Transcript East Asians
East Asians Chapter 11 Introduction Asia has 1/3 the world’s land mass 2/3 of the world’s population Includes parts of Russia, Central Asia, and the Middle East EAST ASIA China, Taiwan, Japan, North and South Korea, and the Mongolian People’s Republic Have been in the US since the 1800’s Recent immigrants from political oppression Chinese 4000 year old civilization Varied geography Population exceeds 1.3 Billion people Numerous ethnic and racial groups Diverse language with many dialects Immigration First wave in 1850 when Chinese came for the Gold Rush. Slowed by 1880 because of exclusion laws Most from Canton region Population dropped until 1920 Lived in “Chinatown” in their area Could become naturalized US citizens in 1943 Current Demographics and Socioeconomic Status Immigrants after 1943 from other regions of China Better educated Urban dwellers Recent immigrants after Tiananmen Square in 1989 Uncertainty of Taiwan’s future ¼ of Asians in US are Chinese 1/3 foreign born arriving after 2000 More than half in CA and NY Taiwanese where science employment available 4 Types of Chinese American Households Sojourners ◦ Men from early 20th century who came intending to gain wealth and return. Now stranded Sojourners ◦ Brought their wives to the US. Often still live in Chinatown neighborhoods, but children have moved New immigrant families Acculturated suburban families Socioeconomic Status Chinese value education Almost half hold college degrees Successful in business and professional employment 28% recent immigrants do not have a high school diploma Taiwanese noted for “transnational” business careers Worldview: Religion Most not affiliated with a specific church Combination of: ◦ ◦ ◦ ◦ Ancestor worship Confucianism Taoism Buddhism Early religion a mixture of ancestor worship and respect for nature and the heavenly bodies ◦ Supreme power was either Tien (Heaven) or ◦ Shang Ti (the Supreme Ruler or the Ruler Above) Ceremonies for the dead are a prominent practice Worldview: Religion Confucianism A sage who gave order to Chinese society by defining how people should live and work together Children obey their parents/parents take care of their children Tolerance in the eldest brother/humility in the younger Proper behavior by the husband/submission by the wife Respect for one’s elders and compassion in adults Allegiance to rulers and benevolence by leaders Values influence Chinese society today Worldview: Religion - Taoism Heaven and humanity function in unison and can achieve harmony People are subordinate to nature’s way Everything in nature contains both yin and yang and must be balanced Simple life, communion with nature, avoidance of extremes Worldview: Religion – Buddhism Not as common today as has been in the past Often blended with traditional Chinese beliefs Two dominant schools in China ◦ Ch’an (Zen Buddhism in Japan) ◦ Pure Land Worldview: Religion – Chinese American Spirituality Catholic and Protestant churches established in the US and now in China Often maintain aspects of Buddhism, Taoism, spirit or ancestor worship in their daily lives Taiwanese followers of Baptist, Presbyterian churches in US but few in Taiwan Worldview: Family Confucian teaching important Usually patriarchal Women taught to be unassuming and yielding ◦ “Thrice obeying” Submissive to their father Subordinate to their husbands Mothers obey sons Children are quiet and obey their elders Do not fight, cry or show emotion Honor the family Traditional Health Beliefs and Practices: Traditional Chinese Medicine (TCM) Five elements that may become unbalanced ◦ ◦ ◦ ◦ ◦ Fire Earth Metal Water Wood Correspond with the organs ◦ ◦ ◦ ◦ ◦ Heart Spleen Lungs Kidneys Gallbladder Additional associations with secretions, seasons, colors, directions, time of day, odors, sounds, emotion Traditional Health Beliefs and Practices: Traditional Chinese Medicine Adapted to include concept of yin and yang Balance opposites Illness develops when imbalance occurs Excess of yang ◦ Acne, rash, hemorrhoids, ear infections, fever Excess of yin ◦ Anemia, colds, nausea, weight loss ◦ Weak blood during growth, pregnancy, postpartum or old age treated with yang Traditional Health Beliefs and Practices: Traditional Chinese Medicine Vital force of life is qi ◦ Energy, breath, air ◦ Flows along 12 meridians Must also balance ◦ Jing Sexual or primordial energy ◦ Sheng Spiritual energy or essence of consciousness Wind Poison which is related to allergies Fright in children where soul is scattered Traditional Health Beliefs and Practices: Traditional Chinese Medicine Difference between Chinese medicine and biomedicine : ◦ Body and mind are unified, governed by the heart Emotions related to specific conditions Maintain health through balanced diet, moderation in activities and sleep, and avoidance of sudden imbalance Traditional Health Beliefs and