effectiveness of diet and physical activity interventions
TRANSCRIPT
Beasley et al. BMC Public Health (2020) 20:1019 https://doi.org/10.1186/s12889-020-08805-3
RESEARCH ARTICLE Open Access
Effectiveness of diet and physical activity
interventions among Chinese-originpopulations living in high incomecountries: a systematic review Jeannette M. Beasley1* , Janelle M. Wagnild2, Tessa M. Pollard2, Timothy R. Roberts3 and Nasima Ahkter2Abstract
Background: This review examines the effectiveness of diet and physical activity interventions to reducecardiometabolic risk among Chinese immigrants and their descendants living in high income countries. Theobjective of this review is to provide information to help build future interventions aimed at improving diet andincreasing physical activity levels among Chinese immigrants.
Methods: Outcomes included BMI, weight, waist circumference (WC), waist-hip ratio (WHR), cholesterol (LDL, HDL),systolic and diastolic blood pressure (SBP, DBP), hemoglobin A1c (HgbA1c), fasting blood glucose (FBG), andHOMA-IR. Six databases were systematically searched from database inception to date of search (February 2020).Meta-analyses used random effect models to estimate pooled effects of outcomes with 95% confidence intervals.The outcomes assessed were changes in mean outcomes (post-intervention versus baseline) among theintervention group versus control groups.
Results: Twenty-one articles were included for synthesis, and eight of these were included in the meta-analysis.Among children/adolescents, there were no significant effects of intervention for any of the outcomes havingsufficient data for meta-analysis (BMI, WHR, SBP, and DBP). Among adults, the pooled effect including three studiesshowed significant changes in BMI (effect size = − 1.14 kg/m2; (95% CI: − 2.06, − 0.21), I2 = 31%). There were alsosignificant effects of intervention among adults in terms of changes in SBP and DBP, as the pooled effect acrossthree studies was − 6.08 mmHg (95% CI − 9.42, − 2.73), I2 = 0% and − 3.81 mmHg (95% CI: − 6.34, − 1.28), I2 = 0%,respectively. Among adults there were no other significant effects among the meta-analyses conducted (weight,WC, LDL, HgbA1c, and FBG).
(Continued on next page)
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: [email protected] of Medicine, NYU Grossman School of Medicine, 462 FirstAvenue CD 673, New York, NY 10016, USAFull list of author information is available at the end of the article
Beasley et al. BMC Public Health (2020) 20:1019 Page 2 of 25
(Continued from previous page)
Conclusions: This review is the first to summarize the effectiveness of diet and physical activity interventionsspecifically designed for Chinese immigrants living in high income countries. There were clinically meaningfulchanges in BMI and blood pressure among adults, but evidence was weak for other cardiometabolic outcomes(weight, WC, LDL, HgbA1c, and FBG), and among children, there was no evidence of effect for any cardiometabolicoutcomes. Given our mixed findings, more work is needed to support the design of successful interventions,particularly those targeting children and their families.
Trial registration: The systematic review protocol was registered in PROSPERO on December 17, 2018, theinternational prospective register of systematic reviews (registration number: CRD42018117842).
Keywords: Migrants, nutrition, Food, Exercise, Tai chi, Strength, Body mass index, Blood pressure, Lipids
BackgroundPeople of Chinese origin make up one of the fastestexpanding groups in high-income countries such as theUnited States, Australia and Canada [1]. The cardiomet-abolic disease profile for this group is generally positive[1], but there are concerns about a high prevalence oftype 2 diabetes identified in some studies [2, 3] andabout increasing adiposity. While measures of adipositysuch as BMI and waist circumference are generally lowin Chinese-origin populations in high-income countriesin comparison with other ethnic groups [3, 4], there isevidence that it increases with time living in a high-income country [4], that it is higher in those born toChinese-origin parents in the United States than in mi-grants from China [4–6], and some evidence that it hasbeen increasing faster amongst Chinese ethnic groupsthan amongst others [7]. People of Asian origin have ahigher risk of cardiovascular disease at a given BMI rela-tive to other ethnic subgroups [3], suggesting that strat-egies to improve diet and physical activity behaviors maybe particularly important for those of Asian origin, in-cluding Chinese immigrants and their descendants [8].There is good evidence of differences in physical ac-
tivity and dietary practices between Chinese migrantgroups and the rest of the population in a number ofcountries with the largest Chinese-origin populations.There was a higher prevalence of inactivity amongChinese Australians than non-Chinese Australians [3],Canadians of South-East Asian origin (includingpeople with Chinese origins) were more likely to bephysically inactive than the White population ofCanada [9], those of Chinese origin reported lowerlevels of physical activity compared with the generalpopulation in the UK [10], and not only were Non-Hispanic Asians in New York City less likely to meetphysical activity guidelines than non-Hispanic Whitesor Blacks, but Chinese Americans were less likely tomeet physical activity guidelines than other Asiansubgroups [11]. Similarly, in New Zealand those ofChinese ethnicity were less likely to achieve physicalactivity recommendations [8].
Dietary differences are harder to characterize. Thoseof Chinese origin ate greater amounts of fruit and vege-tables than the general population in the UK and fat in-take was relatively low [12], while studies in the UnitedStates and in New Zealand found that those of Chineseethnicity were less likely to meet recommendations forconsumption of vegetables than the general population[13, 14]. Dietary patterns change with length of resi-dence amongst migrants from China, with migrants toCanada and the United States showing negative changessuch as reduced consumption of fruit and vegetables, in-creased portion sizes and greater consumption of con-venience foods [14, 15] and a survey of Chineseimmigrant mothers living in NYC reported severalchanges in diet after immigration including a decrease infamily meals [7]. Thus interventions to promote physicalactivity and healthful diets could be particularly benefi-cial for those of Chinese-origin.Considerations for developing interventions for Chinese
migrants and/or their descendants include: 1) language(whether the intervention was offered in Cantonese, Man-darin, English, etc.); 2) health literacy; 3) traditional Chin-ese diet; 4) migration and acculturation; and 5) traditionalChinese medicine [16]. Successful interventions may en-courage maintenance of healthful dietary practices, in-corporate traditional and cultural beliefs, and provideinformation that would enable the participants to makehealthful dietary modifications [17]. Adaptations at a sur-face level may involve the use of vernacular phrases, rolemodels that represent the targeted group, identifying suit-able media channels and settings for recruitment, andemploying ethnically matched staff to administer the pro-gram [18]. At the deep structure level, adaptations mayaddress the opposing cultural dimensions of collectivismand individualism [18].In the context of some concerns about diet and phys-
ical activity in those of Chinese origin living in high-income countries, and evidence that this group maybenefit from tailored interventions, this review examinesthe effectiveness of interventions designed to modifydietary and physical activity behaviors to reduce
Beasley et al. BMC Public Health (2020) 20:1019 Page 3 of 25
cardiometabolic risk in this group. The objective of thisreview is to provide information to build future interven-tions aimed at improving the diet and increasing phys-ical activity levels among Chinese immigrants.
MethodsThe review was conducted following the PRISMA Proto-col for Systematic Reviews (PRISMA) [19] and theprotocol was registered in PROSPERO, Internationalprospective register of systematic reviews (CRD42018117842).
