for certain foods in
some areas
Rural Laotians may use their fingers, using balls
of
sticky rice to scoop up
fish/meats/vegetables/sauce
Spoons are used as needed
In urban areas forks are now common
Hmong typically use forks and spoons
Cambodians use spoons, chopsticks, or fingers
Special Occasions - Filipino
Predominantly Catholic festivals
 Food served buffet-style with a
roasted pig (lechon) as the
centerpiece
 Media noche after midnight mass on
Christmas Eve and New Year’s Eve
with fiesta foods
 Many practices with Easter
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Special Occasions: Vietnamese
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New Year’s Celebration called Tet
◦ Observance at family grave sites
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23rd day of the 12th lunar month
◦ Celebrates departure of the Spirit of the
Heart, Ong Tao
 Returns to celestial realm each year to report on
family behavior
 Returns one week later
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Buddhist holiday called Trung Nguyen or
Wandering Souls Day for Vietnamese
Birthdays not traditionally celebrated but
death dates
Special Occasions:
Other Mainland SE Asians
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Cambodia’s largest holiday is also New
Year’s Chaul Chnam
◦ Prayers and special foods offered to New
Year’s Angel
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Water Festival in November
Laotian holidays religious in origin
◦ Pha Vet commemorates the life of Buddha
◦ Boon Bang Fay honors Buddha with
fireworks
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Hmong and Laotians’ biggest
celebration is New Year’s
Therapeutic Uses of Food - Filipino
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Philippines introduced to hot/cold
theory from Spanish
◦ By innate qualities or effect on body
◦ Not by spiciness or temperature
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Balance attempted at meals
Therapeutic Uses of Food - Filipino
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Hot Foods
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Avocados
Alcohol
Coconuts
Nuts
Legumes
Spices
Chile peppers
Fatty meats
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Cold Foods
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Tropical fruits
Vegetables
Milk and dairy
Eggs
Fish
Lean or inexpensive
meats
Therapeutic Uses of Food - Filipino
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Hot or cold illnesses
◦ Diarrhea and fevers are hot
◦ Colds and chills are cold
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Sympathetic qualities
◦ Like causes like
Therapeutic Uses of Food - Filipino
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Herbals popular and may be approved
by their Dept of Health
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Bitter melon for diabetes
Garlic to lower cholesterol and BP
Pepperonia to treat arthritis and gout
Sambong as a diuretic
Betel nuts to prevent tooth decay
◦ Leave permanent stains
Therapeutic Uses of Food:
Vietnamese and Other Mainland Asians
Vietnamese follow yin (âm) - yang
(duong) theory from Chinese
 Classification based on characteristics
rather than temperature or spiciness
 Balance must be maintained within a
meal but also avoid extremes during
certain conditions like pregnancy
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Therapeutic Uses of Food:
Vietnamese and Other Mainland Asians
Hot Foods
 Red meat
 Unripe fruit
 Ginger
 Garlic
 Coffee
 Alcohol
Cold Foods
 Noodles
 Bananas
 Oranges
 Gelatin
 Ice cream
Therapeutic Uses of Food:
Vietnamese and Other Mainland Asians
 Five flavors of sour, bitter, sweet,
pungent, salty
 Specific organ meats will benefit
internal organs
◦ Eat liver for a stronger liver
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May avoid some foods because they
resemble disorders
◦ Pregnant women may refuse to eat ginger
because it is multi-lobed and believed to
cause too many digits in the baby
Therapeutic Uses of Food:
Vietnamese and Other Mainland Asians
 Chile peppers to get rid of worms
 Noodles with roasted rice paper and
shrimp sauce for curing the flu
 Cambodians may drink water with
bitter melon for fevers
 Vietnamese pregnant women may
consume large amounts of salt
 Mothers may not feed babies chicken
or duck to prevent children from
becoming deaf or mute
Contemporary Food Habits in the US:
Adaptations of Food Habits: Filipinos
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Can obtain traditional foods easily
May eat rice daily, but not with every
meal
Have more variety in the US
◦ More milk, green vegetables, meat, sweets
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All maintain some traditional foods
Snacking uncommon
Filipinos born in the US eat traditional
US breakfast
◦ Traditional items appear periodically
Contemporary Food Habits in the US:
Vietnamese and Other SE Asians
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Eat more bread in
the US
Still eat rice daily
More meat and
poultry, less fish and
shellfish
Pork preferred to
beef
VietnameseAmerican
adolescents prefer
native diet
Contemporary Food Habits in the
US: Adaptations of Food Habits
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Similar findings with the Hmong and Cambodians
Most-liked items among the adults
◦ Steak, oranges, candy, and soft drinks
◦ All of which are prestige foods in Cambodia and Laos
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Least-liked items
◦ Cheese, chocolate milk, and milk.
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May eat just 2 meals daily
◦ Children will have free lunch
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Grow their own fruits and vegetables, seasonings
Some harvest fish
◦ Many will consume the whole fish
Contemporary Food Habits in the
US: Adaptations of Food Habits
Women report more help with
shopping or cooking from the men
 Adolescents may help with food
purchases and fixing dinner
 Women more likely to have a job or be
in school
 Eat fewer meals together