Practices: Traditional Chinese Medicine Home remedies used first Then TCM sought Diagnosis made by ◦ ◦ ◦ ◦ Extensive history Examination of the client Palpitation of pulses Evaluation of the tongue Pattern determines treatment, not illness Treatment to restore harmony TCM remedies are decoctions taken in a single dose Traditional Health Beliefs and Practices Acupuncture ◦ Thin needles inserted where meridians surface Moxibustion ◦ Small bundles of wormwood heated and carefully applied to certain meridians ◦ Often used during labor and delivery Massage or therapeutic exercise Traditional Food Habits Eat a wide variety of foods and avoid few Reflects food habits and preferences of the largest ethnic group in China – the Han Beijing has a large Muslim population Foreigners introduced numerous ingredients now popular ◦ Bananas ◦ Peanuts ◦ Chile peppers Traditional Food Habits: Staples Numerous fruits, vegetables and protein items consumed Few dairy products Grains are foundation Less foods grown for home consumption Increase in eating away from home Less grain consumption now Traditional Food Habits: Staples Rice ◦ Prefer polished, long grain, non sticky variety ◦ Congee – a porridge Wheat in the north Noodles ◦ Won tons ◦ Spring rolls ◦ Dumplings Buckwheat in north Traditional Food Habits: Protein Pork Mutton Chicken Duck Fish seafood Eggs ◦ 1000 year old eggs Snakes, frogs, turtles Insects Soybeans ◦ Poor man’s cow Common Chinese Soy Bean Products Traditional Food Habits: Vegetables Extensive use of vegetables Many familiar to US Leafy bok choy Wrinkled Napa cabbage Long beans Small purple eggplant Chinese kale Large white icicle radish Winter melon Many mushrooms Traditional Food Habits: Fruits Eat fresh fruit infrequently Maybe a snack or for desert Preferred slightly ripe or salted Dates, persimmons, pomegranates, tangerines Kumquats, lychees, longans, loquats Traditional Food Habits: Tea 3 types of tea Green ◦ Dried, tender leaves ◦ Yellow, slightly astringent drink Black (red) ◦ Toasted, fermented leaves ◦ Reddish drink ◦ Common in Europe and US Oolong (black dragon) ◦ Partially fermented leaves Traditional Food Habits: Beverages Alcoholic drinks called wines but usually from grains or fruit like plums Beer is very popular Bottled water Bottled beverages Traditional Food Habits Very few raw foods consumed Stir-frying Steaming Deep fat frying Simmering Roasting Woks used ◦ May also steam using bamboo container Preserves limited fuel Foods preserved if necessary by pickling or fermenting Regional Variations: 5 Culinary Regions Northern Region Shandong, Beijing ◦ Peking Duck ◦ Mu Shu Pork ◦ Mandarin wheat pancakes Honan ◦ Sweet-sour freshwater fish made from whole carp ◦ Grilling or barbecuing ◦ Mongolian Hot Pot Cool climate with preserved foods Regional Variations: 5 Culinary Regions Southern – 3 Areas Sichuan-Hunan ◦ Chiles, garlic, Sichuan pepper ◦ Hot/sour soup Yunnan ◦ Use of dairy products ◦ Hot and spicy Cantonese ◦ ◦ ◦ ◦ Most familiar to Americans Stir-fry Dim sum Tea Regional Variations Fukien provincial fare ◦ Numerous seafood dishes ◦ Clear broths ◦ Paper-wrapped foods and egg rolls may have originated here ◦ Red foods due to red wine paste Hakka cuisine ◦ Soul food of Southern China ◦ Hearty, robust Mongolian Fare Red foods (meat) and white foods (dairy) Some grain Mutton, goal, beef, camel Dairy foods from cow, sheep, yak, goat or camel’s milk ◦ ◦ ◦ ◦ ◦ ◦ Milk added to tea Butter Sour milk Milk leather Fresh cheese Kumys Fermented mare’s milk Millet is staple grain Special occasions include Lunar New Year and the Naadam festival – a 3 day event featuring wrestling, archery, horse races Tibetan Fare Isolated Foundation of diet is tsampa/zampa ◦ Toasted flour from barley or buckwheat Mixed with butter, sugar, milk cream Used to make momos ◦ Tibetan dumpling with meat Yak or mutton Dairy products common Meal Composition and Cycle: Daily Patterns 3 meals daily Numerous snacks Breakfast is hot rice, hot steamed bread Lunch a smaller version of dinner both including soup, rice or wheat dish, vegetables, fish or meat, sliced fruit at the end of the meal Meal Composition and Cycle: Composition of the Meal Balance yin and yang Proper amounts of fan and cai Fan ◦ Foods made from grains ◦ Separate bowl to each diner ◦ Primary item of the meal Cai ◦ Cooked meats and vegetables ◦ Shared bowl in center of table ◦ Makes the meal more tasty Meal must contain fan but not cai Banquet is the opposite Etiquette Traditional utensils ◦ Chopstick ◦ All of porcelain Tea cup Rice bowl Soup spoon Few finger foods All courses served at once Etiquette Wait until elders have started eating Don’t reject food Pick up soup or rice bowl Bones or other debris placed on small plate or next to rice bowl Chopstick etiquette ◦ Don’t lick them ◦ Don’t drop them ◦ Don’t stick them straight up in a bowl Offering to the dead ◦ Don’t lay