East AsiansChapter 11

IntroductionEast Asia has 1/3 the worlds land mass 2/3 of the worlds populationIncludes parts of Russia, Central Asia, and the Middle EastChina, Taiwan, Japan, North and South Korea and the Mongolian Peoples Republic

Chinese4000-year-old civilizationVaried geographyPopulation exceeds 1.2 billion peopleNumerous ethnic and racial groupsDiverse language with many dialects

History of Chinese in the USFirst surge was in the 1850s with the Gold Rush in CaliforniaAlso immigrated to HawaiiMany came from what is known as the Canton region in ChinaToday many large cities have Chinatowns

Current Demographics and Socioeconomic StatusChinese began coming to the US after 1943 and again after 1992Represent about of all Asians in the USChinese numbers may or may not include TaiwaneseEmployed in professional occupationsEspecially the sciences

Current Demographics and Socioeconomic StatusFour Types of Chinese American householdsMen born early in the 20th century who came here planning to return and were stranded when politics changedThose who were able to bring their wives to the USNew immigrant familiesAcculturated suburban families

Current Demographics and Socioeconomic StatusValue educationAlmost half with college and graduate degreesWell-compensated in professional employmentSuccessful transition to the USMany who immigrated early were not well educated but have done wellMany Taiwanese immigrated since 1980Transnational careers between two nations

Worldview: ReligionMost not affiliated with a specific churchCombination of:Ancestor worshipConfucianismTaoismBuddhismEarly religion a mixture of ancestor worship and respect for nature and the heavenly bodiesCeremonies for the dead are a prominent practice

Worldview: Religion - ConfucianismA sage who gave order to Chinese society by defining how people should live and work togetherChildren obey their parents and parents take care of their childrenTolerance in the eldest brother and humility in the youngerProper behavior by the husband and submission by the wifeRespect for ones elders and compassion in adultsAllegiance to rulers and benevolence by leadersValues influence Chinese society today

Worldview: Religion - Taoism Heaven and humanity function in unison and can achieve harmonyPeople are subordinate to natures wayEverything in nature contains both yin and yang and must be balancedSimple life, communion with nature, avoidance of extremes

Worldview: Religion BuddhismNot as common today as has been in the pastOften blended with traditional Chinese beliefs

Worldview: Religion Chinese American SpiritualityCatholic and Protestant churches established in the US and now in ChinaOften maintain aspects of Buddhism, Taoism, spirit or ancestor worship in their daily livesTaiwanese followers of Baptist, Presbyterian churches in US but few in Taiwan

Worldview: FamilyConfucian teaching importantUsually patriarchalWomen taught to be unassuming and yieldingThrice obeyingSubmissive to their fatherSubordinate to their husbandsMothers obey sonsChildren are quiet and obey their eldersDo not fight, cry or show emotionHonor the family

Traditional Health Beliefs and Practices:Traditional Chinese MedicineFive elements that may become unbalancedFireEarthMetalWaterWood

Correspond with the organsHeartSpleenLungsKidneysGallbladder

Additional associations with secretions, seasons, colors, directions, time of day, odors, sounds, emotion

Traditional Health Beliefs and Practices:Traditional Chinese MedicineAdapted to include concept of yin and yangBalance oppositesIllness develops when imbalance occursExcess of yangAcne, rash, hemorrhoids, ear infections, feverExcess of yinAnemia, colds, nausea, weight lossWeak blood during growth, pregnancy, postpartum or old age treated with yang

Traditional Health Beliefs and Practices:Traditional Chinese MedicineVital force of life is qiEnergy, breath, airFlows along 12 meridiansMust also balance Jing Sexual or primordial energyShengSpiritual energy or essence of consciousnessWindPoison which is related to allergiesFright in children where soul is scattered

Traditional Health Beliefs and Practices:Traditional Chinese MedicineDifference between Chinese medicine and biomedicine is the idea that body and mind are unified, governed by the heartEmotions related to specific conditionsMaintain health through balanced diet, moderation in activities and sleep, and avoidance of sudden imbalanceTreatment restores harmonyTCM remedies are decoctions taken in a single dose

Traditional Health Beliefs and PracticesAcupunctureThin needles inserted where meridians surfaceMoxibustionSmall bundles of wormwood heated and carefully applied to certain meridiansOften used during labor and deliveryMassage or therapeutic exercise

