East Asians

Chapter 11
Introduction
East Asia has 1/3 the
worlds land mass
2/3 of the worlds
population
Includes parts of
Russia, Central Asia,
and the Middle East
China, Taiwan, Japan,
North and South
Korea and the
Mongolian Peoples
Republic
Chinese
4000-year-old
civilization
Varied geography
Population exceeds
1.2 billion people
Numerous ethnic and
racial groups
Diverse language with
many dialects
History of Chinese in the US
First surge was in the 1850s with the
Gold Rush in California
Also immigrated to Hawaii
Many came from what is known as
the Canton region in China
Today many large cities have
Chinatowns
Current Demographics and
Socioeconomic Status
Chinese began coming to the US
after 1943 and again after 1992
Represent about of all Asians in
the US
Chinese numbers may or may not
include Taiwanese
Employed in professional occupations
Especially the sciences
Current Demographics and
Socioeconomic Status
Four Types of Chinese American households
1. Men born early in the 20
th
century
who came here planning to return
and were stranded when politics
changed
2. Those who were able to bring their
wives to the US
3. New immigrant families
4. Acculturated suburban families
Current Demographics and
Socioeconomic Status
Value education
Almost half with college and graduate degrees
Well-compensated in professional
employment
Successful transition to the US
Many who immigrated early were not well
educated but have done well
Many Taiwanese immigrated since
1980
Transnational careers between two nations
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
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
1. Children obey their parents and parents take
care of their children
2. Tolerance in the eldest brother and humility in
the younger
3. Proper behavior by the husband and submission
by the wife
4. Respect for ones elders and compassion in
adults
5. 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 natures 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

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
Five elements
that may become
unbalanced
1. Fire
2. Earth
3. Metal
4. Water
5. Wood