them across the top of the rice bowl Etiquette Don’t make noise while eating anything except soup ◦ Slurp soup Do not grab food, eat quickly or pick your teeth Do not put food back on the communal plate after tasting Serve tea to others first and use both hands to serve tea Do not drink alcohol alone When the toast is made drain your glass May play games at the table Multiple conversations typical Interruptions common Compliment the host/hostess Special Occasions Chinese week does not include a day of rest Numerous feasts to break up work days Festival days do not fall on the same day each year due to lunar calendar Celebrations are yang and yang foods are featured Special meals with guest are generally held at restaurants Special Occasions New Year’s is most important festival Settle old debts Honor ancestors, parents, elders Kitchen God’s lips are smeared with honey and his picture burned Can’t use knives on this day Deep-fried dumplings, steamed turnip, rice flour puddings Special Occasions New Year’s foods are very symbolic Food served that sound like lucky words Feast of Lanterns ends New Year’s season ◦ Dragon dancing ◦ Firecrackers Ch’ing Ming ◦ Chief spring festival ◦ Graves of the dead tended ◦ Food symbolically fed to the dead Special Occasions Dragon Boat Festival ◦ Commemorates drowning death of a famous poet ◦ Boat races and special dumplings of glutinous rice Moon Festival ◦ Harvest festival ◦ Moon is “yin” so typically female or family festival ◦ Large round “moon” cakes consumed Therapeutic Uses of Food Hot foods High in calories Cooked in oil Irritating to the mouth Red, orange or yellow Ex: ◦ ◦ ◦ ◦ ◦ ◦ Most meats and eggs Chile peppers Tomatoes Onions Ginger Alcoholic beverages Cold foods Low in calories Raw or boiled/steamed Soothing Green or white Ex: ◦ Many fruits and vegetables ◦ Pork, duck, crab, clams Neutral Staples like rice and noodles Soy sauce Black tea Therapeutic Uses of Food Hot foods Eaten in winter Menstruating women For fatigue Pregnancy Postpartum Colds, flu Nausea Anemia As we age Cold foods Consumed in the summer Constipation Diarrhea Hemorrhoids Coughing Sore throat Fever Skin problems Hypertension Therapeutic Uses of Food Strengthening foods ◦ ◦ ◦ ◦ Affect blood Promote wound healing Called pu or bo Most categorized as hot Weak blood (yin) ◦ Associated with pregnancy, postpartum, surgery ◦ Hot foods like protein-rich soups Therapeutic Uses of Food Ginseng is best-known healthpromoting food Root boiled and sediment powdered and used in teas and broths “Cures” cancer, rheumatism, diabetes, sexual dysfunction, aging Numerous others ◦ “Like cures like” Therapeutic Uses of Food Taboos ◦ Avoid soy sauce during pregnancy to prevent dark skin ◦ No iron supplements as it may harden the baby’s bones and make birth difficult ◦ Shellfish may also be avoided during pregnancy Adaptations of Food Habits in the US Changes correlate with increased stay in the US Dinner stays the most traditional Breakfast, lunch, snacks more Americanized Younger persons more likely to adapt Ingredients and Common Foods 88% prefer Chinese fare at home ◦ Age 20 – 34 prefer American Meat/poultry intake increases ◦ Some traditional protein foods do remain popular ◦ Pig’s liver, bone marrow soup Have higher fat, sugar intake Continue high fruit/vegetable intake Milk, dairy intake increases Variety increases in the US ◦ More ethnic available Meal Composition Skipping meals, increased snacking common May continue to attempt to balance yin/yang, hot/cold ◦ Certain food combinations still preferred Food influences from older less acculturated family members may influence food consumed Stir-frying, simmering, and steaming remain popular Some felt cooking Chinese meals was inconvenient Holidays in the US New Year’s Day and the Moon Festival Ch’ing Ming may be celebrated with Easter May celebrate with cultural performances and banquets: ◦ The Founding of the People’s Republic of China (mainland China) on October 1 ◦ Establishment of the Republic of China (Taiwan) on October 10 Nutritional Status: Intake Foreign-born Chinese Americans and U.S.-born Chinese Americans consume more than recommended levels of fat U.S.