Diversities and Complexities in the Health of Asian Women


  • The author reports no conflict of interest or relevant financial relationships.

Approximately 15 million Asians, including three million midlife women, reside in the United States (U.S. Census Bureau, 2011). From 2000 to 2010, the Asian American population grew faster than any other major racial/ethnic group by 43% (U.S. Census Bureau, 2011). Despite the rapidly increasing number of Asians in the United States, very little is known about their health. Indeed, very few studies have been conducted among this specific population because they have been regarded as a healthy immigrant group whose morbidity and mortality rates of acute and chronic diseases are lower than those of any other racial/ethnic groups in the United States.

In reality, however, this is not true for most Asians in the United States, where there are more than 71 subethnic Asian groups (Ito, Chung, & Kagawa-Singer, 1997). Subethnic diversities have been frequently ignored in evaluating the health of Asians as a group, and some subethnic groups have health disparities. For example, breast cancer is the leading cancer in Asian Americans, yet the incidence rates are different by subethnicity (55 per 100,000 Chinese women, 73 per 100,000 Filipino women, 82 per 100,000 Japanese women, and 29 per 100,000 Korean women) (American Cancer Society, 2012; National Cancer Institute, 2012; U.S. Department of Health and Human Services [USDHHS], 2012). Furthermore, for some subethnic groups like Filipino women, breast cancer is the leading cause of death (Chlebowski et al., 2005; Chen, 2005). In addition, Asian American women have higher relative risks and lower 5-year survival rates with increasing age at diagnosis, grade, and stage of cancer compared with White women in the United States (American Cancer Society, 2012; National Cancer Institute, 2012; USDHHS, 2012). However, these diversities in Asian women's health have rarely been incorporated in health care for Asian American women, and we tend to stereotype Asian American women and their health issues.

This In Focus series on the health of Asian women highlights diversity, and the authors present four studies from four different countries: the United States, South Korea, Taiwan, and Japan. The authors of these articles are members of the Asian Women's Health Research Network (ASIA-WH) that currently includes members from the four aforementioned countries. In each article, they describe their current research and make suggestions for future research and clinical care for each specific population of Asian women.

In the first article, Chang et al. report the effects of body mass index (BMI) on menopausal symptoms among Asian American midlife women by using two different classifications. They concluded that the BMI classification for public health action among Asian populations worked better for Asian American midlife women than the international BMI classification. Therefore, they suggested that health care providers consider using the BMI classification for public health action rather than the international BMI classification in development of interventions to prevent and alleviate menopausal symptoms in Asian American midlife women.

In the second article, Yang et al. report research findings on the correlates of self-care behaviors among low-income Korean elderly women with hypertension. They found that after controlling possible confounding variables, hypertension control self-efficacy was the most significant influential factor of hypertension self-care behaviors among low-income elderly women with hypertension in South Korea. They propose that Koreans’ cultural belief that “medication is the answer to the disease” could be a reason for this finding.

In the third article, Matsuzaki et al. present research findings related to testing the reliability and validity of a new instrument, the Pregnancy Physical Activity Questionnaire (PPAQ), among women who read and speak Japanese in the Tokyo area. The instrument was specifically developed for Japanese pregnant women, and the authors adopted it among Japanese pregnant women in the Tokyo area by testing its psychometric properties. They asserted the importance of culturally specific instrument development and use in health care for pregnant Asian women.

In the final article, Tsai et al. explore the relationship between health literacy and health promoting behavior among multiethnic groups of women in Taiwan. Although emphasizing ethnic diversities among women in Taiwan, the authors reported that the majority of the participants with an inadequate level of health literacy were immigrants from Vietnam and those who spoke a language other than the dominant ones in Taiwan. They concluded that low health literacy could be more prevalent among underprivileged women such as ethnic minority immigrant women who use a second language, which has implications for health care providers in the United States who take care of Asian immigrant women.

In summary, the authors of the articles in this series provide significant insider views and insights on the health of Asian women from four different countries. They highlight culturally unique aspects of Asian women's health and provide implications for women's health in the United States. This In Focus series should challenge stereotypes related to Asian American women's health and raise a consciousness on cultural diversity and complexity within this group. Furthermore, these articles should help nurses understand the multifaceted nature of women's health, especially Asian women's health, and provide directions for culturally competent care for this specific population.


  • Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, is the Marjorie O. Rendell Endowed Professor in the School of Nursing, University of Pennsylvania, Philadelphia, PA.