Applied Nursing Research 38 (2017) 70–75

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Applied Nursing Research

journal homepage: www.elsevier.com/locate/apnr

Original article

Acculturative stress in Korean Americans MARK

⁎
Cha-Nam Shin, PhD, RN , Shannon Ruff Dirksen, PhD, RN, FAAN, Bin Suh, BSN
College of Nursing and Health Innovation, Arizona State University, United States

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Acculturative stress is known to contribute to chronic diseases among many immigrants and yet this
Acculturative stress association in Korean Americans remains unclear.
Immigrants Aim: The study purpose was to examine the level of acculturative stress in Korean Americans and to determine if
Korean Americans correlations existed with personal and physiological factors.
Body mass index
Methods: An exploratory, cross-sectional, descriptive study was conducted in a sample of 107 Korean American
Blood pressure
adults. Data on acculturative stress and personal factors were collected using a survey questionnaire in addition
to a direct measure of physiological factors (i.e., body mass index and blood pressure).
Results: All 107 participants were first-generation Koreans. Most participants were women (66.4%), with a mean
age of 53.9 ± 10.7, married (88.8%), and with a college education (84.2%). Acculturative stress was associated
with a number of personal factors (i.e., arrival age, years of U.S education, years of U.S. residency, English
proficiency), and the personal factors of gender, age, employment status, and years of U.S. residency were
associated with the physiological factors. No statistically significant associations were found between ac-
culturative stress and physiological factors.
Conclusions: The mean acculturative stress score in this study was higher than findings from prior studies of
Korean immigrants in the United States or Canada, with the rates of obesity and hypertension higher than prior
reports of Korean Americans or Koreans residing in Korea. Future study is necessary with a larger sample from a
variety of different geographic areas of the United States to examine further the impact of acculturative stress on
physiological factors during the process of acculturation.

1. Introduction
Acculturation is a process of cultural change and adaptation that
occurs when foreign-born individuals interact with people from a new
country (Lopez-Class, Castro, & Ramirez, 2011; Schwartz, Unger,
Zamboanga, & Szapocznik, 2010). During the process of acculturation
to a new environment, some immigrants may have a successful ex-
perience through which they modify their life to adjust to the host
culture, while others may face ongoing challenges and difficulties that
can result in continued stress (Al-Omari & Pallikkathayil, 2008; Berry,
2008; D'Alonzo, Johnson, & Fanfan, 2012). The stress associated with
acculturation is referred as acculturative stress which can adversely
affect an individuals' health, including the development of cardiovas-
cular disease (D'Alonzo et al., 2012; DeVylder et al., 2013; Lee,
Suchday, & Wylie-Rosett, 2015). An understanding of the factors that
contribute to acculturative stress is crucial in helping to mitigate and
lessen health problems that may be associated with this type of stress.
As of 2014, more than 42.4 million foreign-born individuals (13.3%
of U.S. population) reside in the United States (U.S. Census Bureau,
2016). Immigrants are the fastest growing segment of the U.S. popu-
lation with a 350% increase in number from a total of 9.6 million in
1970 to 42.4 million in 2014 (Camarota & Zeigler, 2015). Despite a
relatively short history of immigration to the United States by Koreans,
their numbers have rapidly grown by 39% from 1.2 million in 2000 to
1.7 million in 2010 (Pew Research Center, 2013; U.S. Census Bureau,
2014). In 2013, it was found that 1.8 million Koreans (U.S. born and
foreign born) resided in the United States (U.S. Census Bureau, 2016).
Among them, foreign-born (first generation) Koreans accounted for
nearly four out of five Korean Americans (Pew Research Center, 2013).
This first generation Korean residing in the United States is pre-
dominantly a monolingual speaker in Korean with limited English
proficiency.
The degree of acculturative stress that is experienced by an im-
migrant would seem to vary depending on the degree of similarity or
dissimilarity between the heritage culture and new culture (Rudmin,
2003; Schwartz et al., 2010). For example, White, English-speaking
individuals (e.g., Canadian or Australian) may experience less stress
immigrating to the United States due to similarities in language spoken