Correspond
with the organs
1. Heart
2. Spleen
3. Lungs
4. Kidneys
5. 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 is the idea that 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
Treatment restores 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 of diet
Less grain consumption now
Less foods grown for home
consumption
Increase in eating away
from home
Traditional Food Habits: Staples
Rice
Wheat
Noodles
Spring rolls
Dumplings
Buckwheat
Wheat
Threshing wheat
in northern China
Traditional Food Habits:
Protein
Pork
Mutton
Chicken
Duck
Fish, seafood
Eggs
1000-year-old eggs
Snakes, frogs, turtles
Insects
Soybeans
Poor mans cow
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)
Have added some grain
Mutton, goat, beef, camel
Numerous dairy foods from cow, sheep, goat or
camels milk
Milk added to tea
Butter
Sour milk
Milk leather
Fresh cheese
Kumys
Fermented mares 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
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
Dont reject food
Pick up soup or rice bowl
Bones or other debris placed on small
plate or next to rice bowl
Chopstick etiquette
Dont lick them
Dont drop them
Dont stick them straight up in a bowl
Offering to the dead
Dont lay them across the top of the rice bowl
Etiquette
Dont 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
The 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 Years is most important
festival
Settle old debts
Honor ancestors, parents, elders
Kitchen: Gods lips are smeared with
honey and his picture burned
Cant use knives on this day
Deep-fried dumplings, steamed
turnip, rice flour puddings
Special Occasions
New Years foods
are very symbolic
Foods served that
sound like lucky
words
Feast of Lanterns
ends New Years
season
Dragon dancing
Firecrackers
Special Occasions
Ching Ming
Chief spring festival
Graves of the dead tended
Food symbolically fed to the dead
Dragon Boat Festival
Commemorates the 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 health-promoting
food
Root boiled and sediment powdered and
used in teas and broths
Cures cancer, rheumatism, diabetes,
sexual dysfunction, aging
Therapeutic Uses of Food
Taboos
Avoid soy sauce during pregnancy to prevent
dark skin
No iron supplements as it may harden the
babys bones and make birth difficult
Elders may avoid crab and persimmons
together as these are both extremes and
might be poisonous
Contemporary Food Habits in the US:
Adaptation of Food Habits
Changes in eating
habits correlate with
increased length of
stay in the US
Dinner the most
traditional Chinese
meal
Younger persons
more likely to accept
American fare
Contemporary Food Habits in the US:
Ingredients and Common Foods
Most regularly consume several
Chinese foods
Meat and poultry intakes increase as
do sugar and fat intakes
Traditional fruits and vegetables may
be replaced by readily available ones
Milk, other dairy products well-
accepted
Dietary variety increases after
immigration to US
Contemporary Food Habits in the US:
Meal Composition
Skipping meals
Increased snacking
Breakfasts more
variable
Lunch and dinner
remain more
traditional
Continue to
celebrate major
Chinese holidays
with traditional foods
Nutritional Status: Intake
Traditional Chinese diet is low in fat, dairy
and high in complex carbs and sodium
In US diet becomes more Americanized
with higher fat
Diet continues to have more nutrients
May be low in vitamins A and C
May avoid dairy as lactose intolerant
Alternative sources are bean curd, fortified soy milk
Nutritional Status: Intake
Low rates of obesity and overweight
Lower rates of type 2 diabetes
If overweight, more likely to develop it though
Hypertension rates lower
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
New wt recommendations
for maternal weight gain
proposed
Breastfeeding common
Young children may be
weaned to a diet low in
dairy, fresh fruit and high
in soft drinks
Nutritional Status: Intake
Recent Asian American immigrants
High rates of TB
Parasitic infection
Hepatitis B
Liver fluke infection
Certain inherited conditions
Thalassemia
Glucose-6-phosphate dehydrogenase deficiency
Taiwanese more likely to experience
problems due to overconsumption
Counseling
Accept personal responsibility for their health
Keeping healthy is an obligation to family and
society
Biomedical care underutilized
Language barriers
Low income
Long work hours
Inconvenient locations
Lack of health insurance
Purchasing insurance may be seen as inviting death
Mistrust of biomedicine
Preventative checkups unfamiliar
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
Counseling
Preferred communication style is formal
Unrushed dialogue
Focusing on time is offensive
Detail explanation of the origins and
symptoms in understandable terms
Simple treatment
Positive outlook
Discuss terminal illness first with family
Confidentiality is not widely practiced
Counseling
Quiet, 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 husbands 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
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
Counseling
Few compliance problems noted
Lengthy or continuous medication
may be a problem
Used to single-dose TCM remedies
Difficulty to eliminate high-salt items
Chinese elders dislike western foods
Identify traditional practices
Food combinations may be practiced
without knowing why
Japan
Capital is Tokyo
127 million people
Greatest resource is
the sea
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 and the West Coast
Most women came to the US as
picture brides
Discrimination was common and
increased during WWII
History of Japanese in the US
Japanese Americans
Issei are first generation immigrants born in
Japan
Nisei are second generation Japanese
Americans born in the US
Sansei are 3
rd
generation
Yonsei are 4
th
generation
Current Demographics and
Socioeconomic Status
After the war many resettled on the West
Coast
Discriminatory laws repealed
Successful postwar recovery of Japan
reduced emigration
Less than 1 million in US, most in
California or Hawaii
Highly assimilated
High education, income levels
Low poverty levels
Worldview: Religion
Early Japanese
immigrants joined
Buddhist temple or a
Christian Church
Today more are
Protestant than
Buddhist
Shintoism is indigenous
religion of Japan
No formal organization
Worldview: Religion
Shinto beliefs are fundamental part of
Japanese culture
Believe 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
1. Koko: Children will care for their parents in
their old age, among other things
2. Gaman: Virtuous to suppress emotions
3. Haji: Dont bring shame to family,
community
4. Enyro: Be polite and show respect,
deference, self-effacement, humility,
hesitation
Worldview: Family
Clan or village affiliation traditionally
weaker
Interment of Japanese Americans
during WWII brought changes in
family structure
Accelerated acculturation after the war
Many today have dual career
households
More than half marry outside ethnic
group
Traditional Health Beliefs and Practices
Shinto concepts of purity and
pollution
Health maintained through cleanliness
Avoidance of contaminating
substances such as 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 6
th
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 and underwent
rigorous training
Approach each case individually
Diagnosis an art
Enjoying a resurgence
Biomedicine widely used
Stress-induced illness of particular concern
Work-related fatigue, symptoms of anxiety and depression
have risen dramatically
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
A short-grain rice with
more starch and is
stickier
Sushi is rice mixed with
rice vinegar and formed
with fish and seafoods
Traditional Food Habits:
Staples and Regional Variations
Noodle
Rice
Wheat
Buckwheat
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:
Staples and Regional Variations
Tea
Green tea served with
most meals
Tea ceremony and
accompanying food are 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
and shellfish
Often eaten raw
Kobe beef
Fed beer as an
appetite
stimulant and
regularly
massaged to
relieve stress!
Pork cutlets
Chicken
Traditional Food Habits:
Staples and Regional Variations
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
Some herbs and greens
Sweet potatoes, taro, yams
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
Meal Composition and 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 and Cycle:
Daily Pattern
Meals are not
served by courses
All presented at the
same time in individual
portions
Each food in its own
bowl or plate
Soup served last with
tsukemono
Meal ended with fruit
Meal Composition and 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
Dont hold the rice bowl as close to the
mouth
Eat at tables, 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 neighbors 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
New Years is the most important
celebration
Share many holiday traditions with
the Chinese
Mochi is a rice cake special to New
Years
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 is most important of all and they can wear both the
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
Contemporary Food Habits in the US:
Adaptations of Food Habits
Westernized diet continued with each
subsequent generation
May consume more rice and soy sauce
than non-Asians
Traditional foods still prepared for special
occasions
Contemporary Food Habits in the US:
Adaptations of Food Habits
Westernized diet more common in
Japan
Bread and butter becoming staples
More meat, milk, eggs consumed
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 rectum 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
intra-abdominal fat are higher
Predictive of type 2 diabetes in Japanese
Americans