Information sources and search strategyIn February 2020, co-author (TR), an experienced Med-ical Librarian, searched PubMed Central, Ovid Medline,Ovid Embase, CABI, Food Science Technology Cinahland the Cochrane Central Register of Controlled Trials.The Ovid Medline Search is included as supplementarymaterial (Supplementary Table 1) to this article. Thesearch was not limited by language or publication date.Additionally, the citations of included articles werechecked and, if relevant, were included in the review.
Eligibility criteriaThis review examined diet and physical activity interven-tions to reduce cardiometabolic risk among Chinese im-migrants living in high income countries outside ofChina. To this end, studies were included in the reviewif 1) they quantitatively described the effect of an inter-vention designed to modify dietary and/or physical activ-ity behaviors on cardiometabolic risk factors (BMI,weight, waist circumference (WC), waist-hip ratio(WHR), LDL and/or HDL cholesterol, systolic and dia-stolic blood pressure (SBP and DBP), hemoglobin A1c(HgbA1c), fasting blood glucose (FBG), and HOMA-IR),and 2) the recipients of the intervention were of Chineseorigin and living in a high-income economy, as definedby the World Bank [20]. Exclusion criteria were: studiesinvolving institutionalized populations (as individual-level control over diet and physical activity behaviorsmay be restricted), and studies whose samples includedresidents of Hong Kong, Taiwan, and Macau (as thesehigh-income economies are special administrative re-gions within China). Interventions could be at any level(individual, community, policy). The only types of stud-ies to be excluded were observational studies in whichno intervention was tested. Systematic reviews andmeta-analyses on related topics were tagged for reviewof individual studies, but the review paper itself was notincluded to avoid double counting of studies. Controlgroups were comprised of alternative combinations ofdiet and physical activity interventions, attention control,cross-over designs, or before/after studies.
Study selection and data extractionTitles and abstracts were screened by four independentreviewers (JB, JW, TP, NA), with each citation receivingtwo votes. The full-texts of studies with relevant ab-stracts were assessed for eligibility by two screeners in-dependently (JB, JW). Any conflicts were discussed andresolved through consensus of all four reviewers.Data from studies eligible for inclusion were extracted
using a data extraction form adapted from publishedsources such as the Cochrane review [21, 22]. If pre- andpost-intervention means were not provided in the manu-script, the corresponding author was contacted to re-quest the data. Quality assessment was determined usingthe Cochrane Review’s Risk of Bias tool [21], and guide-lines provided in the Cochrane handbook for systematicreviews of interventions were used to assess risk of bias[23]. Two reviewers (JB, JW) independently extractedoutcomes by reading the full articles, tables, figures andinterpretations for the findings and assessed the qualityof papers to ensure consistency and to minimize individ-ual bias. Discrepancies were resolved by consensus (TP,NA, JB, JW).
Synthesis of resultsA narrative synthesis was used as it allows the compil-ation of data despite potential differences in researchquestions, design, or context in order to find a commonunderlying pattern. If at least two studies included thesame outcome variable and pre- and post-interventionvalues were reported for both the intervention and con-trol group, a meta-analysis was conducted. In caseswhere multiple post-intervention measurements wereavailable, we extracted the measure that correspondedmost closely to the endpoint of the intervention. Westratified analyses by age group (children/adolescentsand adults).
Statistical analysisWhere meta-analysis was possible (e.g. pre-post mea-sures were available for intervention and controlgroups), the analyses involved two steps. The first stepwas to assess mean differences (MD) in outcomes forboth the intervention and control group by comparingchanges in the mean as the difference between post-intervention and baseline measures. For calculating MD,available adjusted or unadjusted means as reported inthe included studies were used. The correspondingchanges in standard deviation (SD) were not directly re-ported in most studies, and therefore was estimatedusing the formula suggested by the Cochrane handbookfor systematic reviews of interventions [23]. A correl-ation of 0.6 between pre- and post-intervention valueswas assumed. The second step involved estimating thepooled effect for outcomes, where at least two
Beasley et al. BMC Public Health (2020) 20:1019 Page 4 of 25
randomized, controlled trials (RCTs) reported on thesame outcome variables. The pooled effects as gain inthe intervention group against the change in controlgroup was reported as the pooled effect estimate with95% CIs. The study weights were equal to the inverse ofthe variance of effect estimate of each study as suggestedby DerSimonian and Laird [24, 25]. The overall effectwas interpreted as statistically significant if the 95% CIsdid not include the null value of 0 (no difference) intheir range. Sensitivity analyses were performed to assesswhether correlation of 0.5 or 0.8 affected the interpret-ation of the pooled effect. Heterogeneity, i.e. variation inthe intervention effects observed in the included studies,was quantified using the I2 statistic. Results are to beinterpreted with caution where there is significant het-erogeneity (I2 > 50%). Meta-analyses were performed inR software using the ‘meta’ package.
ResultsStudy selectionAfter duplicates were removed, 4443 articles were identi-fied (Fig. 1). The initial screening of titles and abstractsremoved 4335 articles, leaving 107 full text articles to bescreened by two reviewers independently (JB, JW). Ofthe full text articles reviewed, 86 articles were excludedfor the reasons listed in Fig. 1. Twenty-one articles wereincluded for synthesis, including one study reportingoutcomes for both children and adults [26]. Of these,eight provided the pre- and post-intervention means forintervention and control groups, allowing for inclusionin the meta-analysis [26–33].
Study characteristicsAmong children/adolescents, the first study was pub-lished in 2008 [34] and the most recent study was 2019[30] (Table 1). The range of publication dates was wideramong adults (1998–2019) (Table 2). All eight studiesconducted among children/adolescents were conductedin San Francisco, CA, USA [26–30, 34–36], and all butone [26] were led by the same principal investigator(Chen) (Table 1). Among adults, one study was set inAustralia [37], one in Canada [33], and one in SouthKorea [38], while all others were conducted in theUnited States [31, 32, 39–47] (Table 2). The averagesample size was 60 and 63 among studies conducted inchildren/adolescents and adults, respectively (Tables 1and 2). The average proportion of female participantswas 50 and 64.5% among studies conducted in children/adolescents and adults, respectively (Tables 1 and 2).The age range for interventions among children/adoles-cents was three to 18. Among children/adolescents, allinterventions included both diet and physical activitycomponents, while among adults, two interventions fo-cused on diet exclusively while three interventions
focused on physical activity exclusively (Tables 1 and 2).Among children/adolescents, intervention duration was2 months for six studies and 6 months for two studies(Table 1). Among adults, intervention duration rangedfrom 5 weeks to 1 year, with most common duration of6 months in four studies (Table 2).
Risk of bias within studiesAmong studies conducted in children/adolescents (Fig. 2and b), only Chen 2018 [30] had low risk of bias for allcriteria. Four of the studies were not evaluated for ran-dom sequence generation, allocation concealment, orblinding, as they were not randomized controlled trials.Four studies had a high risk of bias for incomplete out-come data (attrition bias).Among studies conducted in adults (Fig. 3a and b), all
of the studies had at least one criterion with a high riskof bias. Six of the studies were not evaluated for randomsequence generation, allocation concealment, or blinding,as they were not randomized controlled trials. Commoncriteria rated with a high risk of bias was blinding of out-come assessment (six studies), incomplete outcome data(ten studies), and selective reporting (five studies).