Nutritional Status: Intake - Filipinos





Traditional diet higher in total fat, saturated
fat and cholesterol than other Asian diets
Have high cholesterol levels and high rates of
hypertension
May have genetic inability to process large
amounts
of sodium in diet
Low rates of alcohol consumption
◦ Will increase their blood pressure
Life expectancy rates higher
 Heart disease leading cause of death

Nutritional Status: Intake - Filipinos
Cancer risk is low
Exceptions: lip, oral cavity, pharynx,
liver, and thyroid are above the national
average
 Infant mortality slightly below average
 High rates of preeclampsia, gestational
diabetes, LBW, preterm delivery
compared to other Asians


◦ Neonates at greater risk for death from
infection
◦ Post neonates from respiratory distress
syndrome
Nutritional Status: Intake - Filipinos



Rates of overweight and obesity higher
than in other Asian groups
Lower than the general population
Type 2 diabetes rates 2 – 3x US average
◦ Women have larger waist circumference
◦ Greater risk of gestational diabetes

Rates for hyperuricemia (resulting in
gouty arthritis) higher
◦ Diet may also be higher in purines, which
they should avoid with gout
Nutritional Status: Intake - Filipinos
Many are lactose intolerant
 Calcium intake may be limited

◦ Sources are dried fish, fish sauce and
paste
May have poor intake of vitamin A
 Stained teeth from chewing betel nuts

Nutritional Status: Intake:
Vietnamese

Calcium intake may be low
◦ Broth from acidified bones analyzed and
found that 1 T provided nearly as much
calcium as ½ cup of milk
Riboflavin, magnesium, zinc
consumption low
 Deficiencies in pregnancy numerous
 Iron intake marginal

◦ Anemia rates in refugees vary from 6 –
37%
Nutritional Status: Intake –
Vietnamese

Health conditions among immigrants
compromise nutrition
◦ TB
 50 – 60% of immigrants test positive
◦ Intestinal parasites
◦ Malaria
◦ Liver and renal disease
 Hepatitis is prevalent
◦ Dental problems from chronic malnutrition
 Or in the US from too many sweets


Thallasemia
Poor compliance with treatment
Nutritional Status: Intake –
Vietnamese


Life expectancy higher for Vietnamese
Americans than for general population
Leading cause of death is heart disease
◦ Cervical cancer high in women

Obesity rates very low but risk increases
with length of stay in the US
◦ Lowest of all Asians
◦ Essential hypertension and insulin resistance
more likely with higher BMI

Waist-to-hip ratios higher
Nutritional Status: Intake:
Other SE Asians
Scant data on Cambodian and Laotian
Americans
 Diabetes mortality rate for Cambodians and
Laotians much higher
 Stroke deaths more than double the average for
both

◦ May also include Hmong and Mien

Hmong rates of obesity, diabetes, hypertension,
CVD, kidney failure, cancers all increasing
◦ Low adherence to treatment
◦ May choose no treatment
◦ Mortality rates in women 3 – 4 x higher in Hmong
women than other groups
Nutritional Status: Intake:
Other Mainland SE Asians

Recent immigrants have high incidence
of LBW from poor maternal weight gain
◦ Gain less weight to have smaller babies and
easier birth