Traditional Food HabitsEat a wide variety of foods and avoid fewReflects food habits and preferences of the largest ethnic group in China the HanBeijing has a large Muslim populationForeigners introduced numerous ingredients now popularBananasPeanutsChile peppers

Traditional Food Habits: StaplesNumerous fruits, vegetables and protein items consumedFew dairy productsGrains are foundation of dietLess grain consumption nowLess foods grown for home consumptionIncrease in eating away from home

Traditional Food Habits: StaplesRiceWheatNoodlesSpring rollsDumplingsBuckwheat

WheatThreshing wheat in northern China

Traditional Food Habits: ProteinPorkMuttonChicken DuckFish, seafoodEggs1000-year-old eggsSnakes, frogs, turtlesInsectsSoybeansPoor mans cow

Traditional Food Habits: VegetablesExtensive use of vegetablesMany familiar to USLeafy bok choyWrinkled napa cabbageLong beansSmall purple eggplantChinese kaleLarge white icicle radishWinter melonMany mushrooms

Traditional Food Habits: FruitsEat fresh fruit infrequentlyMaybe a snack or for desertPreferred slightly ripe or saltedDates, persimmons, pomegranates, tangerinesKumquats, lychees, longans, loquats

Traditional Food Habits: Tea3 types of teaGreenDried, tender leavesYellow, slightly astringent drinkBlack (red)Toasted, fermented leavesReddish drinkCommon in Europe and USOolong (black dragon)Partially fermented leaves

Traditional Food Habits: BeveragesAlcoholic drinks called wines but usually from grains or fruit like plumsBeer is very popularBottled waterBottled beverages

Traditional Food HabitsVery few raw foods consumedStir-fryingSteamingDeep fat fryingSimmeringRoastingWoks usedMay also steam using bamboo containerPreserves limited fuelFoods preserved if necessary by pickling or fermenting

Regional Variations: 5 Culinary RegionsNorthern RegionShandong, BeijingPeking duckMu Shu porkMandarin wheat pancakesHonan Sweet-sour freshwater fish made from whole carpGrilling or barbecuingMongolian hot potCool climate with preserved foods

Regional Variations: 5 Culinary RegionsSouthern 3 AreasSichuan-HunanChiles, garlic, Sichuan pepperHot/sour soupYunnanUse of dairy productsHot and spicyCantoneseMost familiar to AmericansStir-fryDim sumTea

Regional VariationsFukien provincial fareNumerous seafood dishesClear brothsPaper-wrapped foods and egg rolls may have originated hereRed foods due to red wine pasteHakka cuisineSoul food of southern ChinaHearty, robust

Mongolian FareRed foods (meat) and white foods (dairy)Have added some grainMutton, goat, beef, camelNumerous dairy foods from cow, sheep, goat or camels milkMilk added to teaButterSour milkMilk leatherFresh cheeseKumysFermented mares milkMillet is staple grainSpecial occasions include Lunar New Year and the Naadam festival a 3 day event featuring wrestling, archery, horse races

Tibetan Fare IsolatedFoundation of diet is zampaToasted flour from barley or buckwheatMixed with butter, sugar, milk creamUsed to make momosTibetan dumpling with meatYak or muttonDairy products common

Meal Composition and Cycle: Daily Patterns3 meals dailyNumerous snacksBreakfast is hot rice, hot steamed breadLunch 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 MealBalance yin and yangProper amounts of fan and caiFan Foods made from grainsSeparate bowl to each dinerPrimary item of the mealCaiCooked meats and vegetables Shared bowl in center of tableMakes the meal more tastyMeal must contain fan but not caiBanquet is the opposite

EtiquetteTraditional utensilsChopstickAll of porcelainTea cupRice bowlSoup spoonFew finger foodsAll courses served at once

EtiquetteWait until elders have started eatingDont reject foodPick up soup or rice bowlBones or other debris placed on small plate or next to rice bowlChopstick etiquetteDont lick themDont drop themDont stick them straight up in a bowlOffering to the deadDont lay them across the top of the rice bowl

EtiquetteDont make noise while eating anything except soupSlurp soupDo not grab food, eat quickly or pick your teethDo not put food back on the communal plate after tastingServe tea to others first and use both hands to serve teaDo not drink alcohol aloneWhen the toast is made drain your glassMay play games at the tableMultiple conversations typical Interruptions commonCompliment the host/hostess