Intervention characteristicsAmong children/adolescents, four studies were random-ized controlled trials, three studies were pre-post single-arm interventions, and one study included a historicalcontrol group (Table 3). The most common interventionwas iStart Smart, which was adapted for Chinese Ameri-can children based on the National Institute of Health’sWeCan! program (educational play-based activitiesteaching self-efficacy, critical thinking, and problem solv-ing skills related to nutrition, physical activity, and cop-ing) [29, 30, 35, 36]. Intervention components includedshort video clips with hands-on activities to reinforceconcepts; interactive dietary software (The Wok); and60min exercise classes (basketball, dodge ball, badmin-ton) weekly for 8 sessions. Study participants were pro-vided with a pedometer, activity diary, and books relatedto physical activity. A one-hour parent workshop wasalso included to provide reinforcement and social sup-port. Theoretical models included the Ecological Modelof Childhood Obesity, Social Cognitive Theory (fivestudies), Transtheoretical model, and Information-Motivation-Behavior Models (Table 3).Among adults, three studies were randomized con-
trolled trials, nine studies were pre-post single-arm in-terventions, and two studies were two-group repeatedmeasures quasi-experimental design (Table 4). Interven-tions included adaptations of the Diabetes PreventionProgram [32, 37, 39, 45] DASH diet [33], a cancer sur-vival program [41], diabetes management programs [43,46, 47], walking programs [38, 40], community-based
Fig. 1 PRISMA Flow Diagram
Beasley et al. BMC Public Health (2020) 20:1019 Page 5 of 25
programs [42], tai chi [44], and an intervention to in-corporate more brown rice in the diet [31]. Theoreticalmodels included Transtheoretical Model, Culture CareTheory, Chronic Care model, Theory of reasoned action,Orem’s theory of self care, Empowerment model, RE-AIM, Social Cognitive Theory, and traditional ChineseMedicine principles (Table 4).
Intervention effectivenessAmong children/adolescents, sufficient data were avail-able for meta-analysis for BMI, WHR, SBP, and DBP.The pooled effect including five studies did not showsignificant changes in BMI (effect size = − 0.27 kg/m2;
(95%CI -0.91, 0.36) (Fig. 4a). For WHR, there were alsono significant changes over time between groups, (twopooled studies with an effect size − 0.01 (95%CI -0.03,0.00). There was also no significant effect of interventionin terms of changes in SBP or DBP as the pooled effectacross three studies was − 3.41 mmHg (95%CI -9.40,2.58) and − 4.58 mmHg (95%CI -9.56, 0.41), respectively.Results did not substantively change in sensitivity ana-lyses using 0.5 and 0.8 as the correlation between base-line and follow-up measures (data not shown). For theother outcomes of interest (WC, LDL, HDL, and FBG)(Table 5), just one study reported findings, and statisti-cally significant differences were only reported for HDL.
Table
1Stud
ycharacteristics,childrenandadolescents
Autho
r,year
(ref)
Setting
Recruitm
entstrategy
Datacollection
perio
dEnrollm
ent
(n)
%Female
Age
rang
e,years
Age
,years
(Mean,
SD)
Immigratio
nhistorya
Interven
tion
(D,PA,
D&P
A)b
Interven
tion
Duration
Che
n2008
[34]
Urban,San
Francisco,CA,
USA
Chine
secommun
itysourcesandafter-scho
olprog
rams
Novem
ber
2005–
Decem
ber
2006
5750.9
8–10
8.8(SD=
0.8)
NR
D&P
A6mon
ths
Che
n2010
[27]
Urban,San
Francisco,CA,
USA
Chine
selang
uage
prog
rams
Septem
ber
2006–
Decem
ber
2008
6743.3
8–10
8.97
(SD=
0.89)
SL-ASIA:2.38(SD=0.69)
sugg
estin
glow
accultu
ratio
n
D&P
A2mon
ths
Che
n2011
[28]
Urban,San
Francisco,CA,
USA
Con
venien
cesamplingfro
mcommun
ityprog
rams
Octob
er2007–
May
2009
5446
12–15
12.5
(SD=3.2)
SL-ASIA:2.13(SD=0.51),
sugg
estin
glow
accultu
ratio
n
D&P
A2mon
ths
Che
n2013
[29]
Urban,San
Francisco,CA,
USA
Providersin
aprim
arycare
clinicrecruited
participants
NR
4137
7–12
NRa
SL-ASIA:1.99(SD=0.48),
indicatin
glow
accultu
ratio
n
D&P
A2mon
ths
Che
n2015
[35]
Urban,San
Francisco,CA,
USA
Providersin
aprim
arycare
clinicrecruited
participants
NR
70~20
7–12
9.5(SD=
1.6)
SL-ASIA:2.01(SD=0.52),
indicatin
glow
accultu
ratio
n
D&P
A2mon
ths
Che
n2016
[36]
Urban,San
Francisco,CA,
USA
Providersin
aprim
arycare
clinicrecruited
participants
NR
115
307–12
9.5(SD=
1.5)
SL-ASIA:2.05(SD=0.56),
indicatin
glow
accultu
ratio
n
D&P
A2mon
ths
Che
n2018
[30]
Urban,San
Francisco,CA,
USA
Twocommun
ityclinicsthat
have
large
Chine
seAmerican
patient
popu
latio
nrecruitedparticipants.
NR
4042.5
13–18
14.9(SD=
1.7)
NR
D&P
A6mon
ths
Sun
2017
[26]c
Urban;San
Francisco,CA,
USA
Four
NorthernCaliforniaHeadStartProg
rams
intheSanFranciscoBayArea:
NR
32100
3–5
36(SD=
4.9)
SL-ASIA:1.92(SD=0.31)
sugg
estin
glow
accultu
ratio
n.
D&P
A2mon
ths;
measuremen
tat
0,3,
and6mon
ths
a SL-ASIASu
inn-Lew
Asian
self-iden
tityaccultu
ratio
nscale,
bDDiet,PA
Physical
Activity
,NRNot
repo
rted
,SDStan
dard
deviation
c Study
participan
tsinclud
edmothe
rsan
dchild
ren;
child
renrepo
rted
here
Beasley et al. BMC Public Health (2020) 20:1019 Page 6 of 25
Table
2Stud
yCharacteristics,Adu
lts
Autho
r,year
(ref)
Setting
Recruitm
entstrategy
Datacollection
perio
dEnrollm
ent
(n)
%Female
Age
rang
e,years
Age
,years
(Mean,SD
)Im
migratio
nhistorya
Interven
tion
(D,PA,
D&P
A)b
Interven
tion
Duration
Che
sla
2016
[39]
Urban,San
Francisco,CA,
USA
Recruitedthroug
hChine
secommun
itycenters,churches,g
rocery
stores
2015
2564
18+
57.6(14.8)
amon
g9
Mandarin
;54.0(10.8)
amon
g16
English
First-ge
neratio
n(n
=20)
orsecond
-gen
eration
(n=5).