Infant mortality rates are low for SE
Asians
◦ Still with nutritional deficiencies
◦ Inadequate prenatal care
◦ Low social economic status

Hmong and Laotian infant mortality
rates increased
Nutritional Status: Intake – Vietnamese
& Other Mainland SE Asians
Most babies in SE Asia breast-fed for
1 year
 In the US declines drastically

◦ Believe formula nutritionally superior
Introduce solid foods later
 Overweight may be associated with
health and babies may be overfed
 Babies are 1 year old at birth from
lunar calendar

Counseling: Filipinos
Accept illness as fate
 Tolerate symptoms until forced to seek
care
 May consult family, healers before
biomedical care obtained
 Language barriers may be significant
 High context
 Expression formal and polite
 Avoid confrontation

Counseling: Filipinos
Do not address elders by first names
 Avoid situations where self-esteem
may be lost
 Modesty may make some topics
difficult

◦ Sexuality
◦ TB
◦ Mental illness
Counseling: Filipinos







Handshaking is common greeting
Avoid other touching
Keep hands at sides, not in pockets
Direct eye contact not common
May expect quick results from health providers
Traditional healers may be used
Relatives play significant role in treatment and
recovery
◦ Discuss plans with family members as well as
patients

Compliance may be motivated to fulfill familial
obligations
Counseling: Filipino







Limited access to health care and lack of
insurance
Language barriers
Illness in the hands of God, spirits or fate
May deny symptoms intolerable or home
remedies ineffective
Prevention not common
Compliance motivated by desire to fulfill
familial obligations and participate in
social life
Use in depth interview
Counseling:
Vietnamese & Other SE Asians


Limited access to health care and
insurance
Trust very important
◦ May be suspicious of biomedical care




Fear invasive tests due to upsetting body
balance
Avoid surgery and autopsies due to fear
of relationship between body and soul
Privacy issues of concern
Same sex health care provider
Counseling:
Vietnamese & Other SE Asians
Want full description of disorders and
therapies
 Health care decision may be the
responsibility of the elders or the entire
family
 Histories may be difficult to obtain
because they have not known the name
of their conditions
 Polite, unhurried, reserved
conversational style appreciated
 Avoid negative statements and
outcomes with Hmong

Counseling:
Vietnamese & Other SE Asians
Confucian and Buddhist beliefs
encourage modesty
 Head is sacred
 Don’t show the bottom of the foot or
shoes and don’t point with foot
 Don’t snap fingers or signal with
upturned index fingers
 Show respect by bowing head and
using both hands to present an item to
elders

Counseling:
Vietnamese & Other SE Asians

Refugees from mainland SE Asia at risk for
mental health problems
◦ PTSD

Adherence to traditional health beliefs varies
◦ Christian churches discourage ancestor worship
Many continue with coining and home
remedies
 Hot/cold theories
 Herbal remedies
 Consult healers and biomedicine

Counseling:
Vietnamese & Other SE Asians

Vietnamese see biomedicine as yang
(hot) and traditional medicine as yin
(cold)
◦ Biomedicine fast-acting, temporary, with
side effects
◦ Traditional seen as slow-acting, gentle,
without side effects, permanent and
preventive
◦ Will use both yin and yang

In depth interview a must
Counseling:
Vietnamese & Other SE Asians

Herbal remedies
◦ Slang nut is source of strychnine and
poisonous in the US but not in Cambodia
◦ Paylooh used for rashes or fever and may
have high levels of lead

Birthing practices reflect hot/cold/wind
◦
◦
◦
◦
◦
May not get out of bed after birth
Refuse to shower or wash hair
No âm (cold) foods
May consume alcohol as it is duong (hot)
Postpartum period is cold
Exploring Global Cuisine: The Cooking
of Malaysia, Singapore, and Indonesia



Parts of Indonesia known as “The Spice
Islands”
Greatly influenced by Malays, Chinese,
Asian Indians, Pakistanis, Arabs, Thais,
Eurasians, Melaka Portuguese,
Peranakan
Numerous religious practices
◦ Islam, Hinduism, Buddhism, Christianity,
Judaism
◦ Malaysia and Indonesia primarily Muslim
◦ Bali is mostly Hindu
◦ Singapore mostly Christian
Exploring Global Cuisine: The Cooking
of Malaysia, Singapore, and Indonesia
 Long-grain and glutinous rice
◦ Steamed, fried, sticky balls, noodles
Noodles eaten at all meals and for
snacks
 Tropical fruits
 Fish, beef, poultry popular