⁎
Corresponding author at: 500 N. 3rd Street, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, United States.
E-mail addresses: Cha-Nam.Shin@asu.edu (C.-N. Shin), Shannon.Dirksen@asu.edu (S.R. Dirksen).

http://dx.doi.org/10.1016/j.apnr.2017.09.010
Received 26 January 2017; Received in revised form 12 July 2017; Accepted 23 September 2017
0897-1897/ © 2017 Elsevier Inc. All rights reserved.
C.-N. Shin et al.
than Asian immigrants who are not proficient in English. White, Eng-
lish-speaking immigrants may also adapt somewhat easier to American
mainstream with less racial discrimination if the culture is closer to
their own heritage culture. In contrast, Asian immigrants to the United
States may experience a higher level of acculturative stress because
they may have to learn a new language (i.e., English), live in a society
with different cultural values and social norms (e.g., collectivism over
individualism), and sometimes deal with racial discrimination
(Schwartz et al., 2010).
A variety of personal factors have been found to impact the degree
of acculturative stress that is experienced by immigrants. For example,
Korean Americans who were men, younger, had high levels of English
proficiency, who arrived to the United States at a younger age, or
stayed more years in the United States experienced lower levels of ac-
culturative stress than did their counterparts who were women, older,
had low levels of English proficiency, who arrived to the United States
at an older age, or stayed less years in the United States (Ji & Duan,
2006; Logan, Barksdale, Carlson, Carlson, & Rowsey, 2012; Moon,
2011). In a study of immigrants from the former Soviet Union, women
and older immigrants to the United States experienced higher levels of
acculturative stress than did men and younger immigrants (Miller et al.,
2006).
In contrast, Asian Indian immigrant men in the United States ex-
perienced higher levels of acculturative stress than did women
(Conrad & Pacquiao, 2005), while older Latinos residing in the United
States experienced lower levels of acculturative stress than did younger
Latinos (Bekteshi & van Hook, 2015). Length of residency was not as-
sociated with acculturative stress in studies of Latinos and Nigerian
immigrants to the United States (Caplan, 2007; Daramola & Scisney-
Matlock, 2014).
Asian Americans and Latinos with low levels of English proficiency
and who stayed less years in the United States experienced high levels
of acculturative stress (Bekteshi & van Hook, 2015; Lueck & Wilson,
2010, 2011). First-generation Latinos with limited English proficiency
were found to experience 13% more acculturative stress than second
generation Latinos (Lueck & Wilson, 2011). This is because linguistic
integration for immigrants in the United States is a social requirement
that enforces the acquisition of English proficiency (Lueck & Wilson,
2011).
Acculturative stress has been associated with physiological changes
occurring within the individual, including hypertension and diabetes in
Latinos and Chinese immigrants to the United States (D'Alonzo et al.,
2012; Lee et al., 2015). In contrast, acculturative stress was not asso-
ciated with blood pressure (BP) levels in Korean and Nigerian im-
migrants to the United States (Daramola & Scisney-Matlock, 2014;
Logan et al., 2012). Acculturative stress has also been linked to elevated
systolic BP among Latino immigrant men, but not among Latino im-
migrant women in the United States (McClure et al., 2010).
Due to the increased numbers of individuals who are immigrating to
a new culture and the observed disparities in health reported outcomes,
researchers are focusing to a greater degree on acculturation, ac-
culturative stress, and factor which may impact this process and the
ensuing stress that may result. Contributing factors to acculturative
stress have been explored; however, the associations between those
factors and acculturative stress are inconsistent across a limited number
of studies. In particular, little information is available as to whether
acculturative stress is associated with physiological factors in Korean
Americans. Given that the fast growing numbers of Korean Americans,