SL-ASIA(M
andarin
Group
):2.1(SD=0.5).
SL-ASIA(Eng
lishGroup
):2.9(SD=0.6)
D&P
A6mon
ths
Chiang
2009
[40]
Massachusetts,
USA
Volunteerswererecruitedfro
mChine
sechurches,the
Chine
seGolde
nAge
Cen
ter,andChine
seou
tpatient
clinics.
NR
128
63Age
minim
umwas
66
73.4(SD=
6.1)
Firstge
neratio
n.Meantim
esince
immigratio
n:Culturally
mod
ified
grou
p(n
=58)=
21.23years
(SD=12.89)
Non
mod
ified
grou
p(n
=70)=
14.74(SD=
9.47)
PA2mon
ths
Den
g2019
[41]
Urban,G
reater
Hou
ston
area,
TX,U
SA
Chine
secancer
survivorsaged
18+were
recruitedthroug
hem
ails,p
ress
releases,
localC
hine
sene
wspapers,and
anno
uncemen
tsat
localTVprog
rams.
Janu
ary2013
toJanu
ary2014
5578
19–91
61.7(SD=
11.8)
Firstge
neratio
n.Mean
timesinceim
migratio
n:22.2years(SD=11.6)
D&PA
50weeks
Lee
2017
[38]
Urban
(Korean-
Chine
sechurch
andamigrant
resource
center);South
Korea
Workerswererecruitedthroug
hpo
sting
anddistrib
utionof
fliersat
3Ko
rean
Chine
sechurches,a
migrant
resource
center,and
Korean
Chine
semarkets.A
pastor’sanno
uncemen
tof
thestud
yat
theen
dof
aSund
ayserviceandwordof
mou
thwerealso
used
torecruit
participants.
Janu
aryto
June
2013
fortheST
grou
pandApril
toAug
ust2014
fortheET
grou
p.
132
100
40–65
56.4(SD=
5.1)
Meandu
ratio
nof
stay
inKo
reawas
102.90
±68.08
mon
ths(abo
ut8.5years)
PA6mon
ths(3
mon
thadop
tionand
3mon
thmainten
ance)
Lu2014
[42]
Urban;Boston,
MA,U
SAAds
wereplaced
inlocalm
edia,and
fliers
weresent
tone
ighb
oringprim
arycare
practices.
mem
bersof
theprog
ram
betw
een
Janu
ary2011–
Decem
ber2011
9958
61–83
70.6(SD=
5.8)
NR
D&P
A6mon
ths
Sun
2012
c
[43]
Urban;San
Francisco,CA,
USA
Con
venien
cesampleof
mem
bersof
Chine
seCom
mun
ityHealth
Partne
rsand
Chine
seCom
mun
ityHealth
Research
Cen
ter’s
gene
ralh
ealth
education
prog
ram.
NR
2752.2
NR
360–69yo;
1270–79yo;
580–89yo;
3 undisclosed
NR
D&P
A6mon
ths
Taing
2017
[37]
Urban;Sydne
y,Australia
16Mandarin
-spe
akingge
neralp
racti-
tione
rs(GPs)practicingwith
intheCen
tral
Sydn
eyGen
eralPracticeNetworkwerere-
cruitedforthestud
yandtraine
dby
bilin-
guallifestyleofficers(LOs)priorto
screen
ingpo
tentialp
articipants.The
two
bilingu
alLO
sinclud
edadietitian
andan
NR
7856.4
50–65
55.5(SD=
4.1)
NR
D&P
A12
mon
ths
Beasley et al. BMC Public Health (2020) 20:1019 Page 7 of 25
Table
2Stud
yCharacteristics,Adu
lts(Con
tinued)
Autho
r,year
(ref)
Setting
Recruitm
entstrategy
Datacollection
perio
dEnrollm
ent
(n)
%Female
Age
rang
e,years
Age
,years
(Mean,SD
)Im
migratio
nhistorya
Interven
tion
(D,PA,
D&P
A)b
Interven
tion
Duration
exercise
physiologistthat
weretraine
din
health
coaching
,group
prog
ram
delivery
andstandardised
data
collectionused
for
evaluatio
n.Chine
seindividu
alswere
screen
edandreferred
tothisstud
yby
theirGP.Aspartof
thescreen
ingandre-
ferralprocess,GPs
administeredtheAUS-
DRISK
assessmen
ttool
tode
term
inethe
person
’sriskof
developing
diabetes
with
infiveyears.Allindividu
alsat
high
riskhadbloo
dteststo
exclud
eun
diag-
noseddiabetes.Tho
sewith
outun
diag-
noseddiabetes
who
weremed
ically
clearedby
theirGPs
werereferred
tothe
stud
y.
Taylor-
Piliae
2006
[44]
Urban;San
Francisco,CA,
USA
Subjectswererecruitedfro
mthe
commun
itycenter
incoho
rts,lim
itedto
20pe
rgrou
p,to
ensure
individu
alattention.
NR
3969.2
NR
65.7(SD=
8.3)
NR
PA3mon
ths
Wang
2019
[45]
Urban;M
idwest
city,U
SAEthn
icallyChine
seem
ployeesat
anurban
caterin
gcompany
worksite
were
screen
edforT2DM
riskfactorsusinga
Chine
seversionof
theCanadianDiabe
tes
Risk
Assessm
entQuestionn
aire
(CANRISK).
NR
683.3
NR
NR
Firstge
neratio
n.The
majority
werefro
mmainlandChina
and
immigratedto
theUS
with
inthepast5–10
yearsof
stud
yen
rollm
ent.
D&P
A3mon
ths
Wang
2013
[31]
Urban;N
ewYo
rk,N
Y,USA
Allparticipantswereethn
icallyChine
seattend
ingamed
icalpracticelocatedin
thene
ighb
orho
odof
Flushing
inNew
York
City.W
escreen
edalargedatabase
ofpatientsattend
ingtheclinic(abo
ut500),from
which
100patientswere
selected
basedon
theexclusion/inclusion
criteria
detailedin
metho
dsand
rand
omlyassign
edto
either
brow
nrice
(n¼
49)or
white
rice(n
¼51)grou
ps
NR
100
67NR
Mean(SD)
forwhite
rice:50
(9)
andbrow
nrice:55
(9)
NR
D3mon
ths
Wang
1998
[46]
Urban;
Hon
olulu,
Haw
aii,USA
Com
mun
itycenter
(“Golde
nAge
rAssociatio
n”)
NR
3652
51–96
71.8(SD=
9.6)
NR
D&P
A12
mon
ths
Wang
2005
[47]
Urban;
Hon
olulu,
Haw
aii,USA
recruitedfro
mChine
seAmerican
social
club
s,religious
organizatio
ns,clinics,
referralsfro
mprivateph
ysicianoffices,
andne
wspaper
advertisem
ents
NR
4051.5(of33
participants)
NR
68.8(SD=
10.1)
Meanleng
thof
timein
theUS(n
=33):16.5
(SD=9.3)
D10
weeks
Beasley et al. BMC Public Health (2020) 20:1019 Page 8 of 25
Table
2Stud
yCharacteristics,Adu
lts(Con
tinued)
Autho
r,year
(ref)
Setting
Recruitm
entstrategy
Datacollection
perio
dEnrollm
ent
(n)
%Female
Age
rang
e,years
Age
,years
(Mean,SD
)Im
migratio
nhistorya
Interven
tion
(D,PA,
D&P
A)b
Interven
tion
Duration
Yeh
2016
[32]
Urban;N
ewYo
rk,N
Y,USA
Chine
seAmerican
Inde
pend
entPractice
Associatio
n(CAIPA),in
collabo
ratio
nwith
theChine
seCom
mun
ityPartne
rshipfor
Health
ofNew
York
Presbyterian-Lower
Manhattan
Hospital(form
erlynamed
New
York
Dow
ntow
nHospital).
