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Behavioral Risk Factor Survey of Korean Americans -- Alameda County, California, 1994

Asians/Pacific Islanders (APIs) account for an increasing proportion of all racial/ ethnic minority groups in the United States: during 1980-1990, the number of persons in this group increased approximately 99% (1). Among APIs in the United States, Korean Americans are the fifth largest subgroup (2). In Alameda County, California, APIs comprise 15% of the population, and Korean Americans account for 5% of that group (3). To assess behavioral risk factors among Korean Americans in Alameda County, Asian Health Services (a nonprofit community clinic) and the Center for Family and Community Health at the University of California, Berkeley, conducted a household telephone survey from August 1994 through February 1995. This report summarizes findings from that survey, which indicate significant differences in the prevalences of some behavioral risk factors and preventive health practices between men and women and between Korean Americans and the total California population.

The survey was adapted from the 1993 California Behavioral Risk Factor Survey (BRFS) and modified for cultural sensitivity and appropriateness. The survey questionnaire was developed in English, translated into Korean, back-translated, and pretested. The project team identified approximately 500 Korean surnames, and Korean surname-based telephone lists were purchased from commercial sources. All 4955 identified telephone numbers in Alameda County were sampled, and 52 were resampled. Of these, 856 (17%) were eligible, 3968 (79%) were ineligible; and 183 (4%) were of unknown eligibility. Most ineligible telephone numbers were incorrect, disconnected, or nonworking (21%), or represented households without an eligible Korean adult (74%). Within each eligible household, Korean persons aged greater than or equal to 18 years were randomly selected (4). A total of 676 interviews were completed (response rate: 79%). Results were weighted to account for different selection probabilities and to adjust the sample to the 1990 Census for the Korean population in Alameda County.

An estimated 55% of participants were women, 36% were aged 18-29 years, and 20% were aged greater than or equal to 50 years (mean: 37 years); 63% were married; 52% were employed; 52% were college graduates; and 48% had a household income of greater than or equal to $35,000. In addition, 91% were born in Korea, and 13% immigrated to the United States after 1989; 54% spoke little or no English.

An estimated 12% of participants reported having been told by a health professional that they had high blood pressure, 12% that they had high blood cholesterol, and 4% that they had diabetes. Overall, 39% reported they had smoked greater than 100 cigarettes during their lifetimes, and 21% currently smoked cigarettes. In addition, 85% reported having ever drunk alcohol, and 47% reported currently drinking alcohol; 31% had not exercised during the preceding month; 15% did not always use safety belts; 13% of current drinkers had driven after drinking during the preceding month; and 18% had never had a routine physical examination.

Men were significantly more likely than women to report having smoked, to currently smoke, to currently drink, or among current drinkers, to have ever driven after drinking (Table_1). Women were significantly more likely to report not having exercised during the preceding month.

Compared with 1995 BRFS estimates for the total California population, the prevalences of two risk factors were lower among Korean Americans: high blood pressure (12% of Korean Americans versus 21% of all California adults) and high blood cholesterol (12% versus 19%) (Table_1). Risk factors more prevalent among Korean Americans included no exercise (31% versus 21%) and no routine physical examination (18% versus 7%) (Table_1). In addition, 40% of Korean American women reported never having had a Papanicolaou test, compared with 8% of California women; 57% of Korean American women aged greater than or equal to 50 years reported never having had a clinical breast examination, compared with 10% of all California women aged greater than or equal to 50 years; and 45% aged greater than or equal to 50 years reported never having had a mammogram, compared with 10% of all California women aged greater than or equal to 50 years.

Reported by: SH Kang, DrPH, AM Chen, MD, R Lew, MPH, K Min, Asian Health Svcs, Oakland; JM Moskowitz, PhD, BA Wismer, MD, IB Tager, MD, Center for Family and Community Health, Univ of California, Berkeley; Cancer Surveillance Section, California Dept of Health Svcs. Office of Global Health; Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that, among Korean American adults residing in Alameda County, the prevalences of many health risk factors were higher than those among the total population of adults in California. Specifically, of the 10 health practices or behaviors, prevalences of five were significantly higher among Korean American adults than among the total adult population in California, and the prevalences of three other health conditions or behaviors were similar to those of the total adult population; the prevalences of only two health conditions were significantly lower among Korean Americans. Among Korean Americans, the prevalence of smoking varied significantly by sex. Previous BRFSs of Chinese and Vietnamese adults in California also documented high prevalences of smoking among men and low use of breast and cervical cancer screening among women, compared with the total California population (5,6).

Factors accounting for these differences may include cultural, linguistic, and financial factors. For example, Korean American women may be uncomfortable seeking health care from non-Korean-speaking providers and, as a result, have lower levels of breast and cervical cancer sceening. In addition, Korean Americans may not have routine health examinations if they are not able to participate in employer-sponsored health insurance plans. Further analysis is being conducted to determine correlates of breast and cervical cancer screening and tobacco use in this community.