◦ Beef and poultry are expensive except in
Singapore
 Singapore has abundant meat and egg dishes
◦ Pork is avoided as Muslim
Exploring Global Cuisine: The Cooking
of Malaysia, Singapore, and Indonesia
Tomatoes, potatoes, eggplants added
to soups and rice
 Salads

◦ Often with peanut sauce
Coconut
 Lots of seasonings
 Sour taste added with lemons, limes,
unripe mangoes, tamarind or vinegar

Exploring Global Cuisine: The Cooking
of Malaysia, Singapore, and Indonesia

Nyonya fare
◦ From Singapore
◦ Combines Chinese (often pork-based) with
Malaysian seasonings such as coconut,
turmeric and lemongrass




All courses served at once
Dishes categorized by preparation
techniques, not ingredients
Forks, spoons, chopsticks, right hand
used to eat
Street vendors available around the
clock
Exploring Global Cuisine: Thai Fare

Climate ideal for growing rice
◦ Long-grain preferred, glutinous is used
Noodles made of rice, mung beans
and wheat are common
 Tropical and temperate fruits and
vegetables
 Seafood, especially shrimp is popular
 Beef, pork, chicken, duck, dried
herring-like fish popular protein foods

Exploring Global Cuisine: Thai Fare
Differs due to flavors
 One of the hottest cuisines in the
world!

◦ Lavish use of chile peppers

Curried dishes daily
◦ Yellow is Indian-like, milder and smoother
with cardamom and turmeric
◦ Red is chunkier and hotter with red chiles
and coconut milk
◦ Green extremely HOT
Exploring Global Cuisine: Thai Fare







Seasonings are basil, coriander leaves and
root, galangal, garlic, ginger root, lime leaves,
lemon grass, mint, tamarind
Fermented fish products added to most
dishes
Yams, salads, noodles, dumplings, peanuts
popular
Began as a court cuisine
Evening meal includes elaborate appetizers,
elaborately carved fruits
Fingers and spoons used
All dishes served at once
Pacific Islanders
10,000 Islands of Oceania

Polynesia
◦
◦
◦
◦
◦
◦
◦
Hawaiian Islands
American Samoa
Western Samoa
Tonga
Easter Island
Tahiti
Society Islands

Micronesia
◦
◦
◦
◦
◦
◦
◦
Guam
Kiribati
Nauru
Marshal Islands
Mariana Islands
Palau
FS of Micronesia
10,000 Islands of Oceania

Melanesia
◦
◦
◦
◦
◦
Fiji
Papua New Guinea
Vanuatu
The Solomon Islands
New Caledonia
Introduction
Geography is
similar with small,
tropical coral or
volcanic islands
 Racially and
culturally diverse
population

◦ European
◦ American
◦ Japanese
History of Pacific Islanders in the US
Migration patterns fluid between the islands
 Few Hawaiians of full native heritage

◦ Many have migrated to mainland US
Samoans left Samoa for Hawaii or mainland
US
 Guamanians have enlisted in the US armed
forces and moved to Hawaii or West Coast

◦ Chamorros are native Micronesians

Tongans have immigrated to mainland US
due to decreased economic opportunities in
Tonga
Current Demographics and
Socioeconomic Status

Hawaiians are largest percentage of
American Pacific Islanders
◦
◦
◦
◦
◦
◦
Half live in Hawaii
Rural and semi-rural areas in Hawaii
Lowest economic strata in Hawaii
Family incomes close to national average
Poverty rates slightly above
College attendance rates higher but
graduation rates lower
Current Demographics and
Socioeconomic Status





More Samoans live outside Samoa than
in both Samoas combined
Mormon Samoans migrate to Mormon
areas in US
Low pay, large immediate families,
responsibilities for family back home
often lead to poor standard of living
College attendance higher than average
Adjustment may be difficult as their titled
rank from Samoa unrecognized in the
US
Current Demographics and
Socioeconomic Status