Special OccasionsThe Chinese week does not include a day of restNumerous feasts to break up work daysFestival days do not fall on the same day each year due to lunar calendarCelebrations are yang and yang foods are featuredSpecial meals with guest are generally held at restaurants

Special OccasionsNew Years is most important festivalSettle old debtsHonor ancestors, parents, eldersKitchen: Gods lips are smeared with honey and his picture burnedCant use knives on this dayDeep-fried dumplings, steamed turnip, rice flour puddings

Special OccasionsNew Years foods are very symbolicFoods served that sound like lucky wordsFeast of Lanterns ends New Years seasonDragon dancingFirecrackers

Special OccasionsChing Ming Chief spring festivalGraves of the dead tendedFood symbolically fed to the deadDragon Boat FestivalCommemorates the drowning death of a famous poetBoat races and special dumplings of glutinous riceMoon FestivalHarvest festivalMoon is yin so typically female or family festivalLarge round moon cakes consumed

Therapeutic Uses of FoodHot foodsHigh in caloriesCooked in oilIrritating to the mouthRed, orange or yellow Ex:Most meats and eggsChile peppersTomatoesOnionsGingerAlcoholic beveragesCold foodsLow in caloriesRaw or boiled/steamedSoothingGreen or whiteEx:Many fruits and vegetablesPork, duck, crab, clamsNeutralStaples like rice and noodlesSoy sauceBlack tea

Therapeutic Uses of FoodHot foodsEaten in winterMenstruating womenFor fatiguePregnancyPostpartumColds, fluNauseaAnemiaAs we ageCold foodsConsumed in the summerConstipationDiarrheaHemorrhoidsCoughingSore throatFeverSkin problemsHypertension

Therapeutic Uses of FoodStrengthening foodsAffect bloodPromote wound healingCalled pu or boMost categorized as hotWeak blood (yin)Associated with pregnancy, postpartum, surgeryHot foods like protein-rich soups

Therapeutic Uses of FoodGinseng is best-known health-promoting foodRoot boiled and sediment powdered and used in teas and brothsCures cancer, rheumatism, diabetes, sexual dysfunction, aging

Therapeutic Uses of FoodTaboosAvoid soy sauce during pregnancy to prevent dark skinNo iron supplements as it may harden the babys bones and make birth difficultElders may avoid crab and persimmons together as these are both extremes and might be poisonous

Contemporary Food Habits in the US: Adaptation of Food HabitsChanges in eating habits correlate with increased length of stay in the USDinner the most traditional Chinese mealYounger persons more likely to accept American fare

Contemporary Food Habits in the US: Ingredients and Common FoodsMost regularly consume several Chinese foodsMeat and poultry intakes increase as do sugar and fat intakesTraditional fruits and vegetables may be replaced by readily available onesMilk, other dairy products well-acceptedDietary variety increases after immigration to US

Contemporary Food Habits in the US:Meal CompositionSkipping mealsIncreased snackingBreakfasts more variableLunch and dinner remain more traditionalContinue to celebrate major Chinese holidays with traditional foods

Nutritional Status: IntakeTraditional Chinese diet is low in fat, dairy and high in complex carbs and sodiumIn US diet becomes more Americanized with higher fatDiet continues to have more nutrientsMay be low in vitamins A and CMay avoid dairy as lactose intolerantAlternative sources are bean curd, fortified soy milk

Nutritional Status: IntakeLow rates of obesity and overweightLower rates of type 2 diabetesIf overweight, more likely to develop it thoughHypertension rates lowerIf risk factors are increased, rates increaseMay be treated by consumption of yin foods as it is a yang conditionChinese Americans who had a stroke had higher risk profiles

Nutritional Status: IntakeLow rates of CVDRates have increased in China as obesity and overweight have increasedCancer is leading cause of death in Chinese AmericansRisk for colorectal and breast increases with length of stayInadequate preventative screeningsLower intake of protective foods and higher intake of saturated fatsHigh rates of liver cancer in men and cervical cancer in women

Nutritional Status: IntakeInfant mortality is very lowLBW similar to that of whitesMay be inappropriate as Chinese infants are typically smaller than the US averageNew wt recommendations for maternal weight gain proposedBreastfeeding commonYoung children may be weaned to a diet low in dairy, fresh fruit and high in soft drinks

Nutritional Status: IntakeRecent Asian American immigrantsHigh rates of TBParasitic infectionHepatitis BLiver fluke infectionCertain inherited conditionsThalassemiaGlucose-6-phosphate dehydrogenase deficiencyTaiwanese more likely to experience problems due to overconsumption