This assessment was possible because of the unique methodology and collaborative approach involving academic and community representatives. Community members participated in each phase of the study, and the community agency collaborated with the academic center in survey design, methodology, implementation, and data analysis. Despite these strengths, the findings in this report are subject to at least one important limitation. The use of Korean surname-based telephone lists for the sampling frame may have biased the sample: Korean Americans who resided in households without telephones, who did not list their telephone numbers, or who did not have Korean surnames were excluded from the sample.

Community-sensitive approaches such as this can assist in characterizing health needs and strategies in ethnic-minority communities. Based on the findings in this report, Asian Health Services and the Center for Family and Community Health are collaborating on a community intervention to improve breast and cervical cancer screening among Korean American women.


  1. US Department of Commerce. We the American...Asians. Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census, 1993.

  2. Lin-Fu JW. Asian and Pacific Islanders: an overview of demographic characteristics and health care issues. Asia Pac J Public Health 1993;1:21-36.

  3. Anonymous. Asians in America: 1990 census -- classification by state. In: Asian Week. San Francisco: Asian Week, 1991.

  4. Kish L. Survey sampling. New York: John Wiley & Sons, Inc., 1965.

  5. CDC. Behavioral Risk Factor Survey of Chinese -- California, 1989. MMWR 1992;41:266-70.

  6. CDC. Behavioral Risk Factor Survey of Vietnamese -- California, 1991. MMWR 1992;41:69-72.

Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Percentage distribution of risk factors/preventive health practices among Korean Americans and total California population, by sex -- Alameda County, California, August
1994-February 1995
                                                                     Korean Americans                                                        Total California population *
                                                         --------------------------------------------------------               --------------------------------------------------------------
                                                                Men               Women               Total                              Men                Women                Total
                                                         ----------------    ---------------    -----------------                -----------------     ---------------      ------------------
Risk factor/Preventive health practice                     %   (95% CI+)       %    (95% CI)       %     (95% CI)                   %    (95% CI)        %    (95% CI)        %    (95% CI)
High blood pressure &                                     11   ( 8%-15%)      12   ( 9%-15%)      12    ( 9%-14%)                  19   (17%-21%)       22   (21%-24%)       21   (19%-22%)
High blood cholesterol @                                  14   ( 9%-18%)      11   ( 9%-14%)      12    (10%-15%)                  17   (16%-19%)       20   (18%-22%)       19   (17%-20%)
Diabetes                                                   5   ( 2%- 8%)       4   ( 2%- 5%)       4    ( 3%- 6%)                   4   ( 4%- 4%)        6   ( 5%- 8%)        5   ( 5%- 6%)
Ever smoked (100 cigarettes)                              70   (65%-76%)      13   ( 9%-17%)      39    (35%-43%)                  50   (47%-52%)       38   (36%-40%)       44   (42%-46%)
Current smoker                                            39   (32%-45%)       6   ( 3%- 9%)      21    (17%-24%)                  19   (17%-21%)       14   (12%-16%)       16   (15%-18%)
Current drinker **                                        65   (59%-72%)      31   (26%-37%)      47    (42%-51%)                  --          --       --          --       --          --
No exercise                                               26   (20%-31%)      36   (31%-41%)      31    (27%-35%)                  20   (18%-22%)       22   (20%-24%)       21   (19%-22%)
Safety-belt nonuse (not always)                           19   (14%-24%)      13   ( 9%-17%)      15    (12%-19%)                  17   (16%-19%)       11   (10%-13%)       14   (13%-15%)
Ever drink and drive ++                                   18   (12%-24%)       6   ( 1%-12%)      13    ( 9%-18%)                  --          --       --          --       --          --
Never had routine physical examination                    17   (12%-22%)      19   (14%-23%)      18    (15%-21%)                   8   ( 6%- 9%)        6   ( 4%- 7%)        7   ( 6%- 7%)
Never had Papanicolaou smear                              --          --      40   (35%-46%)      --           --                  --          --        8   ( 6%- 9%)       --          --
Never did breast self-examination                         --          --      43   (37%-48%)      --           --                  --          --       --          --       --          --
Never had clinical breast examination &&                  --          --      57   (49%-64%)      --           --                  --          --       10   ( 8%-13%)       --          --
Never had mammogram &&                                    --          --      45   (38%-53%)      --           --                  --          --       10   ( 8%-12%)       --          --
*  Source for all variables: California Behavioral Risk Factor Survey (BRFS), 1995. Results were weighted to account for different probabilities of selection and to adjust to the age, sex,
   and race distribution for the 1990 census for Californians.
+  Confidence interval.
&  Persons who had ever been told by a health professional that they had high blood pressure.
@  Persons who had ever been told by a health professional that they had high blood cholesterol.
** Ever drinkers who currently drink alcoholic beverages. Numbers for the total California population were not included because questions on the BRFS were not comparable with those used for
   this survey.
++ Only asked for persons who reported that they were current drinkers. Numbers for the total California population were not included because questions on the BRFS were not comparable
   with those used for this survey.
&& Women aged >= 50 years.

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