Nutritional Status: Intake
Japanese American elders may have
low intake of calcium
High incidence of lactose intolerance
Prevalence of osteoporosis may be
higher than among whites
Calorie consumption and meat intake
decline 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
Place family before the individual
Preserve harmony with society
Respect and care for elders
Illness a symptom of an unbalanced
life
Impediment to fulfilling obligations
May all have positive impact on
health
Counseling
Formality and politeness are
essential
Do not address by first names
Emotional displays are avoided
Nonconfrontational and may be
reluctant to say no
Waving hand in front of face with
palm outward means Im unsure
or I dont know
Counseling
Conversational style is indirect
Frequent pauses up to several
minutes are common
Remain silent during pauses
Direct eye contact is disrespectful
Smiling can indicate pleasure or
displeasure
Sucking in air through the teeth can
be a sign of discomfort or anger
Counseling
A non-touching culture
Stand or sit further apart than
Americans
High-context
Small gestures may have meaning
Light handshake probably okay
Traditional greeting is a bow from
the waist with palms against thighs
Counseling
Health care provider seen as an
authority figure who will meet their
needs without assistance
Expect to be directed in their health
care
Dont criticize clients health habits
Concrete, structured approaches
based on an unhurried interview best
Korea
Democratic Peoples Republic of Korea
(North Korea)
Pyongyang, capital
Communist
The Republic of Korea
(South Korea)
Seoul, capital
Democracy
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
After 1965: numbers increased, including
many college-educated professionals and
their families
Current Demographics
Over half have arrived since 1980
Many North Koreans fled to South
Korea, then to the US
Large numbers in California
Have had some difficulty in
adjustment
Socioeconomic Status
Many temporarily or permanently
underemployed
Language difficulties
Licensing restrictions
Family businesses common
Incomes slightly below US average
Poverty rates slightly higher than US
average
Conflicts within the Korean immigrant
community relate to social standing and
prior social status
Worldview: Religion
Buddhism and Confucianism are the
majority religions
Shamanism
Belief in natural and ancestral spirits
Chundo Kyo
National religion
Mixture of Confucian, Taoist and Buddhist
In North Korea all religious beliefs are
suppressed
Marxism and self-reliance are okay
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
especially 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 of the 12-year cycle of life and have
attained old age

Worldview: Family
Changes occur after immigration
Marriage bond becomes more important
than that to parents
Few elders live with eldest sons 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 being 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
Yin/yang principles applied
Cold, damp, heat or wind can enter
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
Traditional cures include 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 to plant, animal or mineral
Mixed to balance yin, yang, and ki
Accupuncture, moxibustion, cupping,
sweating also used
May use some biomed procedures like
blood pressure, temperature, pill form
meds
Many traditional practices now home
remedies
May believe persons fate is determined at
the moment of birth
Christian Koreans may believe strongly in faith healing
and in 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 served at
every meal
Bok choy, Napa
European cabbage
Long white radish
Eggplant
Cucumbers
Perilla (a green)
Bean sprouts
Sweet potatoes
Winter melon
Added to soups and
braised dishes
Pickled & fermented,
served at every meal
Kimchi
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 BBQs at
table
Bulgogi
Fire pot
Similar to Mongolian hot pot
Chicken and poultry not
really popular
Traditional Food Habits: Ingredients
and Common Foods - Staples
Soybean products
common
Bean curd
Mung beans, adzuki
beans, other legumes
popular
Pine nuts, chestnuts,
peanuts, sesame
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
Panchan
Individual bowls of
rice and soup
served
Panchan on trays
in center
Etiquette
Chopsticks and soup
spoons are the only
eating utensils used
Traditionally seating
was around a low
table
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 Years
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
Childs 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 still preferred
beverage
Continue to observe traditional
Korean holidays
Nutritional Status: Intake
Maintain low-fat diet high in vitamins A, C,
beta-carotene, niacin, fiber, sodium
Those with more Americanized diet will
have higher calories and intake of calcium
Mortality rate lower than for general
population
Infant mortality rates somewhat higher
Leading cause of death is stomach cancer
Aflatoxins may be found 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 rates of CVD
Higher alcohol consumption rates than
some Asian groups
Counseling
Language may be a barrier
Interpreters often crucial to effective
communication
Lower rates of health insurance
coverage
May be ashamed of needing help
Fear being a burden to other family
members
May avoid screening exams
Stresses of acculturation can be
severe
Counseling
Quiet, nonassertive approach to
conversation
Emotional expression over pleasant topics
may be animated
In confrontation, emotional displays
avoided
No loud talking or laughing
Measured, indirect approach to topics
Hesitate to say no or disagree
Direct eye contact expected
Few hand gestures used
Touching uncommon
Rise when an elder enters the room
Counseling
May administer home remedies,
consult shamans, or hanui
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