CounselingAccept personal responsibility for their healthKeeping healthy is an obligation to family and societyBiomedical care underutilizedLanguage barriers Low incomeLong work hoursInconvenient locationsLack of health insurancePurchasing insurance may be seen as inviting deathMistrust of biomedicinePreventative checkups unfamiliar

CounselingHospitals may be seen as the place a person goes to dieHospitalization rates lower than for any other groupBlood tests are seen to diminish permanently the blood supplyFavor biomedical providers of Chinese heritage

CounselingPreferred communication style is formalUnrushed dialogue Focusing on time is offensiveDetail explanation of the origins and symptoms in understandable termsSimple treatmentPositive outlookDiscuss terminal illness first with familyConfidentiality is not widely practiced

CounselingQuiet, conversational approachAvoid interruptions, pauses may be normalAvoid yes or no questions as they may initially say yesAsking questions may be interpreted as disrespectSurprise or discomfort expressed by quickly and noisily sucking in airIndirect eye contact standard

CounselingDeference to authority shown by acceptance and submissionIn the hospital, are often silent and do not voice complaintsTraditional greeting is a nod or bow from waist, often without a smileSurnames first, then given namesWomen do not take husbands last nameTouching uncommon even handshakingGood posture expectedPersonal space further than in western cultures

CounselingChinese American women are modestTraditionally never touched by male health care providersSons receive more concern than daughtersWomen may not feel complaints warrant care

CounselingSelf-diagnosis and treatment at home firstBiomedical care is often soughtTCM may be used for more chronic conditionsMay also consult TCM and biomedical care togetherBeware as TCM product may counteract drug therapyQuestion about herbal treatmentsMultiple burns from moxibustion

CounselingExpect few tests and limited number of questions from practitionersRecommendations on diet, relaxation and sleep are desiredLong-term therapy intended to cure is preferred over short-term surgical or invasive treatmentsMost resolve to die at home

CounselingFew compliance problems notedLengthy or continuous medication may be a problemUsed to single-dose TCM remediesDifficulty to eliminate high-salt itemsChinese elders dislike western foodsIdentify traditional practicesFood combinations may be practiced without knowing why

JapanCapital is Tokyo127 million peopleGreatest resource is the sea

History of Japanese in the USSignificant Japanese immigration to the US after 1890Mainly young men with little education who eventually returnedSettled in Hawaii and the West CoastMost women came to the US as picture bridesDiscrimination was common and increased during WWII

History of Japanese in the USJapanese AmericansIssei are first generation immigrants born in JapanNisei are second generation Japanese Americans born in the USSansei are 3rd generationYonsei are 4th generation

Current Demographics and Socioeconomic StatusAfter the war many resettled on the West Coast Discriminatory laws repealed Successful postwar recovery of Japan reduced emigrationLess than 1 million in US, most in California or HawaiiHighly assimilated High education, income levelsLow poverty levels

Worldview: ReligionEarly Japanese immigrants joined Buddhist temple or a Christian ChurchToday more are Protestant than BuddhistShintoism is indigenous religion of JapanNo formal organization

Worldview: ReligionShinto beliefs are fundamental part of Japanese cultureBelieve humans are inherently goodEvil caused by pollution or filthinessPhysical as well as spiritualGoodness associated with purityRemoved through ritual purificationShinto deities called kami can represent any form of existence and are worshipedPrayers said for divine favors and blessings

Worldview: FamilyStrong Confucianism influenceSimilar to Chinese familiesRigid pattern of conductKoko: Children will care for their parents in their old age, among other thingsGaman: Virtuous to suppress emotionsHaji: Dont bring shame to family, communityEnyro: Be polite and show respect, deference, self-effacement, humility, hesitation

Worldview: FamilyClan or village affiliation traditionally weakerInterment of Japanese Americans during WWII brought changes in family structureAccelerated acculturation after the warMany today have dual career householdsMore than half marry outside ethnic group

Traditional Health Beliefs and PracticesShinto concepts of purity and pollutionHealth maintained through cleanliness Avoidance of contaminating substances such as blood, skin infections, corpsesBotanical remedies used in prevention and treatmentEspecially purgatives

Traditional Health Beliefs and PracticesConcept of harmony applied when Buddhism was introduced in 6th centuryRelationship to nature, family, societyImbalance results from poor diet, insufficient sleep, lack of exercise, conflict with family or societyDisrupts proper flow of energy within the bodyAcupuncture, moxibustion, massage accepted to restore energy flow along meridiansApplication of yin and yang is limited in Japan