it is important to understand what factors contribute to acculturative
stress and if acculturative stress is associated with physiological factors
for this ethnic group. Therefore, we conducted an exploratory study to
describe the level of acculturative stress in Korean Americans and to
examine if correlations existed with level of acculturative stress and
personal (e.g., age, gender) and physiological factors (e.g., BP).
71
Applied Nursing Research 38 (2017) 70–75
2. Methods
2.1. Study design and sample
This study was a secondary analysis of data that were collected for
an exploratory, cross-sectional, descriptive study in a large
Southwestern city in the United States which examined cardiometabolic
risk factors in Korean Americans. We recruited a convenience sample of
Korean American adults who self-identified as Korean, aged 18 and
above, and able to read, write, and speak either in Korean or the English
language from a locally identified Korean community (e.g., restaurants,
groceries, Korean ethnic churches). We had a total of 107 participants
who had completed data on acculturative stress and the personal and
physiological factors. For the correlation analyses conducted in our
study, we had enough power (β = 0.85) to detect correlations of 0.30
with a sample size of 96 according to G*Power 3.1.7 (Faul, Erdfelder,
Buchner, & Lang, 2009).
2.2. Measures
Information about acculturative stress, and the personal and phy-
siological factors were obtained from each participant.
2.2.1. Personal factors
Personal factors included the individual's age, gender, marital
status, education level, annual family income level, employment status,
years of U.S. education, arrival age, and years of residency in the United
States. In addition, English proficiency was determined by asking the
question, “In your opinion, how well do you speak English compared
with most English native speakers?” Responses were rated on a scale
from 1 (very much worse) to 4 (as well as most English native
speakers). For the purpose of data analysis, we recoded this as a di-
chotomous variable (0 = very much worse–somewhat worse, 1 = only
little worse–as well as most English native speakers).
2.2.2. Acculturative stress
The Acculturative Stress Index (ASI) was used to measure the stress
associated with adaptation to a new culture (Noh, Wu, & Avison, 1994).
The ASI is available in both English and Korean languages. The scale
consists of 31 items which assess acculturative stress from experiences
such as homesickness, social isolation, social discrimination, sense of
marginality, family problems, socioeconomic adjustment, and language
difficulties. In the ASI, homesickness for example, is measured by an
item that states: “I am living away from my family, relatives, and
friends.” Language difficulties are examined by a question such as “I
experience difficulties because of my ability to speak and understand
English when I try to understand the TV/radio.” Participants rate the
degree of difficulty in adapting to life in the United States on a 4-point
Likert scale (from 1 = never to 4 = very often). A total ASI score was
derived from the sum of the item scores with higher scores indicating
greater acculturative stress. Because our focus was to measure ac-
culturative stress in general, we used the total ASI score in this study.
Reliability for the ASI was supported by Cronbach's alphas of
0.75–0.95 in research studies of Korean immigrants in Canada and
United States (Ji & Duan, 2006; Moon, 2011; Noh & Avison, 1996; Rhee,
2013). Studies have demonstrated validity for the ASI: appropriate
factor loadings occurring with factor scores 0.40 or above for each item;
and acculturative stress scores predicting depressive symptoms (Moon,
2011; Noh & Avison, 1996). Cronbach's alpha for the ASI was 0.93 in
this study.
2.2.3. Physiological measures
We measured body mass index (BMI) and BP as physiological factors
in this study. To assess BMI, we measured the height and weight of each
participant who wore light clothing and no shoes using a portable
stadiometer (Seca 217, USA) and an electronic scale (Health O meter,
C.-N. Shin et al. Applied Nursing Research 38 (2017) 70–75