-born cohort demonstrated high levels of nutrition knowledge, and diet contained a higher concentration of nutrients than the foreign-born Chinese Americans May continue to avoid milk/dairy due to lactose intolerance Nutritional Status: Intake Low rates of obesity and overweight ◦ Increases with length of stay ◦ Higher with US born ◦ Children are becoming more overweight Some concern with increased eating disorders in young women Nutritional Status: Intake Lower rates of Type 2 Diabetes unadjusted ◦ If adjusted, likelihood of developing it rises 60-74% ◦ If overweight, more likely to develop it Hypertension rates lower ◦ When adjusted, numbers are higher ◦ If risk factors are increased, rates increase ◦ May be treated by consumption of yin foods as it is a yang condition Chinese Americans who had a stroke had higher risk profiles Nutritional Status: Intake Low rates of CVD ◦ Rates have increased in China as obesity and overweight have increased Cancer is leading cause of death in Chinese Americans ◦ Risk for colorectal and breast increases with length of stay ◦ Inadequate preventative screenings ◦ Lower intake of protective foods and higher intake of saturated fats ◦ High rates of liver cancer in men and cervical cancer in women Nutritional Status: Intake Infant mortality is very low LBW similar to that of whites ◦ May be inappropriate as Chinese infants are typically smaller than the US average Breastfeeding common Health High rates of TB, parasitic infection, and hepatitis B in recent immigrants Clonorchiasis, a liver fluke infection identified in Hong Kong immigrants, a few from mainland China High rates of inherited conditions: ◦ Thalassemias ◦ Glucose-6-phosphate dehydrogenase deficiency Diseases of overconsumption more prevalent in Taiwanese ◦ Increasing dramatically in China Counseling Hospitals may be seen as the place a person goes to die Hospitalization rates lower than for any other group Blood tests are seen to diminish permanently the blood supply Favor biomedical providers of Chinese heritage Consult family first with terminal illness Medical confidentiality not the norm Counseling Polychronistic Quiet but formal conversational approach Avoid interruptions, pauses may be normal Avoid “yes” or “no” questions as they may initially say “yes” Asking questions may be interpreted as disrespect Surprise or discomfort expressed by quickly and noisily sucking in air Indirect eye contact standard Counseling Deference to authority shown by acceptance and submission In the hospital, are often silent and do not voice complaints Traditional greeting is a nod or bow from waist, often without a smile Surnames first, then given names Women do not take husband’s last name Touching uncommon – even handshaking Good posture expected Personal space further than in western cultures Counseling Chinese American women are modest Traditionally never touched by male health care providers Sons receive more concern than daughters Women may not feel complaints warrant care Counseling Self-diagnosis and treatment at home first Biomedical care is often sought TCM may be used for more chronic conditions May also consult TCM and biomedical care together ◦ Beware as TCM product may counteract drug therapy ◦ Question about herbal treatments May have multiple burns from moxibustion Counseling Expect few tests and limited number of questions from practitioners Recommendations on diet, relaxation and sleep are desired Long-term therapy intended to cure is preferred over short-term surgical or invasive treatments Most resolve to die at home Accustomed to single dose remedies, not long term pharmaceutical treatments In depth interview is essential JAPAN History of Japanese in the US Significant Japanese immigration to the US after 1890 Mainly young men with little education who eventually returned Settled in Hawaii, the West Coast Most women came to the US as picture brides Discrimination was common and increased during WWII Current Demographics and Socioeconomic Status. CA & HI 95% in mixed urban and suburban areas 90% with HS diplomas 3rd generation: >72% have attended college Hold professional jobs Median income above national avg Few in poverty Worldview: Religion Early Japanese immigrants joined Buddhist temple or a Christian Church ◦ Provided employment ◦ Opportunity to learn English Today more are Protestant than Buddhist Shintoism is indigenous religion of Japan ◦ No formal organization Worldview: Religion Shinto beliefs a fundamental part of Japanese culture Humans are inherently good Evil caused by pollution or filthiness ◦ Physical as well as spiritual ◦ Goodness associated with purity ◦ Removed through ritual purification Shinto deities called kami can represent any form of existence and are worshiped Prayers said for divine favors and blessings Worldview: Family Strong Confucianism influence Similar to Chinese families Rigid pattern of conduct ◦ Koko: Children will care for their parents in their old age, among other things ◦ Gaman: Virtuous to suppress emotions ◦ Haji: Don’t bring shame to family, community ◦ Enyro: Be polite and show respect, deference, self-effacement, humility, hesitation Traditional Health Beliefs and Practices Shinto concepts of purity and pollution Health maintained through cleanliness Avoidance of contaminating substances ◦ Blood, skin infections, corpses Botanical remedies used in prevention and treatment ◦ Especially purgatives Traditional Health Beliefs and Practices Concept of harmony applied when Buddhism was introduced in 6th century ◦ Relationship to nature, family, society ◦ Imbalance results