Guamanian family income just below
national average
Poverty levels near national average
◦ Chomorros become part of Pacific Islander
communities
◦ Native Micronesians

Tongan educational attainment low
◦ Median income close to national norm but
sharing earnings with relatives expected

May suffer discrimination and economic
hardships
Worldview: Religion
Hawaiians practice mainly
Protestantism, Buddhism or Shintoism
 Samoans follow Methodist, Catholic,
Mormon, and Anglican
 Chomorros primarily Catholic
 Tongans in the US are Mormon and
immigration aided by church
 Often prominent in lives of Pacific
Islanders

Worldview: Family
Traditionally social rank and power
established by birth order
 Younger siblings deferred to older
brothers and sisters
 Elders respected
 Senior male managed all group matters
 Extended family help raise children
 Household composition flexible
 Generosity and sharing highly valued
 Social transgressions were responsibility
of the whole family

Worldview: Family




Still maintain extended families
Childrearing shared among family
Household chores assigned by age and
gender
Oldest man or women in home assumes
control of finances, needs
◦ Good of the whole family considered before
benefit to individual
◦ Guided by desire to avoid bringing shame on
family

Stresses of acculturation due to
becoming anonymous
Traditional Health Beliefs and
Practices
Religion and medicine were
traditionally linked
 Losses have occurred with adoption of
nonnative faiths
 Folk healers specialize in herbs,
massage, religious, and/or spiritual
intervention
 Clientele extremely diverse

Traditional Health Beliefs and
Practices: Native Hawaiians

Believe lokahi is essential to good health
◦ Harmony between individuals, nature, gods
Practice massage
 Herbal medicine
 Conflict resolution
 Meditation
 Deep breathing
 Chinese Traditional Medicine
 Healing initiated at the end of each
session with spiritual blessings

Traditional Health Beliefs and
Practices: Native Hawaiians

300 botanical, animal, or mineral-based
cures available traditionally in Hawaii
◦ 58 for respiratory problems

30 used now
◦
◦
◦
◦

Aloe vera for burns, HTN, diabetes, cancer
Plantain leaves to reduce blood sugar
Black nightshade for asthma, coughs, colds
Wild ginger for GI troubles, ulcers, asthma
Home remedies common
Traditional Health Beliefs and
Practices: Samoans

Maintain health by
◦ Good diet
◦ Cleanliness
◦ Harmony in interpersonal relationships

High risk for illness if family or village
obligations are not fulfilled
Traditional Health Beliefs and
Practices: Samoans

Balance is essential
◦
◦
◦
◦

Interpersonal relationships
Working too hard
Sleeping too little
Eating the wrong foods
All cause to’ala (center of one’s
being just beneath the naval) to locate
to another part of the body
Traditional Health Beliefs and
Practices: Samoans

Samoan healers consulted for folk
illnesses
◦ Particularly those of the supernatural
 Spirit possession by malevolent ghosts
 Angry ancestor spirits
◦ Muso
 Mental illness in young men and women
characterized by extreme withdrawal
Traditional Health Beliefs and
Practices: Samoans
Herbalists
 Masseuses
 Bone setters
 Midwives
 Taulasea

◦ For Samoan illnesses

Power healers
◦ Spiritual interventions

Diviners
◦ Specialize in why illnesses occur
Traditional Food Habits:
Pacific Islanders




Cooking developed without metal pots,
pans or utensils
Many foods eaten raw
Indigenous cuisine based on breadfruit,
taro, cassava, yams, and maybe pigs
and poultry
Fruits widely available
◦ Bananas and coconuts

Influenced by European missionaries
and traders and other SE Asian
immigrants
Traditional Food Habits:
Pacific Islanders

Starches were
mainstay of diet
◦ Taro
 Poi is taro root paste
partially fermented
◦ Breadfruit
◦ Cassava
◦ Yams
Lots of seaweed
 Fish and seafood

Traditional Food Habits:
Pacific Islanders







Pork most commonly
eaten meat
Traditionally cooked in
an imu
Fire built over stones
lining a pit
Banana leaves or palm
fronds added
Then the pig and other
foods placed on leaves
Covered with more
leaves
Sealed with dirt to cook
Traditional Food Habits:
Pacific Islanders