USA). We used the standard formula for the BMI calculation: weight Table 1
(kg) / [height (m)]2 (Centers for Disease Control and Prevention, Sample characteristics.
2015). Obesity was determined by the American Heart Association
Variable Category n (%) M (SD)
(AHA) criteria related to individual BMI values: the ideal weight value
is a BMI < 25 kg/m2, a person is considered overweight if BMI value is Gender Male 36 (33.6)
25–29.9 kg/m2, and obese if BMI value is ≥ 30 kg/m2 (Mozaffarian Female 71 (66.4)
Agea 53.9
et al., 2016). In addition, we determined obesity using criteria that has
(10.7)
been specified for Asian populations including: ideal weight value is a Marital status Married 95 (88.8)
BMI < 23 kg/m2, overweight if BMI value is 23–24.9 kg/m2, and Separated/divorced/widowed 12 (10.2)
obese if BMI value is ≥ 25 kg/m2 (Obesity in Asia Collaboration et al., Education level ≤ High school 16 (15)
2007). (n = 106) ≥ College 90 (84.2)
Income levelb ≤$49,999 38 (35.5)
For the BP measure, we used a standard procedure: having the
(n = 104) > $50,000 66 (61.7)
participant rest for a minimum of 5-min in the sitting position before Employment status Employed 68 (63.6)
the BP was checked, and two readings were taken and averaged. The Unemployed 39 (36.4)
AHA definition of hypertension was used: a SBP of < 120 mm Hg and a Arrival age in U.S.a (n = 106) 31.9
(11.1)
diastolic blood pressure (DBP) of < 80 mm Hg were considered as
Length of residency in U.S.a (n = 104) 21.6
ideal, and a SBP of ≥ 120 mm Hg and a DBP of ≥ 80 mm Hg were (12.2)
considered high (Mozaffarian et al., 2016). Equipment for each as- English proficiency Very much worse–somewhat 67 (62.6)
sessment was calibrated during the study at frequent intervals to worse
maintain accuracy. Only little worse–as well as 40 (37.4)
most English speakers
Acculturative stress (Acculturative Stress Index) 50.4
2.3. Procedures (13.2)
Body mass index (kg/ Ideal (< 25) 77 (72.0) 23.6 (3.0)
After obtaining institutional review board approval from the uni- m2) Overweight/obese (≥25) 30 (28.0)
Systolic blood Ideal (< 120) 38 (35.5) 121.1
versity where the study was housed, we screened individuals for elig-
pressure (mm Hg) High SBP (≥ 120) 69 (64.5) (15.1)
ibility and then obtained informed consent from each participant prior Diastolic blood Ideal (< 80) 25 (23.4) 81.3
to beginning the study. The data were collected at a convenient place pressure (mm Hg) High DBP (≥ 80) 82 (76.6) (10.56)
chosen by the participant, including the university research office,
participant's home, and Korean ethnic churches. All study documents Note. Sample size of subgroups is 107 except variables indicated.
a
(e.g., informed consent, survey questionnaires) were available in both Measured in years.
b
Family annual income.
English and Korean, and participants were given a choice to complete
them in either language version. Following the BP and BMI assessments,
participants were found to have arrived in the United States at age of 30
participants received information about their BMI and BP so that they
or older, 83% had been in the United States for a minimum of 10 years,
could share this information with their primary healthcare provider.
51.4% had received formal education of at least one year in the United
States, and 62.6% reported they spoke English “very much worse–-
2.4. Data analysis
somewhat worse” when they compared themselves to most native
speakers. The mean score for the ASI was 50.4 (range 31–124), which
Prior to analysis, data were screened for entry errors, outliers, and
falls below the midpoint of the scale. More than one quarter of the
missing values. Data were normally distributed without outliers for the
participants (28%) were overweight or obese (≥25 kg/m2) based on
variables entered into the data analysis. Due to a small number of cases
the criteria by the AHA. When we examined BMI criteria specific for
of missing values (< 3% of the sample) and missing data are randomly
Asians (≥23 kg/m2), 45.9% of the study sample was identified as being
distributed across the data set (Hair, Black, Babin, Anderson, & Tatham,
overweight or obese. More than half of the participants had a higher
2006; Howell, 2008), we drop those values from the analyses. De-
than ideal value for SBP (64.5%) and DBP (76.7%).
scriptive statistics were used to summarize the data on acculturative
stress, and personal and physiological factors. To examine correlations
between level of acculturative stress and personal and physiological 3.2. Variable associations
factors, we calculated Pearson correlation coefficients for the con-
tinuous variables of age, arrival age, U.S. education, length of re- The Pearson and point-biserial correlation coefficients demon-
sidency, BMI, SBP, and DBP. Point-biserial correlations were used for strated that many associations existed among the variables (Table 2). A
the dichotomous variables of sex, marital status, education level, in- positive association was found between acculturative stress and arrival
come, employment status, and English proficiency. Variables that were age (r = 0.33), while a negative association revealed between ac-
entered into the data analysis met the assumptions for the statistical culturative stress and years of U.S. education (r = − 0.34), years of U.S.
analyses that were used (e.g., normal distribution, no outliers, equal residency (r = − 0.43), and English proficiency (r = − 0.21). Gender
variance). IBM SPSS statistics version 22.0 was used to analyze the data. was negatively associated with BMI (r = − 0.49), SBP (r = −0.34),
An alpha level of 0.05 was used to determine significance for all sta- and DBP (r = −0.37), whereas age was positively associated with SBP
tistical tests. (r = 0.45) and DBP (r = 0.22). Employment was negatively associated
with SBP (r = −0.22), while years of U.S. residency was positively
3. Results correlated with SBP (r = 0.27). Acculturative stress was not correlated
with BMI, SBP, and DBP.
3.1. Sample characteristics
4. Discussion
All 107 participants were first-generation Koreans, and they all
chose to read and sign the consent form in Korean and complete all the The level of acculturative stress in this sample (the mean ASI
study measures in Korean. Participants had a mean age of 53.9 ± 10.7 score = 50.4) was higher than the levels (the mean ASI score = 34–40)
(range 30–79), a majority were women, married, and educated at a found in Korean Americans living in cities of Ohio, Kentucky, and
college level or above (Table 1). Slightly more than half (51.9%) of the Indiana (Ji & Duan, 2006; Rhee, 2013), but lower than the levels (the