2012–2013
6056.7
NR
Mean
(SD)Con
trol:
60.9(12.2)
Interven
tion:
56.8(9.5)
NR
D&P
A12
mon
ths
Zou
2017
[33]
Urban;G
reater
TorontoArea,
Canada
Amon
gthe618Chine
seCanadians
who
participated
inbloo
dpressure
screen
ing,
105(17.0%
)individu
alswereeligibleto
participatein
thispilottrial.Amon
gthese
105individu
als,60
(57.1%
)agreed
toparticipateandwererecruited.
NR
6051.7
NR
62.0years
(SD=11.2)
Meannu
mbe
rof
years
livingin
Canadawas
9.2
(SD=6.2)
D&P
A5weeks;p
reandpo
sttest
follow-upat
8weeks
a SL-ASIASu
inn-Lew
Asian
self-iden
tityaccultu
ratio
nscale,
bDDiet,PA
Physical
Activity
,NRNot
repo
rted
,SDStan
dard
deviation
c Study
participan
tsinclud
edmothe
rsan
dchild
ren;
mothe
rsrepo
rted
here
Beasley et al. BMC Public Health (2020) 20:1019 Page 9 of 25
Fig. 2 a and b. Risk of Bias Assessment, Children and Adolescents
Fig. 3 a and b. Risk of Bias Assessment, Adult
Beasley et al. BMC Public Health (2020) 20:1019 Page 10 of 25
Table
3Interven
tioncharacteristics,children
Autho
r,year
(ref)
Stud
yde
sign
aInterven
tiongrou
pconten
tCom
parison
grou
pconten
tInterven
tiongrou
pde
livery
Com
parison
grou
pde
livery
Theo
reticalBasis
CulturalStrateg
ies
Major
Cardiometabolic
Find
ings
b
Che
n2008
[34]
pre-po
stsing
learm
Tailoreded
ucational
materialson
nutrition
,ph
ysicalactivity,and
healthyweigh
tmainten
ance
basedon
baselineassessmen
tof
theirchildren’sweigh
t,diet,and
physical
activity.Paren
tswere
instructed
tofollow
the
recommen
datio
nsand
shareinform
ationwith
theirchildren.
NA
Mothe
rsweremailed
oneed
ucationalp
ackage
totheirho
mes.
Researcherscalled
parentsto
ensure
mailed
materialswere
unde
rstood
.
NA
Ecolog
ical
Mod
elof
Childho
odObe
sity
Preven
tion
(Davison
and
Birch,2001)
Materialsweremod
ified
tobe
compatib
lewith
Chine
seandChine
seAmerican
cultu
re.
Researcherswere
bilingu
alandbicultu
ral,
andinform
ation
presen
tedto
the
mothe
rswas
inChine
seandEnglish.
BMId
eclined
sign
ificantlyam
ong
childrenwho
werein
theoverweigh
tcatego
ryat
baseline(p
=0.01).
Che
n2010
[27]
RCT
ABC
Interven
tion:In
sessions,childrenspen
t15
min
onph
ysical
activities
and30
min
werefocusedon
children’sknow
ledg
eregardingnu
trition
and
physicalactivity
and
reinforced
theno
tionof
self-efficacyregarding
food
choicesandalter-
natives
tohigh
-fatand
high
-sug
arfood
sand
television
view
ing.
Theparent
interven
tion
includ
edaworkboo
k,vide
oclipsand
discussion
oftechniqu
es.
Wait-listcontrolg
roup
participated
indata
collectionactivities
atthesametim
eas
the
interven
tiongrou
p.
Smallg
roup
weekly
sessionactivities
for
children,andtw
osm
all
grou
pworksho
psfor
parents.Children
received
afood
diary,
books,andaweekly
packet
ofmaterials.
After
completingthe
finalfollow-upassess-
men
t,thecontrolg
roup
received
theABC
stud
yinterven
tion.
SocialCog
nitive
Theo
ry(Bandu
ra)
Worksho
pswereledby
bicultu
ral/b
iling
ualstaff.
Materialswereprovided
inbo
thChine
seand
English.
Interven
tionde
creased
body
massinde
xand
diastolic
bloo
dpressure.
Che
n2011
[28]
RCT
Web
-based
tailored
prog
ram
includ
ing
activities
toim
prove
nutrition
,physical
activity,and
coping
.
Web
-based
gene
ral
health
inform
ation
relatedto
nutrition
,de
ntalcare,safety,
common
derm
atolog
ycare,and
risk-taking
behaviors
8weeklyon
linesessions
foradolescents;315
min
lesson
sforparents
8weeklyon
line
sessions
foradolescents;
315
min
lesson
sfor
parents
Transthe
oretical
Mod
el–Stage
sof
Chang
eand
socialcogn
itive
theo
ry.
Interven
tionde
livered
inEnglishto
adolescents
andin
Englishand
Chine
seto
parents;
Interactivedietary
softwareprog
ram
(The
Wok)tailoredto
common
Chine
sefood
s.
Interven
tionde
creased
waist-to-hipratio
and
diastolic
bloo
dpressure
Che
n2013
[29]
pre-po
stwith
historical
comparison
grou
p
iStartSm
art(edu
catio
nal
play-based
activities
teaching
self-efficacy,
criticalthinking,
and
prob
lem
solvingskillsre-
latedto
nutrition
,phys-
icalactivity,and
coping
).Shortvide
oclipswith
Historicalcontrolg
roup
with
weigh
t,he
ight,
andbloo
dpressure
measuredas
thesame
intervalas
childrenin
iStartSm
art.
Parentsandchildren
met
separatelyforsm
all-
grou
psessions.8-w
eekly,
1.5hsessions
forchil-
dren
;asing
le1-hparent
worksho
p.
NA
Socialcogn
itive
theo
ry(Bandu
ra2004)
Interven
tionde
livered
inEnglishto
childrenand
inEnglishandChine
seto
parents.;Interactive
dietarysoftw
are
prog
ram
(The
Wok)
tailoredto
common
Chine
sefood
s
Interven
tionredu
ced
BMIand
BPin
overweigh
tandob
ese
children,andim
proved
know
ledg
eandself-
efficacyrelatedto
nutrition
.