LauLau
◦ Packets of food steamed wrapped in ti or
taro leaves
Chicken and eggs widely available
 Milk and dairy uncommon
 Fruits and nuts are important

◦ Haupia is a gelatin-like dessert made from
coconut milk with sugar
◦ Macadamia nuts are a Hawaiian favorite
Traditional Food Habits:
Pacific Islanders
Traditionally food is not highly
seasoned
 Lime, lemon, coconut milk or cream,
and salt

◦ Ginger, garlic, tamarind, scallions or
onions

Coconut oil and lard are preferred fats
Exploring Global Cuisine:
Australian and New Zealand Fare

Believed to be initially populated from
peoples from SE Asia
◦ Maoris are those of Polynesian and New
Zealand heritage
◦ British

Meat is the mainstay of the diet
◦ Beef in Australia
◦ Lamb in New Zealand
Exploring Global Cuisine:
Australian and New Zealand Fare

Lots of fruits and vegetables
◦ Kiwifruit

Sweets eaten daily
◦ Scones
◦ Lamingtons
◦ ANZAC biscuits
Morning and afternoon tea
 Australia is noted for it’s beer and wines
 Pavlova is national dessert

Exploring Global Cuisine:
Australian and New Zealand Fare
 Aboriginal food of Australia
◦ Bush tucker
◦ Kangaroo, wombat, emu, wichetty grubs,
wild plants
Prepared simply over a fire, in the
ashes or boiled
 Sweet potatoes, taro and ti plants
introduced into the Maori diet from
Polynesians
 Pit-roasting called hangi

Meal Composition and Cycle:
Daily Patterns






Traditional meals included poi, breadfruit,
green bananas, fish or pork, greens or
seaweed
Little distinction made between foods of
the meals
Fresh fruits for snacks
Beverages from coconut juice or sap
Asians introduced teas
Kava is a common drink
◦ Tastes like licorice
Etiquette
Hospitality is an honor and outsiders
exempt from traditional manners
 Rude to eat in front of someone
without sharing in Samoa
 Respect shown for food, including not
talking during the meal
 Most hosts won’t eat until a guest is
satisfied
 Impolite to refuse food, but don’t have
to eat everything

Special Occasions


Holidays usually associated with
religious affiliation
Special events commemorated with
feasting
◦ Pit-roasted foods



In Hawaii, celebrated with a luau
In Samoa preceded by a kava ceremony
Hawaiians celebrate
◦ Prince Kuhio on March 26
◦ Kamehameha Dynasty on June 11
Special Occasions
Samoans feast nearly every Sunday,
 Most celebrate White Sunday

◦
◦
◦
◦
Third Sunday of October
Celebration of children
Special service, festive meal
Children waited on by their parents
Guamanians celebrate Liberation Day
July 21
 Tonga celebrates King Tuafa’ahau
Tuopu IV’s birthday

Special Occasions
Food holds particular importance in
Pacific Island cultures
 Sharing of food shows generosity and
support
 Expresses prosperity or social
standing
 Traditional gender roles defined by
food interactions
 Gifts of food often given

◦ Never reject any item presented
Role of food





Holds particular importance in most PI
cultures.
Sharing demonstrates generosity , support
for family and village.
Expresses prosperity or social standing
Events celebrated with feasting and food
eaten to excess as part of the ceremony
Gender roles were defined by food
interactions
◦ At 8 or 9 boys and girls were separated for
training in food procurement (farming and fishing)
or food preparation (cooking and food storage).

Never reject a gift of food
Therapeutic Uses of Food

Numerous botanicals used in Hawaii
◦ Pepper plant used to make kava
 May be used as an analgesic or narcotic
 Sedative
 Teething aid for infants
◦ Noni used as a juice for numerous things
◦ Tumeric used as a blood cleanser
◦ Breadfruit made into tea
 Treat highs blood sugar and blood pressure
Contemporary Food Habits in the
US: Adaptations of Food Habits


Ingredients and Common Foods
Hawaii combines elements of Eastern
and Western Foods
◦ They like Spam
◦ Soy sauce most common condiment
◦ Snacking prevalent