72
C.-N. Shin et al. Applied Nursing Research 38 (2017) 70–75

Table 2 the less they are acculturated to the new society and also the more they
Correlations between personal and physiological factors and acculturative stress. experience acculturative stress (Bleakley & Chin, 2010; Ji & Duan,
2006). In another Korean American study, 14% of the participants were
Personal factors Acculturative stress BMIb SBPc DBPd
U.S. born, while 46.3% of the participants completed the English ver-
Gender (1 = female) 0.15 − 0.49⁎⁎ − 0.34⁎⁎ − 0.37⁎⁎ sion of the survey (Ji & Duan, 2006). The participants who completed
Agea − 0.15 0.08 0.45⁎⁎ 0.22⁎ the English version of the survey showed a lower acculturative stress
Marital status 0.05 0.14 − 0.05 0.00
compared to participants who completed the Korean version of the
Education level 0.07 0.06 − 0.15 − 0.03
Income − 0.16 − 0.01 − 0.10 − 0.10 survey (Ji & Duan, 2006).
Employment 0.07 − 0.04 − 0.22⁎ − 0.11 These findings may indicate that greater length of residency does
Arrival agea 0.33⁎⁎ 0.04 0.14 0.17 not guarantee more acculturation to the dominant society and less ac-
U.S. educationa − 0.34⁎⁎ 0.08 − 0.11 − 0.09 culturative stress for individuals who arrived to the United States at
Length of residencya − 0.43⁎⁎ 0.03 0.27⁎⁎ 0.04
their older age (i.e., after puberty). The role of arrival age as a factor
English proficiency − 0.21⁎ − 0.02 0.04 0.05
Acculturative stress 1 − 0.11 − 0.10 0.05 that may influence acculturation and acculturative stress needs further
investigation. Future research exploring additional factors (e.g., ethnic
a
Measured in years. identity, native language proficiency, coping strategies, support and
b
BMI = Body mass index. resources in new community) that may influence acculturative stress
c
SBP = Systolic blood pressure.
d
will provide a better understanding of Korean Americans' experiences
DBP = Diastolic blood pressure.
⁎
p < 0.05.
with acculturative stress, and how nursing may positively impact these
⁎⁎
p < 0.01. factors; thereby reducing the level of stress associated with accultura-
tion.
mean ASI score = 55–66) found in Korean immigrants residing in Ca- The study findings revealed that a majority of participants had
nada and Korean Americans in Chicago (Lee & Holm, 2012; higher values of SBP and DBP than the values that had been obtained in
Noh & Avison, 1996). This variation in acculturative stress might be prior results of Korean immigrants and Koreans living in their native
related to differences in the personal factors of the participants in the country. The rate of obesity in our study (28% with BMI > 25 kg/m2
studies and the varying environments where acculturation was taking criteria) was higher than the rate (22.2%) reported in a study of
place. Koreans residing in Korea (Noh, Jo, Huh, Cheon, & Kwon, 2014) al-
Support for these ideas comes from two older studies (Lee & Holm, though it was lower than the rates (45%–53%) reported prior in other
2012 [data collection in 2002]; Noh & Avison, 1996) that were con- studies of Korean Americans (Kim et al., 2015; Palaniappan, Wong,
ducted when fewer Koreans immigrated to Western countries. These Shin, Fortmann, & Lauderdale, 2011). The rate of obesity (49.5%) with
studies indicate that Korean immigrants 10 to 20 years ago were more a BMI > 23 kg/m2 was higher than the rate (46%) reported in another
likely to have fewer resources for living in a new environment than they study of Korean immigrants in California (Cho & Juon, 2006). The rates
have in the present time, which could have resulted in these immigrants of hypertension in this sample were (64.5% in SBP; 76.7% in DBP) also
experiencing more stress during the process of adjusting to a new greater than the rates (46%–60%) reported in Korean Americans or
country than more recent immigrants. Future research is vitally needed Koreans residing in Korea (Kim, Lee, Ahn, Bowen, & Lee, 2007; Logan
to more fully examine how resources available to a Korean immigrant et al., 2012).