Traditional Health Beliefs and PracticesComplex herbal meds of China brought to Japan as kanpoLimited availability so use confined to the elitePractitioners called kanpo-I and underwent rigorous trainingApproach each case individuallyDiagnosis an artEnjoying a resurgenceBiomedicine widely usedStress-induced illness of particular concernWork-related fatigue, symptoms of anxiety and depression have risen dramatically

Traditional Food Habits:Similar to the Chinese but differs in presentation and preparationEach item is to be seen, tasted and relishedVisual appeal very important and should reflect balanceMuch of their food is imported due to the mountainous terrain

Traditional Food Habits:Staples and Regional VariationsRiceA short-grain rice with more starch and is stickierSushi is rice mixed with rice vinegar and formed with fish and seafoods

Traditional Food Habits:Staples and Regional VariationsNoodleRiceWheatBuckwheat Kudzu

Traditional Food Habits:Staples and Regional VariationsSoybeansTofu (bean curd)Soy sauceTeriyaki sauceMade from soy sauce and mirin which is a sweet rice wineMiso (fermented bean paste)

Traditional Food Habits:Staples and Regional VariationsTeaGreen tea served with most mealsTea ceremony and accompanying food are a cultural ideal that reflects the search for harmonyMeal features six small coursesBalance taste of sweet, sour, pungent, bitter, saltySpecial blend of tea usedFrothy green drink

Traditional Food Habits:Staples and Regional VariationsProtein sourcesSoybean productsWide variety of fish and shellfishOften eaten rawKobe beefFed beer as an appetite stimulant and regularly massaged to relieve stress!Pork cutletsChicken

Traditional Food Habits:Staples and Regional VariationsSmall amounts of meat usedDo not eat many dairy foods

Traditional Food Habits:Staples and Regional VariationsFruits and vegetables most desirableEaten only in seasonSome herbs and greensSweet potatoes, taro, yamsDaikon radishShiitake mushroomsPickled vegetablesFresh fruit a traditional dessert

Traditional Food Habits:Staples and Regional VariationsSeaweed and algaeSeasoningWrappingIn salads and soupsFood classified by the way it is preparedSee table 11.4Pickled food served at every mealFood is usually cut into small piecesMay be modified for children

Meal Composition and Cycle:Daily Pattern3 meals daily plus a snackBreakfast and lunch are simple mealsSoup and one side plus riceDinner is soup and 3 sides plus ricePickles called tsukemonoPink pickled ginger garnishes many mealsSoy sauce usually availableWasabi Pungent green horseradish-like condiment

Meal Composition and Cycle:Daily PatternMeals are not served by coursesAll presented at the same time in individual portionsEach food in its own bowl or plateSoup served last with tsukemono Meal ended with fruit

Meal Composition and Cycle:Daily PatternBoxed meal called bento common10 items packaged attractivelySnacks SweetsRice crackersFruitGreen tea served after all mealsAfter western meals coffee or black tea is servedBeer or sake served with dinnerEating out is common

EtiquetteSimilar rules as the Chinese for chopsticksConsume soup directly from the bowlSlurp soup and noodlesSilently sip teaDont hold the rice bowl as close to the mouthEat at tables, kneeling or cross-leggedWomen tuck their legs to the sideRemove shoes first

EtiquetteDishes on left picked up with right handDishes on right are lifted with left handImpolite to serve beverages to oneselfFill your neighbors glass when it is half emptyGuests entertained at restaurantsMenu chosen in advanceFrequent toastsGames and karaoke are commonGuests are expected to participate

Special OccasionsNumerous festivalsHarvesting of specific cropsLocal Shinto shrinesBuddhist templesNew Years is the most important celebrationShare many holiday traditions with the ChineseMochi is a rice cake special to New Years

Special OccasionsObon FestivalBuddhist festival Appreciate the livingHonor the deadComfort the bereavedCertain birthdaysMan at 42, woman at 33Special festivities to prevent misfortune61 marks beginning of second childhoodRed cap77 they put on a long, red overcoat88 is most important of all and they can wear both the hat and coat

Therapeutic Uses of FoodFood pairs may be harmfulEels and pickled plumsWatermelon and crabCherries and milkFood pairs may be beneficialPickled plums and hot tea to prevent constipationPickled plums and rice porridge easily digested and well tolerated during recovery from illness