Beasley et al. BMC Public Health (2020) 20:1019 Page 11 of 25
Table
3Interven
tioncharacteristics,children(Con
tinued)
Autho
r,year
(ref)
Stud
yde
sign
aInterven
tiongrou
pconten
tCom
parison
grou
pconten
tInterven
tiongrou
pde
livery
Com
parison
grou
pde
livery
Theo
reticalBasis
CulturalStrateg
ies
Major
Cardiometabolic
Find
ings
b
hand
s-on
activities
toreinforceconcep
ts;Inter-
activedietarysoftware
(The
Wok);60
min
exer-
cise
classes(basketball,
dodg
eball,badm
inton)
weeklyfor8sessions;
Provided
pedo
meter,ac-
tivity
diary,andbo
oks
relatedto
physicalactiv-
ity.O
ne1-hparent
worksho
pto
provide
reinforcem
entandsocial
supp
ort.
Che
n2015
[35]
pre-po
stsing
learm
iStartSm
art(based
onmod
ificatio
nsto
theABC
prog
ram
develope
dpreviouslyby
thefirst
author
andthenatio
nal
WeCan!(Waysto
EnhanceChildren’s
Activity
&Nutrition)
prog
ram
develope
dby
theNationalInstituteof
Health
)
NA
Weeklyclassroo
mactivities
combine
dwith
60min
ofeach
classin
physicalactivity
for
children.Childrenalso
received
ape
dometer,
activity
diary,andbo
oks
relatedto
physical
activity.The
ywere
encouraged
todo
cumen
ttheir
pedo
meter
readings
and
challeng
ethem
selves
toachieve10,000
step
sa
day.
Med
icalcare
was
integrated
into
the
prog
ram
throug
hindividu
alized
weigh
tmanagem
entsupe
rvised
byape
diatricianat
sche
duledmed
icalvisits
durin
gthecurriculum
,andat
structured
follow-
upintervals.Thepro-
vide
radvisedthefamily
regardingthepatient’s
riskforCVD
inthecon-
text
ofthelifestylebe
-haviors,labo
ratory
values,and
family
history.
NA
Socialcogn
itive
theo
ry(Bandu
ra2004)
Childrens’intervention
sessions
wereledby
abicultu
ral,bilingu
alresearch
assistant.The
parent
worksho
pwas
cond
uctedin
Cantone
seandEnglishand
discussedbo
thChine
seandwestern
diets.
Average
BMIp
ercentile
decreasedfro
m94.6
(SD=7.4)
to93.4(SD=
8.2).Sim
ilarredu
ctionof
waist/hip
ratio
and
bloo
dpressure
were
also
foun
dat
6mon
thfollow
up.
Beasley et al. BMC Public Health (2020) 20:1019 Page 12 of 25
Table
3Interven
tioncharacteristics,children(Con
tinued)
Autho
r,year
(ref)
Stud
yde
sign
aInterven
tiongrou
pconten
tCom
parison
grou
pconten
tInterven
tiongrou
pde
livery
Com
parison
grou
pde
livery
Theo
reticalBasis
CulturalStrateg
ies
Major
Cardiometabolic
Find
ings
b
Che
n2016
[36]
pre-po
stsing
learm
Childrens’w
eekly
worksho
psinclud
eda
health
curriculum
and
physicalactivity.The
parent
worksho
psaimed
toincrease
parents’
know
ledg
eandskills
regardinghe
althyfood
prep
aration,active
lifestyleandmaintaining
ahe
althyweigh
ttailored
tothene
edsof
each
family.The
prog
ram
also
includ
edafield
trip
toa
localg
rocery
store.
NA
Thechildren’sprog
ram
includ
ed60
min
ofinteractivehe
alth
curriculum
and60
min
ofph
ysicalactivity
each
week.Theparent
worksho
pdiscussed
both
Chine
seand
Western
dietsandways
toincrease
physical
activity
inurban,
unde
rresou
rced
commun
ities.
NA
Socialcogn
itive
theo
ry(Bandu
ra2004)
Childrens’intervention
sessions
wereledby
abicultu
ral,bilingu
alresearch
assistant.The
parent
worksho
pwas
cond
uctedin
Cantone
seandEnglishand
discussedbo
thChine
seandwestern
diets.
Sign
ificant
redu
ctionof
BMI,waist/hip
ratio
,and
systolicbloo
dpressure
at6-mon
thfollow-up.
Inadditio
n,sign
ificant
im-
provem
entof
high
-de
nsity
lipop
rotein
chol-
esteroland
decrease
intriglycerid
ewerefoun
dat
6-mon
thfollow-up.
Che
n2018
[30]
RCT
Participants(1)used
asensor
totrackph
ysical
activity
anddiet
forsix
mon
ths,(2)re
view
edeigh
ton
lineed
ucational
mod
ules
forthree
mon
ths,andthen
mod
ules,(3)received
tailored,
biweeklytext
message
sforthree
mon
ths.
Participants(1)used
anOmronH
J-105pe
dom-
eter
andablankfood
-and-activity
diaryto
record
forthree
mon
ths;(2)re
view
edeigh
ton
linemod
ules
relatedto
gene
ralado
-lescen
the
alth
issues
Sequ
entialstage
s;wearablesensor
for6
mon
ths,then
review
edeigh
ton
lineed
ucational
mod
ules
forthree
mon
ths,and,
after
completingthemod
ules,
received
tailored,
biweeklytext
message
sforthreemon
ths
Ado
lescen
tswereasked
totrackandrecord
physicalactivity,
sede
ntaryactivity,and
food
intake
inadiary
forthreemon
thsand
wereaskedto
access
anon
lineprog
ram
that
consistedof
eigh
tmod
ules
relatedto
gene
ralado
lescen
the
alth
issues
Socialcogn
itive
theo
ry(Bandu
ra2004)
Materialsinclud
edconcep
tsandbe
liefs
with
regard
toprom
otingbalancein
health
inChine
seand
food
exam
ples
that
are
consistent
with
Chine
sepractices
andWestern
dietarypractices.
Interven
tionredu
ced
BMI,sugary
beverage
,TV
andcompu
tertim
eand
increasedself-efficacyin
nutrition
andph
ysical
activity
sign
ificantly
morethan
thosein
the
controlg
roup
.
Sun
2017
[26]
RCT
Family-cen
tered
mod
ules
were
develope
das
atablet-
baseded
ucationaltoo
ladaptedfro
mexistin
gprog
rams.Thesepro-
gram
scontaine
drecom-
men
datio
ns(5
servings
fruits
andvege
tables,4
cups
water,3
servings
dairy,2
hscreen
time,1
hph
ysicalactivity,0
sug-
arydrinks)forchildren
andfamilies
toachievea
healthylifestyle..
Weeklymailings
ofprintedhe
alth
inform
ation(e.g.,food
safety,cho
king
hazards,
oralhe
alth)
Interven
tionconsistedof
8weekly30-m
in,inter-
active,Cantone
se,edu
-catio
nalm
odules
delivered
viatablet.Six
ofeigh
tlesson
swere10
to15-m
inanim
ated
shortvide
osin
Canton-
ese,andtw
olesson
swerein
atalkshow
for-
mat
hosted
byabilin-
gualregistered
dietitian.
Weeklymailings
over
an8-weekpe
riod
Inform
ation–
Motivation–
Behavior
(IMB)
mod
el
Registered
dietitiansand
health
educatorswrote
lesson
scrip
tsin
English
which
werethen
translated
into
Chine
seby
anexpe
rienced
translator
onthe
research
team
.