from poor diet, insufficient sleep, lack of exercise, conflict with family or society Disrupts proper flow of energy within the body Acupuncture, moxibustion, massage accepted to restore energy flow along meridians Application of yin and yang is limited in Japan Traditional Health Beliefs and Practices Complex herbal meds of China brought to Japan as kanpo Limited availability so use confined to the elite Practitioners called kanpo-i ◦ ◦ ◦ ◦ ◦ Undergo rigorous training Approach each case individually Diagnosis an art Enjoying a resurgence Use natural medications Biomedical physicians will refer to kanpo-i Traditional Health Beliefs and Practices Stress induced illness of particular concern ◦ Work related fatigue, symptoms of anxiety depression have risen dramatically Koroshi ◦ Death from overwork Iyashi ◦ Stress related therapies ◦ Gaining great popularity Traditional Food Habits Similar to the Chinese but differs in presentation and preparation Each item is to be seen, tasted and relished Visual appeal very important and should reflect balance Much of their food is imported due to the mountainous terrain Traditional Food Habits: Staples and Regional Variations Rice ◦ Eaten at every meal ◦ Short-grain rice with more starch and is stickier ◦ Sushi is rice mixed with rice vinegar and formed with fish and seafood Noodles ◦ Rice ◦ Wheat ◦ Buckwheat Soba Noodles ◦ Kudzu Traditional Food Habits: Staples and Regional Variations: Soybeans Tofu ◦ Bean curd Soy sauce ◦ Teriyaki sauce Made from soy sauce and mirin which is a sweet rice wine ◦ Miso Fermented bean paste Traditional Food Habits: Beverages Japanese green tea ◦ Very healthy Sake ◦ Rice wine Beer ◦ A favorite Traditional Food Habits: Staples and Regional Variations Tea ◦ Green tea served with most meals ◦ Tea ceremony and accompanying food is a cultural ideal that reflects the search for harmony Meal features six small courses Balance taste of sweet, sour, pungent, bitter, salty Special blend of tea used Frothy green drink Traditional Food Habits: Staples and Regional Variations Protein sources ◦ Soybean products ◦ Wide variety of fish/shellfish Often eaten raw ◦ Kobe beef Fed beer as an appetite stimulant and regularly massaged to relieve stress! ◦ Pork cutlets ◦ Chicken Small amounts of meat used Do not eat many dairy foods Traditional Food Habits: Staples and Regional Variations Fruits and vegetables most desirable Eaten only in season Herbs, greens, sweet potatoes, taro, yams Edamame ◦ Young soybean pods boiled in salt water, then popped open for a snack, often with beer Daikon radish Shiitake mushrooms Pickled vegetables Fresh fruit a traditional dessert Traditional Food Habits: Staples and Regional Variations Seaweed and algae ◦ Seasoning ◦ Wrapping ◦ In salads and soups Food classified by the way it is prepared ◦ See table 11.4 Pickled food served at every meal Food is usually cut into small pieces May be modified for children Selected Japanese Cooking Styles Meal Composition an Cycle: Daily Pattern 3 meals daily plus a snack Breakfast and lunch are simple meals ◦ Soup and one side plus rice Dinner is soup and 3 sides plus rice ◦ Pickles called tsukemono Pink pickled ginger garnishes many meals Soy sauce usually available Wasabi ◦ Pungent green horseradish-like condiment Meal Composition an Cycle: Daily Pattern Meals are not served by courses ◦ All presented at the same time in individual portions ◦ Each food in its own bowl of plate ◦ Soup served last with tsukemono ◦ Meal ended with fruit ◦ Beauty in presentation is hallmark of Japanese foods Meal Composition an Cycle: Daily Pattern Boxed meal called bento common ◦ 10 items packaged attractively Snacks ◦ Sweets ◦ Rice crackers ◦ Fruit Green tea served after all meals ◦ After western meals coffee or black tea is served Beer or sake served with dinner Eating out is common Etiquette Similar rules as the Chinese for chopsticks Consume soup directly from the bowl Slurp soup and noodles Silently sip tea Don’t hold the rice bowl as close to the mouth Eat at tables in kneeling or cross-legged ◦ Women tuck their legs to the side ◦ Remove shoes first Etiquette Dishes on left picked up with right hand Dishes on right are lifted with left hand Impolite to serve beverages to oneself ◦ Fill your neighbor’s glass when it is half empty Guests entertained at restaurants ◦ Menu chosen in advance ◦ Frequent toasts Games and karaoke are common ◦ Guests are expected to participate Special Occasions Numerous festivals ◦ ◦ ◦ ◦ Harvesting of specific crops Local Shinto shrines Buddhist temples Not a big emphasis on foods New Year’s is the most important celebration Special Occasions: New Year’s Day Share many holiday traditions with the Chinese Homes are cleaned thoroughly All debts paid Food prepared ahead so that no knives or cooking will interfere with the 7 day event 10 – 20 special dishes served in special set of nesting