may impact acculturative stress, including cultural specific strategies to Our findings regarding the association of physiological factors and
access resources that are congruent with the individual's values, beliefs, some of the personal factors were consistent with previous findings. A
and traditions. Of particular interest to future research is the potential number of studies across ethnic groups (i.e., Koreans, Filipinos, and
role of social support in buffering the stress of acculturation among African immigrants) have reported that individuals who were older,
Korean American immigrants. men, employed, and stayed longer years in the Unites States showed
Our findings confirmed that a significant association existed be- higher values of BMI, SBP, and DBP (Afable et al., 2016; Cho & Juon,
tween acculturative stress and personal factors of the immigrant. 2006; Daramola & Scisney-Matlock, 2014; Mozaffarian et al., 2016).
Support for these findings comes from research of Koreans, Asians, and This study also lent credence to the results of a previous study with a
Latinos or Latinas who had immigrated to the United States, which larger Korean population (N = 407,858) in South Korea that showed
indicated that individuals at an older age, who had lower levels of higher BMI, SBP, DBP values occurred more often in men than in
English proficiency, none or less years of U.S. education, or less years of women (Kim, Jee, Yun, Baek, & Lee, 2013).
U.S. residency had higher levels of acculturative stress (Bekteshi & van Consistent with prior research of African immigrants in the United
Hook, 2015; Ji & Duan, 2006; Lueck & Wilson, 2010, 2011; Moon, States, we did not find significant associations between acculturative
2011). stress and physiological factors (Daramola & Scisney-Matlock, 2014).
As noted earlier, the length of U.S. residency and English profi- Researchers have suggested that the body's stress response to the long-
ciency may reflect an immigrant's degree of acculturation, and ac- term effect of acculturative stress can lead to cardiovascular disease
culturative stress appears to be greater among those individuals who risks (Lee et al., 2015; Logan et al., 2012). A meta-analysis of 125
are less acculturated to the dominant society (Bekteshi & van Hook, studies (N = 223,355) reported that BP levels were related to ac-
2015; Lueck & Wilson, 2010; Moon, 2011). Given that the average culturation level (SBP, d = 0.40; DBP, d = 0.43), whereas accultura-
length of U.S. residency was about 22 years in our study participants, it tion was not associated with BMI in Latinos in the United States,
was interesting that the level of acculturative stress was higher than Turkish immigrants in Germany, and Ethiopian immigrants in Israel
their counterparts in other Korean immigrant studies in the United (Steffen, Smith, Larson, & Butler, 2006). The largest effect sizes re-
States. ported of acculturation on BP occurred in immigrants at the time of
This could be partially explained by the mean arrival age (32 years initial contact with the new culture with the effect then dropping ra-
old) to the United States, and that the Korean language remained the pidly within the first 3 years of acculturation: (SBP, d = 0.66 during 0
language of preference after so many years of U.S. residency (i.e., all to 3 months, d = 0.52 during 3 months to 3 years, d = 0.38 during 3 to
participants replied to the study documents in Korean rather than 15 years; DBP, d = 0.65 during 0 to 3 months, d = 0.57 during
English) in this study. Researchers have reported that the critical period 3 months to 3 years, d = 0.33 during 3 to 15 years). Given the average
of a new language acquisition is before puberty (Birdsong, 2006; of > 20 years of U.S. residency in this study, the sample might have
Bleakley & Chin, 2010). The later immigrants arrive to a new society, learned coping skills or utilized other resources that buffered the ne-
gative effect of acculturative stress on BMI and BP. Additional measures