Interven
tionredu
ced
maternalb
odymass
inde
x,waist
circum
ference,and
improved
maternal
eatin
gstyleandself-
efficacyforprom
oting
healthyeatin
g.
a RCT
Rand
omized
,con
trolledtrial,bBM
IBod
ymassinde
x
Beasley et al. BMC Public Health (2020) 20:1019 Page 13 of 25
Table
4Interven
tioncharacteristics,adults
Autho
r,year
(ref)
Stud
yde
sign
Interven
tiongrou
pconten
tCom
parison
grou
pconten
tInterven
tiongrou
pde
livery
Com
parison
grou
pde
livery
Theo
reticalBasis
CulturalStrateg
ies
Major
Find
ings
Che
sla
2016
[39]
sing
le-group
repe
ated
-measures
Adapted
Group
Lifestyle
Balance(GLB)curriculum
:Culturaladaptationof
thecurriculum
was
cond
uctedover
6mon
thsby
ateam
ofnu
rses,a
psycho
logist,
andasocialworkerfro
macommun
ityagen
cythat
serves
new
Chine
seim
migrants.
NA
(a)acore
phase,
consistin
gof
12weekly
sessions
over
3mon
ths;
(b)atransitio
nph
ase,
consistin
gof
4sessions
ofde
creasing
frequ
ency
over
3mon
ths
NA
NR
Culturaladaptation
involved
asession-by-
sessionreview
ofed
uca-
tionconcep
ts,activation
strategies,and
behav-
ioralexamples.Three
first-gen
erationbilingu
alnu
rseresearch
assistants
(RAs)translated
theGLB
participanthand
outs,in-
corporatingthemod
ifi-
catio
nsrecommen
ded
bytheresearch
team
.Translations
ofpartici-
pant
hand
outswere
checkedforapprop
riate
diabetes
lang
uage
and
concep
tsby
aseparate
commun
itycertified
dia-
betesed
ucator,w
howorkedin
ahe
alth
agen
cythat
serves
Chin-
eseim
migrants.Treat-
men
tsessions
were
facilitated
byfirstge
ner-
ationbilingu
al/bicultural
nurseRA
swho
were
traine
din
theGLB
prog
ram.
5.4%
weigh
tloss
at6
mon
thsof
thestud
y.Totaland
low-den
sity
lipop
rotein
cholesterol
improved
.The
rewere
nostatisticallysign
ificant
change
sin
fasting
plasmaglucoseor
A1C
levels.
Chiang
2009
[40]
two-grou
prepe
ated
measures
quasi-
expe
rimen
tal
design
Walking
prog
ram
mod
ified
toem
phasize
theChine
secultu
ral
valueof
authority,fam
ilymem
bers’involvemen
t,harm
ony,andbalance.
Non
cultu
rally
mod
ified
walking
prog
ram.
NR
NR
Transthe
oreticalMod
elandCulture
CareTheo
ryThisstud
yintentionally
adde
dChine
secultu
reto
onlyon
eof
the
grou
ps.
Thewalking
prog
ram
hadno
sign
ificant
effects
onbloo
dpressure
orwalking
endu
rance.
Den
g2019
[41]
sing
le-group
,pre-po
sttest
design
Aho
me-baseddiet
and
exercise
interven
tionthat
was
design
edto
im-
provetheph
ysicalfunc-
tionof
cancer
survivors.
RENEW
materialswere
translated
into
Mandarin
Chine
se(REN
EW-C)with
additio
nalP
Aanddietary
inform
ationto
ensure
that
theinform
ationis
cultu
rally
approp
riate.
NA
Participantsen
gage
din
a50-w
eekprog
ram
that
consistedof
(1)pe
rson
-allytailoredworkboo
kandseriesof
quarterly
newsletters,(2)
4con-
sultatio
nsessions
con-
ducted
byregistered
dietitianswho
review
edthedietarylesson
sand
prob
lem-solve
with
sur-
vivors,(3)
13teleph
one
NA
Socialcogn
itive
theo
ry/
Transthe
oreticalmod
elTheRENEW
materials
weretranslated
into
Mandarin
Chine
se.
(REN
EW-C)w
ithadditio
nalP
Aand
dietaryinform
ationto
ensure
that
the
inform
ationwas
cultu
rally
approp
riate.A
focusgrou
pwas
held
toevaluate
the
approp
riatene
ssand
After
theinterven
tion,
participantsconsum
edhigh
ernu
mbe
rof
servings
ofvege
tables
anden
gage
din
PAmorefre
quen
tly;m
ore
participantsfellwith
inthehe
althyweigh
trang
e.Participants
show
edlower
limitatio
nin
doingtheirworkor
othe
ractivities
dueto
Beasley et al. BMC Public Health (2020) 20:1019 Page 14 of 25
Table
4Interven
tioncharacteristics,adults(Con
tinued)
Autho
r,year
(ref)
Stud
yde
sign
Interven
tiongrou
pconten
tCom
parison
grou
pconten
tInterven
tiongrou
pde
livery
Com
parison
grou
pde
livery
Theo
reticalBasis
CulturalStrateg
ies
Major
Find
ings
RENEW
-Cgo
alsforeach
dayareto
(1)walkat
least30
min,(2)
eatat
least3servings
offru
its,
(3)eatat
least4servings
ofvege
tables,(4)
eatno
morethan
20gof
satu-
ratedfat,and(5)usethe
“Propo
rtionDoctor”tool.
coun
selingand4
prom
ptscond
uctedby
traine
dLSAstaffandvol-
unteers.Ph
onecoun
sel-
ingandprom
ptswere
design
edto
enhanceso-
cialsupp
ortandself-
efficacy,mon
itorpro-
gress,iden
tifybarriers,
andexploreresources
acceptability
ofRENEW
-Cmaterials.The
sugg
ested
food
sandcorrespo
nding
caloric
andfatconten
tsin
theworkboo
kwere
change
dto
accommo-
date
thedietaryhabits
ofChine
seAmericans.
physicalhe
alth
orem
otionalp
roblem
sand
encoun
teredless
expe
rienceof
psycho
logicald
istress
andsocial/role
incapacity.
Lee
2017
[38]
two-grou
p,repe
ated
measures
quasi-
expe
rimen
tal
design
Overa12
weekpe
riod,
1)motivationaltext
message
sto
encourage
walking
weresent
weekly;2)
Mob
ileph
one
cartoo
nillustrations
tohe
lpcultu
raladaptation
weresent
once
every2
weeks;3)Participants
texted
theprog
ram
offices
every2weeks
with
theirdaily
step
sfor
thepriorweek.4)Atext
message
repo
rtwas
sent
atweeks
4and8with
ane
wsugg
estedstep
goal.D
uringweeks
13–
24,nointerven
tionwas
provided
,but
wom
encontinuedto
text
their
step
coun
tsevery4
weeks.