boxes Each dish symbolizes a specific value Special Occasions: New Year’s Day Rice cake special to New Year’s is Mochi O sonae mochi ◦ Large rice cake topped with a smaller rice cake then a tangerine ◦ Preserves good fortune and happiness for future generations Ozoni – soup with mochi Otoso – rice wine Special Occasions: Obon Festival ◦ Buddhist festival Appreciate the living Honor the dead Comfort the bereaved Certain birthdays ◦ Man at 42, woman at 33 Special festivities to prevent misfortune ◦ 61 marks beginning of second childhood Red cap ◦ 77 they put on a long, red overcoat ◦ 88 most important of all and wear both hat and coat Therapeutic Uses of Food Food pairs may be harmful ◦ Eels and pickled plums ◦ Watermelon and crab ◦ Cherries and milk Food pairs may be beneficial ◦ Pickled plums and hot tea to prevent constipation ◦ Pickled plums and rice porridge easily digested and well tolerated during recovery from illness Adaptations of Food Habits Each generation becomes more acculturated Still eat more rice and soy sauce then non-Asian Americans Western diet becoming more popular in Japan Nutritional Status: Intake Traditional diet high in carbs and very low in fat and cholesterol Higher risk of colon cancer in mainland Japanese Americans due to diet Japanese Americans have more rapid atherosclerosis progression than Japanese ◦ Less fiber, more fat Breast and prostate cancers now more common Nutritional Status: Intake Japanese American men have high rates of Type 2 Diabetes Rates of obesity and overweight are low Insulin resistance and increased intraabdominal fat is higher ◦ Predictive of type 2 diabetes in Japanese Americans Nutritional Status: Intake Japanese American elders may have low in take of calcium High incidence of lactose intolerance Prevalence of osteoporosis may be higher than among whites Calorie consumption and meat intake declines with age in Japanese Americans Nutritional Status: Intake Conditions linked to high sodium diets are extremely high in Japan ◦ Hypertension, stroke, stomach cancer ◦ Rates are dropping with westernized diet Infant mortality rates low ◦ US born mothers more likely to have LBW babies than foreign born Nutritional Status: Intake Americans of Japanese heritage have the most permissive attitude towards drinking, particularly among women Japanese American men have high rates of heavy drinking, fewest abstainers Women show similar trends Alcohol consumption may be more than previously assumed Counseling Will place family before the individual Preserve harmony with society Respect and care for elders Illness both a symptom of an unbalanced life as well as an impediment to fulfilling personal obligations. Japanese Americans less accepting of pain behaviors Counseling Formality and politeness are essential Emotional displays avoided, especially anger Very nonconfrontational ◦ May be reluctant to say “no” even when the answer to a question is negative Conversation style is indirect Frequent, long pauses ◦ Remain silent Direct eye contact is disrespectful Counseling Non touching More personal space than Americans Extremely high context ◦ Slightest gesture may have meaning Traditional greeting is a bow from the waist with palms against thighs ◦ Longer and lower the bow the more respect shown Expected to be directed in their health care Do not criticize health habits In depth interview is crucial KOREA History of Koreans in the US Few immigrated to the US prior to 1900 1903 – 1905: Christian missionaries recruited 7000 Koreans to work in Hawaiian sugarcane fields 1905 – 1924: Picture brides and oppressed political activists only 1924: Japanese Exclusion Act included Koreans – no immigration 1959 – 1971: wives and children of US soldiers who fought in the Korean war History in the US After 1965 immigration increased ◦ Primarily college-educated, middle class professionals and their children Currently over half have come to the US since 1980 Many come to avoid North/South Korean conflicts CA, NY, IL, NJ, TX, WA,VA, PA, MD, and HI Some adjustment difficult noted and expatriot communities exist Socioeconomic Status Language difficulties and licensing restrictions have caused some issues with employment Early immigrant descendants securely middle class High achievement in education and professionalism Quick mastery of language Greater willingness to give up Korean traditions >50% have college degrees Incomes slightly above average, poverty rates above the national percentage Worldview: Religion Buddhism and Confucianism are majority religions 28% Christians Shamanism ◦ Belief in natural and ancestral spirits Chundo Kyo ◦ National religion formerly Tonghak ◦ Mixture of Confucian, Taoist and Buddhist In North Korea all religious beliefs are suppressed ◦ Marxism and self-reliance are ok Worldview: Religion Early Korean immigrants were Christians escaping discrimination Many recent