Dietary habits and health beliefs of Korean-Americans in the San Francisco Bay Area
Barbara H. J. Gordon
Thirty-three percent of nearly 800,000 Korean-Americans live in California , the fifth largest Asian subgroup in the United States  that may increase to 1.3 million by 2000 . To be effective counselors and policy makers, health practitioners need to understand cultural food habits, health-related values, and illnesses in this population [4-8].
Korean cooking retains distinctive characteristics despite influences of several other Asian cuisines . Traditional diets include 3 meals (breakfast, lunch, and supper) plus snacks [3,9-12]. Diets include steamed rice, noodles, and broth garnished with shellfish, meat, and/or vegetables . Kimchi, a spicy fermented cabbage dish sometimes with fish, is eaten with meals . Fresh fruit, soybean products, legumes, and nuts are consumed . Beverages include ginseng tea and barley water. Milk and other dairy products are not part of the traditional Korean diet .
Korean health beliefs embrace traditional shamanism, herbal remedies, and Chinese and Western medical treatment modalities . Ancient therapies include ginseng, which is believed to be an aphrodisiac that promotes health, strength, and happiness . Hanbang, a traditional Korean health modality similar to Chinese herbal therapies, and acupuncture are available also .
The objective of this study was to collect demographic data on frequency and prevalence of traditional Korean dietary health practices and health beliefs.
Sample and Questionnaire
The survey tool was assessed for its face validity by nutrition professionals familiar with research on cultural values and diets before its use to investigate dietary habits, health beliefs, and demographic characteristics of Korean-American subjects. A food frequency list of 42 popular Korean and American foods was adapted from Sanjur . The survey was presented in either English or Korean. Elderly subjects unable to complete the questionnaire were interviewed in their preferred language. Subjects were recruited by 1 of the authors from groups of attendees at Korean churches and community centers in San Francisco, California.
The data were analyzed using the Epi-Info statistical package (version 6.02, 1995, Bethesda, Md). T tests or ANOVA were used with continuous variables, tests were used to analyze categorical variables [[chi].sup.2] . Results were considered statistically significant at P[less than].05.
Characteristics of the Sample Population
Participants in this convenience sample of 193 Korean Americans consisted of 97 men and 96 women 19 of whom were aged 55 years or older. The majority had lived in the United States longer than 5 years. For the 65 subjects living here fewer than 5 years, 87% still spoke more Korean than English or only Korean at home (Table 1).
Health Behaviors and Beliefs
The majority of respondents (63%) preferred Western medical treatments. However, a small number still practiced only traditional modalities (Table 1).
More than half of the respondents (52%) used ginseng products; the number increased with age but overall there was no change with time in the United States. Of the 121 subjects who preferred Western medicine only, nearly half used ginseng compared to ginseng use by three-quarters of those who preferred traditional treatments (P[less than].05).
As shown in Table 2, hot ginger tea was consumed as a cold remedy by more than half of male and female subjects equally, with no change over time. Forty-seven subjects age 35 to 54 years consumed ginger tea more often than did the others (P[less than].05). Other cold remedies included soybean sprout soup, yoojacha (a hot citrus fruit beverage marinated in sugar or honey), and lemon-honey tea.
More than 60% of food shoppers were women. The majority shopped at American food markets as much as they did at Korean stores. Younger subjects used taste, whereas older respondents used nutritional value to guide their food choices (P[less than].05).
Bread, cereal, rice, and pasta group More subjects continued to consume rice daily compared to bread (Table 2). Nearly all consumed rice at least once each day whereas the most subjects over age 55 years did so more often; Japanese sticky rice was preferred to the long grain variety. Traditional roasted barley or beverages from water of boiled corn were consumed after meals.
Vegetable and Fruit Groups Vegetables were consumed more frequently than were meat products. Nearly 80% consumed kimchi daily (Table 2). Over-all there was no change with length of residence here. Women consumed fruits and vegetables significantly more often than did men. Seventy percent of women consumed salad at least several times a week, while only 53% of men had similar eating habits (P[less than].03). A variety of blanched vegetables were eaten at least once a day. Frequency of orange and apple consumption (Table 2) among women (84% and 81%) was also higher than it was for men (61% and 63%) (P[less than].001 and P[less than].01, respectively).
Milk, yogurt, and dairy group Nearly 40% of the respondents consumed milk daily. In all age groups, milk consumption several times each week was high. Yogurt and cheese were not popular (Table 2).