73
C.-N. Shin et al.
that indicate cardiovascular risk disease such as family history, diet,
and blood values (cholesterol and triglycerides) prior to immigration
were not obtained in this study and would be included in a future study
to better examine this association.
Living in closer proximity to other immigrants of the same ethnicity
with a longer residency may help in the procurement of necessary re-
sources for living in a new country, which results in fewer lingual and
cultural barriers (Kang, Domanski, & Moon, 2009; Schwartz et al.,
2010). We may better understand whether level of acculturative stress
is impacted by area where the immigrant lives (ethnic enclaves vs. non-
ethnic enclaves) and how this difference impacts BMI and BP by adding
the variable of community setting to future study.
This study has limitations. Our results may not be generalizable to
all Korean immigrants residing in the United States because we col-
lected data from one geographical region. Our sample also had a
slightly higher percentage of participants who were married (88.8% vs.
56%) with higher levels of education (84.2% vs. 53% for the college
education) than the general Korean population residing in the United
States (Pew Research Center, 2013; U.S. Census Bureau, 2016). Ac-
culturative stress might be not the sole stress in the life of the partici-
pants; therefore, future research needs to explore other contributing
factors (e.g., family history, physical inactivity, consumption of un-
healthy food) that are important in determining BMI and BP values.
Nevertheless, this study has strengths. The height, weight, and BP
were directly measured; therefore, they reflect the accurate physiolo-
gical condition of participants rather than relying on a self-report of
values by the participants. Participants were also given the choice of
completing the survey questionnaire in Korean or English. This choice
by the participant in replying to each survey item can be assumed to be
a more reliable indicator of the participant's response with a better
comprehension of each item and a decreased risk for misinterpretation
to occur.
5. Conclusion
Despite the lack of significant associations between acculturative
stress and physiological factors (i.e., BMI, BP), the findings of this study
provide researchers and healthcare professionals with greater insight
related to acculturative stress in Korean Americans in the southwestern
United States. A number of personal factors demonstrated significant
associations with acculturative stress, BMI, and BP. These linkages
support prior research into the importance of considering many factors
that may predispose an immigrant to cardiovascular disease, including
acculturative stress, personal factors related to immigration, and al-
ready well documented variables of BMI and BP.
Conflicts of interest
None.
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