Jingxi Sheng

Date of Award

Summer 2022

Document Type

Open Access Dissertation


College of Nursing

First Advisor

Sue P. Heiney


Asian Americans (AsAm) comprise about 7% of the United States population and are the only racial group for whom cancer is the leading cause of death. Breast Cancer (BrCa) is the most commonly diagnosed cancer in this population, with the highest incidence in the age of 45-49 years, which is 30 years younger than for non-Hispanic Whites. The incidence of BrCa has been increasing for over three decades in AsAm.

Physical activity (PA) is a modifiable protective factor for BrCa. Unfortunately, AsAm women have a low PA prevalence of meeting PA recommendations. The increased BrCa risk, younger age at diagnosis, and low PA levels among AsAm highlight the urgency of developing PA-promoting interventions. Therefore, the purpose of this dissertation is to examine PA predictors and understand PA experiences in AsAm women to provide knowledge for establishing health promotion programs to increase PA and lowering BrCa risk in this population.

Two data-based studies were conducted for this dissertation. In the first study, a quantitative approach used data from the 2011-2018 National Health and Nutrition Examination Survey to assess PA and identify predictors related to PA in AsAm women (n=1605, age³18). PA was self-reported as minutes of weekly PA by domains (work PA [WPA], transportation PA [TPA], and leisure PA [LPA]). Multivariable logistic regression was performed to build separate models for meeting the recommendations of ≥150 minutes of weekly moderate-intensity PA for each PA domain and total PA. The prevalence of meeting PA guidelines through any combination of WPA, TPA, or LPA was 47.8%. For total PA, odds of meeting aerobic PA recommendations were higher for those who were younger (p

The second study was a descriptive qualitative study of 21 Chinese American women (CAW) aged 24-60 to explore the PA experiences and self-perceived PA knowledge of BrCa prevention. Using Braun and Clark’s thematic analysis approach to analyze the data, this study identified 12 themes: two on knowledge, five on motivations and barriers, and five on culture/acculturation. The findings suggest a lack of understanding of PA benefits in BrCa prevention among CAW. The process of acculturation influenced their PA experiences. Except for LPA, other domains of PA were substantially reduced when those women immigrated. Although acculturation facilitated leisure-time PA, CAW's PA preference was continuously impacted by cultural heritage.

Overall, the findings from the two studies are congruent regarding the changes in PA domains that AsAms gradually converted their PA behaviors towards the dominant society as they acculturated to the US. The qualitative findings provide further explanations for how this PA change occurred. Based on the continuous increase in BrCa incidence and low PA in AsAm women, findings from this dissertation emphasize the importance of promoting PA and enhancing PA knowledge in BrCa prevention. Future research is needed to understand whether other Asian American subgroups have experienced similar PA changes and the impact of the development of culture-specific interventions. Strategies to improve PA and reduce breast cancer risk in this population should take this population's cultural background into account.


© 2022, Jingxi Sheng

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