immigrants are believed to be Christian Some continue ancestor worship along with Christian practices Small numbers of Buddhists Worldview: Family Confucianism influenced family structure Family highly valued Generational ties, parents and elders important Males are head of household Birth sequence, especially older male children\ Women take care of home and care for children Parenting is authoritative and children behave Major birthdays at 1 and 60 ◦ 5 cycles/12 year cycle of life -attain old age Worldview: Family Changes occur after immigration Marriage bond becomes more important than that to parents Few elders live with eldest son’s family Old age may be seen as a negative experience Male dominance diminishes Divorce rates are high Intergenerational conflict increases with length of time in the US Traditional Health Beliefs and Practices Relate health to ◦ ◦ ◦ ◦ ◦ Happiness Ability to live life fully Function without impairment Not be a burden to their children Good appetite Digestion and circulation prominent in health maintenance ◦ Energy is absorbed into the body through the stomach Traditional Health Beliefs and Practices Um (Yin)/yang principles applied Influenced by ◦ 5 evolutive elements Fire, water, wood, metal, and earth ◦ Ki vital energy Cold, damp, heat or wind enters body through pores and weaken yang. Symptoms include indigestion, arthritis, asthma Physical exhaustion, eating too much or too little food, spiritual intervention can result in disease Traditional Health Beliefs and Practices May attribute diabetes to eating too much rich food and getting too little exercise Blood conditions that interfere with distribution of vital energy ◦ Lack of blood Drying or hardening of the blood Typical in old age causing indigestion, aches ◦ Bad blood From a sudden fright Chronic pain Traditional Health Beliefs and Practices Korean specific folk illnesses Somatic complaints that are expression of psychological distress Excessive emotions believed to cause certain physical conditions ◦ Hwabyung, Traditional cures includes use of a shaman or spiritual mediator Sacred therapeutic rituals may be used Traditional Health Beliefs and Practices Traditional approach to natural cures called Hanyak Healer is called a hanui ◦ ◦ ◦ ◦ Medical history Clinical observations Quality of voice Takes pulse 24 pulse conditions including floating, sunken, smooth, vacant, accelerated Traditional Health Beliefs and Practices Classified as plant, animal mineral source Mixed to balance yin, yang, and ki Accupuncture, moxibustion, cupping, sweating Biomed procedures like blood pressure, temperature, pill form meds Many traditional practices now home remedies Person’s fate is determined at the moment of birth ◦ Christian Koreans may believe strongly in faith healing, fate Traditional Food Habits: Ingredients and Common Foods Influenced by Chinese and Japanese Hearty and highly seasoned Sweet, sour, bitter, hot and salty tastes all combined White, red, black, green, yellow All used in preparation and presentation Traditional Food Habits: Ingredients and Common Foods - Staples Based on grains flavored with spicy vegetable and meat, poultry or fish side dishes Rice is the foundation ◦ Must be cooked correctly ◦ Short grain preferred ◦ Regular and glutinous (sticky) Millet and barley may be used as extenders Noodles from wheat, buckwheat, mung beans, sweet potatoes and kudzu Traditional Food Habits: Ingredients and Common Foods - Staples Vegetables every meal Bok choy, Napa European cabbage Long white radish Eggplant Vegetables are added to soups and braised dishes Pickled and fermented served at every meal ◦ Kimchi Cucumbers Perilla (a green) Bean sprouts Sweet potatoes Winter melon Traditional Food Habits: Ingredients and Common Foods - Staples Fruits mostly eaten fresh ◦ Asian pears Fish and shellfish population ◦ Dried or salted in inland areas Beef and beef variety cuts ◦ Cubes, thin slices, ribs of marinated beef BBQ’s at table Bulgogi Fire pot called sinsullo ◦ Similar to Mongolian hot pot Chicken and poultry not really popular Traditional Food Habits: Ingredients and Common Foods - Staples Soybean products ◦ Bean curd Mung beans, adzuki beans, other legumes popular Pine nuts, chestnuts, peanuts, sesame Seasonings ◦ Garlic, ginger root, black pepper, chile peppers, scallions, toasted sesame, ginseng Traditional Food Habits: Ingredients and Common Foods - Staples Soup or thin barley water used as a beverage Herbal teas ◦ Ginseng tea with cinnamon ◦ Spice tea ◦ Rice tea Wine ◦ Made from rice and other grains Beer Milk and other dairy products not generally used or consumed Traditional Food Habits: Meal Composition and Cycle – Daily Pattern 3 small meals, frequent snacking Breakfast traditionally the main meal ◦ Today more likely light ◦ Soup with rice topped with eggs, meat or fish Lunch typically noodles with broth, garnished