Contemporary Food Habits in the US: Adaptations of Food HabitsWesternized diet continued with each subsequent generationMay consume more rice and soy sauce than non-AsiansTraditional foods still prepared for special occasions

Contemporary Food Habits in the US: Adaptations of Food HabitsWesternized diet more common in JapanBread and butter becoming staplesMore meat, milk, eggs consumed

Nutritional Status: IntakeTraditional diet high in carbs and very low in fat and cholesterolHigher risk of colon cancer in mainland Japanese Americans due to dietJapanese Americans have more rapid atherosclerosis progression than JapaneseLess fiber, more fatBreast and rectum cancers now more common

Nutritional Status: IntakeJapanese American men have high rates of type 2 diabetesRates of obesity and overweight are lowInsulin resistance and increased intra-abdominal fat are higher Predictive of type 2 diabetes in Japanese Americans

Nutritional Status: IntakeJapanese American elders may have low intake of calciumHigh incidence of lactose intolerancePrevalence of osteoporosis may be higher than among whitesCalorie consumption and meat intake decline with age in Japanese Americans

Nutritional Status: IntakeConditions linked to high-sodium diets are extremely high in JapanHypertension, stroke, stomach cancerRates are dropping with westernized dietInfant mortality rates lowUS-born mothers more likely to have LBW babies than foreign-born

Nutritional Status: IntakeAmericans of Japanese heritage have the most permissive attitude towards drinking, particularly among womenJapanese American men have high rates of heavy drinking, fewest abstainersWomen show similar trendsAlcohol consumption may be more than previously assumed

CounselingPlace family before the individualPreserve harmony with societyRespect and care for eldersIllness a symptom of an unbalanced lifeImpediment to fulfilling obligationsMay all have positive impact on health

CounselingFormality and politeness are essentialDo not address by first namesEmotional displays are avoidedNonconfrontational and may be reluctant to say noWaving hand in front of face with palm outward means Im unsure or I dont know

CounselingConversational style is indirectFrequent pauses up to several minutes are commonRemain silent during pausesDirect eye contact is disrespectfulSmiling can indicate pleasure or displeasureSucking in air through the teeth can be a sign of discomfort or anger

CounselingA non-touching cultureStand or sit further apart than AmericansHigh-contextSmall gestures may have meaningLight handshake probably okayTraditional greeting is a bow from the waist with palms against thighs

CounselingHealth care provider seen as an authority figure who will meet their needs without assistanceExpect to be directed in their health careDont criticize clients health habitsConcrete, structured approaches based on an unhurried interview best

Korea Democratic Peoples Republic of Korea (North Korea)Pyongyang, capitalCommunistThe Republic of Korea(South Korea)Seoul, capitalDemocracy

History of Koreans in the USFew immigrated to the US prior to 19001903 1905: Christian missionaries recruited 7000 Koreans to work in Hawaiian sugarcane fields1905 1924: picture brides and oppressed political activists only1924: Japanese Exclusion Act included Koreans no immigration1959 1971: wives and children of US soldiers who fought in the Korean warAfter 1965: numbers increased, including many college-educated professionals and their families

Current DemographicsOver half have arrived since 1980Many North Koreans fled to South Korea, then to the USLarge numbers in CaliforniaHave had some difficulty in adjustment

Socioeconomic StatusMany temporarily or permanently underemployedLanguage difficulties Licensing restrictions Family businesses commonIncomes slightly below US averagePoverty rates slightly higher than US averageConflicts within the Korean immigrant community relate to social standing and prior social status

Worldview: ReligionBuddhism and Confucianism are the majority religionsShamanismBelief in natural and ancestral spiritsChundo KyoNational religionMixture of Confucian, Taoist and BuddhistIn North Korea all religious beliefs are suppressedMarxism and self-reliance are okay

Worldview: ReligionEarly Korean immigrants were Christians escaping discriminationMany recent immigrants are believed to be ChristianSome continue ancestor worship along with Christian practicesSmall numbers of Buddhists

Worldview: FamilyConfucianism influenced family structureFamily highly valuedGenerational ties, parents and elders especially importantMales are head of householdBirth sequenceespecially older male childrenWomen take care of home and care for childrenParenting is authoritative and children behaveMajor birthdays at 1 and 605 cycles of the 12-year cycle of life and have attained old age