Others began changes before
immigration to US
◦ High reliance on imported and processed
foods
◦ Consumption of native foods highest on
Sundays
Contemporary Food Habits in the
US: Adaptations of Food Habits


Western Samoans in the US have a diet
higher in fat and lower in protein,
cholesterol and salt eaten by American
Samoans
Guamanians consume meats, fried
foods, coconut milk, white rice,
sweetened beverage
◦ Low amounts of produce
◦ Traditional foods reserved for feasting

Samoans in Hawaii have greater variety
of foods
◦ Minimal use of traditional foods
Contemporary Food Habits in the
US: Meal Composition and Cycle
3 meals daily
 Breakfast is cereal with coffee
 Traditional meals for lunch and dinner

◦ Hawaiians may still eat poi
Fruit more often part of the meal
 Sunday feasting among Samoans still
believed prevalent

Nutritional Status: Intake




Serious nutritional deficiencies
uncommon in most Pacific Islander diets
High calorie intake generally guarantees
nutritional sufficiency
Samoans in Hawaii had low riboflavin,
calcium and iron intake
Children in Guam consumed fruits and
vegetables less than once daily
◦ Low intakes of calcium, vitamin E, and folate
Nutritional Status: Intake

Hawaiians and Samoans have lower than
average life expectancies
◦
◦
◦
◦
◦
Leading cause of death is heart disease
Deaths from stroke higher
High cholesterol common
Hypertension higher among Native Hawaiians
Higher incidence of some cancers w/lower
survival rates
Most fat in traditional Pacific Islander diet is
saturated
 Guamanians have longer than average life
expectancies

◦ High rates of some types of cancers
Nutritional Status: Intake

Infant mortality of Native Hawaiians
higher than national average
◦ In California, higher rates of infant deaths
among Samoans and Pacific Islanders

Increased risk for gestational diabetes
◦ High birth rates in American Samoans
◦ Rapid weight gain in infants
Nutritional Status: Intake
Breastfeeding is common
 Early introduction of solids before 4
months of age common

◦ May introduce sweetened beverages and
baby food desserts early
◦ Tooth decay a problem
Nutritional Status: Intake



Obesity rates among the highest in the
world
Gain weight more with modernization
Same for adults/children, regardless of
where they live
◦ Native Hawiian children more susceptible to
acanthosis nigricans
 Hyperpigmentation disorder associated with obesity
and type 2 diabetes.


Overeating combined with inadequate
physical exercise
Overweight is the aesthetic preference
Nutritional Status: Intake

Obesity may be related to heredity or
change in types and amount of carbs
consumed
◦ Can lose weight, lower cholesterol, blood
pressure, decrease insulin requirements
when consuming higher amounts of
traditional carbs

May have greater nonfat density
◦ Modify BMI cutoffs for overweight and obesity

May associate thinness with illness
Nutritional Status: Intake

Risk for type 2 diabetes is high
◦ Native Hawaiians highest rates
◦ Samoans

Not insulin resistant but risk from
overweight and obesity
◦ Central body adiposity is predictive

Samoans may be especially susceptible
to kidney damage
◦ End-stage renal failure common cause of
death in American Samoan diabetes patients
Counseling
May not take responsibility for personal
health
 Decisions made by entire family
 Prefer a comprehensive approach to
care
 Seek symptom relief and are not
interested in long-term prevention or
management
 Low compliance rates noted
 Often delay seeking care until symptoms
are advanced

Counseling
Language barriers
 Samoans expect extreme politeness
in interactions
 Reserved conversational style
 May endure pain
 Judgmental or accusatory attitudes
regarding lifestyle (weight gain) may
cause them to not return

Counseling
Greet each person with smile and
handshake
 Eye contact expected
 All participants at equal physical level
(sitting, standing, etc.)
 Keep legs crossed or close to body
while seated
 In depth interview needed

Counseling

Weight loss intervention in Hawaii well
received using traditional food
◦ Difficult to adhere to diet long term
◦ Difficulties in obtaining fresh produce
◦ Obesogenic environment

Cultural conflict in Micronesia when
mothers tried to restrict intake of
overweight children
◦ Food associated with love
◦ Grandparents accuse mothers of inadequate
care when they perceive children as being
too thin