with shellfish, meat or vegetables Dinner similar to breakfast but with steamed rice ◦ May now be the largest meal of the day Snacks from street vendors ◦ Grilled and steamed tidbits of all types ◦ Sweets and dried fruits Traditional Food Habits: Meal Composition and Cycle – Daily Pattern Rice main dish Everything else is an accompaniment ◦ Panch’an Individual bowls of rice and soup served Panch’an on trays in center Traditional Food Habits: Distilled beverages consumed mostly by men ◦ Soju ◦ Sweet potato vodka ◦ Served with snacks such as spicy squid or stuffed chile peppers Anju ◦ Separate category of foods ◦ An alternative to a full meal ◦ Similar to appetizers or tapas Etiquette Chopsticks and soup spoons are the only eating utensils used Elders served first, children served last Fill the soy sauce dish of your neighbor Food passed with right hand Communal beverage may be passed for all to share Special Occasions Historically Korean cooking divided into everyday fare and cuisine for royalty Traditions of palace cooking and food presentation are used for special occasions More dishes are served, plus wine and dessert Special beverages ◦ Thick drink of persimmons or dates, nuts, spices ◦ Beverage from molasses and magnolia with flowers Special Occasions New Year’s ◦ Traditional dress worn and elders honored First full moon light firecrackers to frighten away evil spirits Shampoo Day ◦ Bathe in streams to ward off fevers Thanksgiving ◦ Fall harvest festival Child’s first birthday Therapeutic Uses of Food Many follow um and yang classification Believed to be similar to other Asians ◦ Um (cold) foods Mung beans, winter melon, cucumber, other vegetables and fruits ◦ Yang (hot) foods Meats, chile peppers, garlic, ginger Preparing healthy, tasty foods is an important way Korean women show affection for their family and friends Therapeutic Uses of Food Good appetite is a sign of good health Health promoting foods ◦ ◦ ◦ ◦ ◦ ◦ Bean paste soup Beef turnip soup Rice with grains and beans Broiled seaweed Kimchi Ginseng tea Stamina and alleviates fatigue More than half report using ginseng Therapeutic Uses of Food Ginger tea Hot citrus beverage Bean sprout soup Lemon with honey in hot water Restorative herbal medicines, vitamin supplements, meat and bone marrow soup Pregnant women use strengthening foods ◦ Taboos involved “like causes like” Blemished fruit = baby with skin problems Contemporary Food Habits in the US: Adaptations of Food Habits Traditional food habits continue after immigration to the US Rice, kimchi, beef, beef variety cuts, fish, sesame oil used regularly Add oranges, low-fat milk, bagels, tomatoes, bread Acceptance of American foods widespread Traditional diet in Korea has changed ◦ Become more westernized Contemporary Food Habits in the US: Meal Composition and Cycle Similar to the US American foods most common at breakfast and lunch Traditional Korean foods at dinner Hot barley water the favored beverage Continue to observe traditional Korean holidays Preferences trending towards a more Americanized diet regardless of length of stay Nutritional Status: Intake Maintain more traditional low-fat diet high in Vitamins A, C, beta-carotene, niacin, fiber, sodium More Americanized diet have higher kcals/calcium Mortality rate lower than for general population Infant mortality rates somewhat higher Leading cause of death is stomach cancer ◦ Higher rates of liver, and esophageal cancers ◦ Toxins may be from fermentation process ◦ Aflatoxins in soy sauce Hepatitis B which causes liver cancer is high Nutritional Status: Intake Obesity rates lower in foreign born than in Korean Americans, but still lower than US ◦ Men more likely than women ◦ Acculturation increases risk for obesity Do not exercise regularly Develop Type 2 diabetes at high rates At risk for hypertension ◦ Family history, being male ◦ May be noncompliant with treatment Low death rates from CVD Higher alcohol consumption rates than some Asian groups Counseling Language barrier may be an issue Lower rates of health insurance coverage Cultural attitudes may affect health care ◦ Ashamed to seek help ◦ May avoid screening procedures May administer home remedies, consult shamans, or hanui Counseling Some concern regarding safety of some traditional products ◦ May have to make a choice between traditional therapy and biomedicine Religious affiliation may have a significant impact on health and nutrition care Quiet, nonassertive approach Emotional expressions only over pleasant topics Measured, indirect approach to topics May be hesitant to say no Counseling Direct eye contact Demonstrate sincerity and attentiveness Touching uncommon Rise for elders when they enter a room Family is involved in health care ◦ Terminal illness, life support a decision by family Determine who is head of the family/household May want permanent cure In depth interview crucial