Worldview: FamilyChanges occur after immigrationMarriage bond becomes more important than that to parentsFew elders live with eldest sons familyOld age may be seen as a negative experienceMale dominance diminishesDivorce rates are highIntergenerational conflict increases with length of time in the US

Traditional Health Beliefs and PracticesRelate health to HappinessAbility to live life fullyFunction without impairmentNot being a burden to their childrenGood appetiteDigestion and circulation prominent in health maintenanceEnergy is absorbed into the body through the stomach

Traditional Health Beliefs and PracticesYin/yang principles appliedCold, damp, heat or wind can enter body through pores and weaken yangSymptoms include indigestion, arthritis, asthmaPhysical exhaustion, eating too much or too little food, spiritual intervention can result in disease

Traditional Health Beliefs and PracticesMay attribute diabetes to eating too much rich food and getting too little exerciseBlood conditions that interfere with distribution of vital energyLack of bloodDrying or hardening of the bloodTypical in old age causing indigestion, achesBad bloodFrom a sudden frightChronic pain

Traditional Health Beliefs and PracticesKorean-specific folk illnessesSomatic complaints that are expression of psychological distressExcessive emotions believed to cause certain physical conditionsTraditional cures include use of a shaman or spiritual mediatorSacred therapeutic rituals may be used

Traditional Health Beliefs and PracticesTraditional approach to natural cures called HanyakHealer is called a hanuiMedical historyClinical observationsQuality of voiceTakes pulse24 pulse conditions including floating, sunken, smooth, vacant, accelerated

Traditional Health Beliefs and PracticesClassified as to plant, animal or mineralMixed to balance yin, yang, and kiAccupuncture, moxibustion, cupping, sweating also usedMay use some biomed procedures like blood pressure, temperature, pill form medsMany traditional practices now home remediesMay believe persons fate is determined at the moment of birthChristian Koreans may believe strongly in faith healing and in fate

Traditional Food Habits: Ingredients and Common FoodsInfluenced by Chinese and JapaneseHearty and highly seasonedSweet, sour, bitter, hot and salty tastes all combinedWhite, red, black, green, yellowAll used in preparation and presentation

Traditional Food Habits: Ingredients and Common Foods - StaplesBased on grains flavored with spicy vegetable and meat, poultry or fish side dishesRice is the foundationMust be cooked correctlyShort grain preferredRegular and glutinous (sticky)Millet and barley may be used as extendersNoodles from wheat, buckwheat, mung beans, sweet potatoes and kudzu

Traditional Food Habits: Ingredients and Common Foods - StaplesVegetables served at every mealBok choy, NapaEuropean cabbageLong white radishEggplant CucumbersPerilla (a green)Bean sproutsSweet potatoesWinter melonAdded to soups and braised dishesPickled & fermented, served at every mealKimchi

Traditional Food Habits: Ingredients and Common Foods - StaplesFruits mostly eaten freshAsian pearsFish and shellfish populationDried or salted in inland areasBeef and beef variety cutsCubes, thin slices, ribs of marinated beef BBQs at tableBulgogiFire potSimilar to Mongolian hot potChicken and poultry not really popular

Traditional Food Habits: Ingredients and Common Foods - StaplesSoybean products commonBean curd Mung beans, adzuki beans, other legumes popularPine nuts, chestnuts, peanuts, sesameGarlic, ginger root, black pepper, chile peppers, scallions, toasted sesame, ginseng

Traditional Food Habits: Ingredients and Common Foods - StaplesSoup or thin barley water used as a beverageHerbal teasGinseng tea with cinnamonSpice teaRice teaWineMade from rice and other grainsBeerMilk and other dairy products not generally used or consumed

Traditional Food Habits: Meal Composition and Cycle Daily Pattern3 small meals, frequent snackingBreakfast traditionally the main mealToday more likely lightSoup with rice topped with eggs, meat or fishLunch typically noodles with broth, garnished with shellfish, meat or vegetablesDinner similar to breakfast but with steamed riceMay now be the largest meal of the daySnacks from street vendorsGrilled and steamed tidbits of all typesSweets and dried fruits

Traditional Food Habits: Meal Composition and Cycle Daily PatternRice main dishEverything else is an accompanimentPanchanIndividual bowls of rice and soup servedPanchan on trays in center

EtiquetteChopsticks and soup spoons are the only eating utensils used Traditionally seating was around a low tableElders served first, children served lastFill the soy sauce dish of your neighborFood passed with right handCommunal beverage may be passed for all to share