Meat, poultry, fish, and tofu group Pork was consumed less often than were beef and chicken (Table 2). Ham, sausage, and bacon were rarely eaten; the majority of subjects who did consume these items were younger than 35 years of age. Few consumed oxtail or bone marrow soup once per week (Table 2) but nearly 50% did so once per month. Fish remained a frequent component of the diet as did beef (Table 2). Tofu products were consumed once weekly to daily by 93% of subjects regardless of their length of residence (Table 2).
Fats and Oils Sesame and corn oil were used daily by most subjects. Only a few subjects used butter, margarine, or mayonnaise (Table 2).
Condiments and flavorings We agree with those who report use of traditional condiments and seasonings such as salt, red pepper, green onions, soy sauce, soybean paste known as chang, garlic, ginger, sesame seeds, and rice vinegar . Mustard, catsup, and mayonnaise were used by fewer than 10% (Table 2).
Limitations include the use of different and nonrandomized, local subjects for each time frame. No data on education, income, job, and generation were collected. Small numbers of eligible subjects in the United States between 5 and 10 years hampered statistical analysis. Data on specific vegetable and fruit intake, including quantitative nutrient intakes, could clarify nutrition education needs [12,17]. Comparative data for Korean-born United States-born ethnic Koreans might provide important dietary information.
Food frequency questionnaires have been used with similar populations in the past [18-20] as have 24-hour recall methods [18,21-23].
This study stratified subject data by length of stay in the United States as a measure of acculturation. Rice remains a staple food and kimchi a side dish as reported in another study ; however, others report that rice consumption has decreased even by Koreans living in Korea . Kimchi remains an important source of vitamin C (21 to 40 mg per half c portion), vitamin A, folate, riboflavin, thiamin, and niacin as well as fiber [13,24]. Thus, it is unlikely that these Korean-Americans would experience deficits of these nutrients. In addition, some report that cabbages, radishes, eggplant, cucumbers, carrots and potatoes both white and sweet, are vitamin sources [3,19]. Traditionally, fruit is eaten fresh as our data suggest . Ginseng use was not affected by age, gender, length of residence in the United States, or language used at home. Although we had expected increased “American-type” food consumption and decreased traditional food consumption, these data suggest longstanding, unchanged dietary hab its and health beliefs. The ethnic diversity in the United States, and more specifically the large Korean community in the San Francisco Bay area, may decelerate the rate of cultural and structural acculturation reported here and by others [4,25,26].
Moreover, some researchers [27,28] have reported lactose intolerance in most Asians. But others suggest that lactose intolerance may be overestimated, at least in the United States . Still others report the routine consumed of dairy products . In fact, dairy product consumption by Koreans in South Korea has been reported to be increasing . In 1 report, however, Korean-Americans still consumed less than the Recommended Dietary Allowance for calcium .
As Asian populations increase in the United States, knowledge of continued intake of Korean foods, preferred medical approaches, preferred language, and level of adaptation and acculturation would better equip health professionals to promote healthful practices with clients [26,32,33]. Awareness of specific cultural meal patterns, personal requirements, dietary preferences, and disease patterns enhance the services of dietitians and nutrition educators [22,31,34]. To provide effective medical nutrition therapy, dietitians need to be aware of continued and rejected traditional beliefs and practices. Current literature indicates that meat and dairy product consumption is increasing. Moreover, data suggest that cancer is the leading cause of death in Korean-Americans between ages 25 and 44 years and cancer or heart disease is the leading cause of death for those aged in 45 to 64 years [35,36]. These age-related death rates are midrange compared to those for all Asian Pacific Islanders and are similar to rates fo r whites in the United States . Therefore, modification of culturally familiar and accepted dishes may facilitate disease prevention and health promotion with this population. Continued consumption of low-energy soups and recipes with fish or chicken that include vegetables need to be acknowledged as familiar and valid sources of nutrients [37,38].
In future studies, assessment of preferred language spoken at home and at work as well as quantities of fruits and vegetables, meats, and fats purchased and consumed may clarify the degree of structural and social acculturation. This information is necessary for effective nutrition counseling.
B. H. J. Gordon is an instructor and K. P. Sucher is a professor in the Department of Nutrition and Food Science at San Jose State University, San Jose, Calif. M. S. Y. Kang is a dietitian with Korean Center, Inc, San Francisco, Calif. At the time the study was completed she was a graduate student in the Department of Nutrition and Food Science, San Jose State University, San Jose, Calif. P. Cho is an epidemiologist with San Joaquin County Public Health Services, Stockton, Calif. At the time the study was completed, he was a teaching assistant in the Department of Health Sciences, San Jose State University, San Jose, Calif.
Address correspondence to: Barbara Gordon, PhD, San Jose State University, One Washington Square., San Jose, Ca 95192-0058.
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