Special OccasionsHistorically Korean cooking divided into everyday fare and cuisine for royaltyTraditions of palace cooking and food presentation are used for special occasionsMore dishes are served, plus wine and dessertSpecial beveragesThick drink of persimmons or dates, nuts, spicesBeverage from molasses and magnolia with flowers

Special OccasionsNew Years Traditional dress worn and elders honoredFirst full moon light firecrackers to frighten away evil spiritsShampoo DayBathe in streams to ward off feversThanksgivingFall harvest festivalChilds first birthday

Therapeutic Uses of FoodMany follow um and yang classificationBelieved to be similar to other AsiansUm (cold) foods Mung beans, winter melon, cucumber, other vegetables and fruitsYang (hot) foodsMeats, chile peppers, garlic, gingerPreparing healthy, tasty foods is an important way Korean women show affection for their family and friends

Therapeutic Uses of FoodGood appetite is a sign of good healthHealth-promoting foodsBean paste soupBeef turnip soupRice with grains and beansBroiled seaweedKimchiGinseng teaStamina and alleviates fatigueMore than half report using ginseng

Therapeutic Uses of FoodGinger teaHot citrus beverageBean sprout soupLemon with honey in hot waterRestorative herbal medicines, vitamin supplements, meat and bone marrow soupPregnant women use strengthening foodsTaboos involved - like causes likeBlemished fruit = baby with skin problems

Contemporary Food Habits in the US: Adaptations of Food HabitsTraditional food habits continue after immigration to the USRice, kimchi, beef, beef variety cuts, fish, sesame oil used regularlyAdd oranges, low-fat milk, bagels, tomatoes, breadAcceptance of American foods widespreadTraditional diet in Korea has changedBecome more westernized

Contemporary Food Habits in the US: Meal Composition and CycleSimilar to the USAmerican foods most common at breakfast and lunchTraditional Korean foods at dinnerHot barley water still preferred beverageContinue to observe traditional Korean holidays

Nutritional Status: IntakeMaintain low-fat diet high in vitamins A, C, beta-carotene, niacin, fiber, sodiumThose with more Americanized diet will have higher calories and intake of calciumMortality rate lower than for general populationInfant mortality rates somewhat higherLeading cause of death is stomach cancerAflatoxins may be found in soy sauceHepatitis B which causes liver cancer is high

Nutritional Status: IntakeObesity rates lower in foreign-born than in Korean Americans, but still lower than USMen more likely than womenAcculturation increases risk for obesityDo not exercise regularlyDevelop type 2 diabetes at high ratesAt risk for hypertensionFamily history, being maleMay be noncompliant with treatmentLow rates of CVDHigher alcohol consumption rates than some Asian groups

CounselingLanguage may be a barrierInterpreters often crucial to effective communicationLower rates of health insurance coverageMay be ashamed of needing helpFear being a burden to other family membersMay avoid screening examsStresses of acculturation can be severe

CounselingQuiet, nonassertive approach to conversationEmotional expression over pleasant topics may be animatedIn confrontation, emotional displays avoidedNo loud talking or laughingMeasured, indirect approach to topicsHesitate to say no or disagreeDirect eye contact expectedFew hand gestures usedTouching uncommonRise when an elder enters the room

CounselingMay administer home remedies, consult shamans, or hanuiSome concern regarding safety of some traditional productsMay have to make a choice between traditional therapy and biomedicineReligious affiliation may have a significant impact on health and nutrition care

*Pagoda in rural SW China*Graves are often found in the fields where the ancestors can bless the crops. Offerings of food, incense, and other things are left on specific dates.*Taoist temple in Hong Kong with woman receiving her fortune, which will be then read by a fortune-teller.**Catholic Church in SW China*Foot massage is believed to prolong life. There are actually foot massage parlors throughout China.*Dumplings shaped like animals in Xian. Think these are chickens. *Seafood restaurant/market in Hong Kong. **Bamboo steamers*Carp*Dim Sum in Hong Kong*Just some food.**Tibetan market

*Chinese Breakfast*Chinese dinner. Note the steamed bread in front.*Chinese place setting.*Dragon dance*Not quite so traditional Chinese Breakfast. *Healthy Chinese baby.*sushi*Miso soup*Picking tea leaves in Guilin, China.Picking tea leaves in Guilin, China*Seahorses and scorpions on a stick*Bulgogi*Ginger