1)Tw
oface-to-face
meetin
gswith
anu
rse
interven
tionist2)Walking
manual,ape
dometer,a
walking
step
goal,and
awalking
step
diary.3)Par-
ticipantscalledthepro-
gram
offices
every2
weeks
torepo
rttheir
daily
step
sfortheprior
week.4)
Aregistered
nursespoketo
wom
enon
theph
oneand
review
edandadjusted
theirstep
goalsat
weeks
4and8.5)
At12
weeks,
wom
enmet
with
the
nurseinterven
tionistto
discussandadjuststep
goals.Duringweeks
13–
24,nointerven
tionwas
provided
,but
wom
encontinuedto
calltheir
step
coun
tsevery4
weeks.
Foreach
stud
yarm,the
principal
investigator
(PI)provided
training
sessions
totheinterven
tionistsforthe
individu
almeetin
gsbasedon
the
interven
tionmanual.ThePI
directly
observed
theinterven
tionistforthe
first4to
5sessions
andpe
riodically
thereafter
topreven
tdrift.The
interven
tionistwho
delivered
thecalls
totheST
participantsreceived
training
from
thePI
onsettingstep
goalsand
how
tolim
itthecallto
justproviding
thestep
goal.Ind
ividualm
eetin
gs,
phon
ecalls
toparticipants,and
text
message
swererecorded
ina
spreadsheetandmon
itoredweeklyby
thePI.
NR
Themob
ileph
one
cartoo
nswerebasedon
exitinterviewswith
the
21Ko
rean
Chine
sewom
en.The
ywere
asked,
“Whatkind
ofinform
ationregarding
everyday
lifewou
ldhe
lpyouwith
adjustingto
theKo
rean
cultu
re?”A
graphicde
sign
erused
theinform
ationto
draw
illustrations
with
cartoo
ncaptions
ofatypical
daily
encoun
terthat
presen
tedan
issue
relatedto
adjustingto
theirne
wcultu
re.The
illustrations
includ
edwom
enlearning
abou
t(1)thepo
intcard
system
utilizedin
atypical
Korean
grocerystore,(2)
laun
derin
ganddry-
cleaning
labe
ls,(3)
orde
r-ingcoffeeor
drinks
incommon
cafes,(4)com-
mun
icationskills,(5)the
meaning
ofSPFsun-
screen
,and
(6)nu
tri-
tionalvalueson
food
labe
ls.
Asign
ificant
decrease
was
foun
din
10-yearrisk
forcardiovascular
dis-
ease
(CVD
),bloo
dpres-
sure,fastin
gglucose,
body
massinde
x,and
waist-hip
ratio
atweeks
12and24
inbo
thgrou
ps,b
uttherewere
nosign
ificant
grou
pdifferences.
Lu2014
[42]
sing
le-group
repe
ated
-measures
6-mon
thprog
ram
providingexercise,
nutrition
al,cou
nseling
andsocialsupp
ortto
commun
ityreside
nts
NA
Halfo
ftheparticipants
attend
edat
least70%
ofthe1-hed
ucationses-
sion
with
ameanat-
tend
ance
of17
(63%
)
NA
Wagne
r’s(1998)
chronic
Caremod
eland
multifaceted
approach
1)Interven
tionlocatio
nwas
conven
ient
toelde
rlyChine
seim
migrants;2)Bilingu
alandbicultu
ralstaff
Sign
ificant
decrease
inbo
dyweigh
t,BM
I,systolicanddiastolic
bloo
dpressure.
Beasley et al. BMC Public Health (2020) 20:1019 Page 15 of 25
Table
4Interven
tioncharacteristics,adults(Con
tinued)
Autho
r,year
(ref)
Stud
yde
sign
Interven
tiongrou
pconten
tCom
parison
grou
pconten
tInterven
tiongrou
pde
livery
Com
parison
grou
pde
livery
Theo
reticalBasis
CulturalStrateg
ies
Major
Find
ings
with
chronicdiseases
andmen
talh
ealth
issues.1)6-mon
thmem
-be
rshipto
theYM
CA
was
provided
forano
m-
inalfeebasedon
in-
come.2)
Participants
met
with
aYM
CAcare
manager
weeklyfora1-
hhe
alth
education
prog
ram.
times
outof
atotalo
f27
sessions.Seven
ty-five
per
cent
oftheparticipants
completed
atleast46
exercise
visitsto
YMCA
durin
ga6-mon
thpe
riod,
with
amean
valueof
69.4tim
espe
rpe
rson
,which
translates
into
anaverageof
11.6
times
perpe
rson
per
mon
th.
delivered
interven
tion;3)
Redu
cedpriceYM
CA
mem
bershipto
increase
access
forlow
income
participants;4)Prim
ary
care
physicians
referred
patientsto
theprog
ram
Sun
2012
[43]
sing
le-group
repe
ated
-measures
1)12
biweekly90-m
insupp
ortgrou
psessions
ledby
amultid
isciplin-
ary,bilingu
alteam
;2)A
bilingu
al67-pagebo
ok-
letde
velope
dby
CCHRC
titled“Diabe
tesManage-
men
t”was
provided
toparticipants.
NA
Prog
ram
was
implem
entedin
a6-
mon
thpe
riod.
Prog
ram
educatorsmadefollow-
upreminde
rcalls
toen
-courageattend
ance
and
answ
erparticipants’
questio
ns.H
ealth
pro-
motionincentives
were
provided
atno
charge
.Apatient
navigatorwas
available6days
per
weekto
locate
onlinebi-
lingu
alhe
alth
inform
a-tio
nforparticipants,
provideadditio
nalg
uid-
ance
forutilizing
glucose
meters,andconn
ectpar-
ticipantswith
potential
resourcesthat
wou
ldaid
intheirdiabetes
man-
agem
ent.A
commun
ity-
basedparticipatoryre-
search
approach
was
used
toassess
theeffect-
iven
essof
Diabe
tesSelf-
Managem
ent.
NA
Chron
iccare
mod
el,
Theo
ryof
reason
edactio
n,andSocial
Cog
nitiveTheo
ry
Allinstructionalm
aterials
werewrittenat
aChine
selaym
anfourth-
gradelevel.To
ensure
in-
form
ationwas
cultu
rally
approp
riate,p
rogram
ed-
ucatorsincorporated
Chine
secommon
lyprac-
ticed
activities
andfood
itemsinto
theed
uca-
tionalcurriculum
andin-
person
sessions.The
classcurriculum
and
hand
outswerefocus
grou
ptested
with
the
target
popu
latio
n.Clas-
seswerehe
ldin
amed
-icalofficebu
ildingin
San
FranciscoChinatown,all
activities
werecon-
ducted
inCantone
se,
andparticipantswere
givenabilingu
albo
okon
diabetes
managem
ent.
Statisticallysign
ificant
increasesin
glycem
iccontroland
diabetes
know
ledg
e.At6mon
ths
afteren
rollm
ent,42.1%
(n=8)
ofthe
participantshada
clinicalsign
ificant
glycem
iccontrol
improvem
entby
achieving≥1.0%
decrease
inA1C
;31.6%
(n=6)
hadslight
improvem
entsin
A1C
(<1.0%
decrease);and
26.3%
(n=5)
hadno
improvem
entor
increase
inA1C
(≤0.0%
decrease)
from
baseline.
Statisticallyinsign
ificant
differences
wereshow
nin
diabetes
managem
ent
practices.Secon
dary
outcom
esassessed
participants’p
erceived
diabetes
managem
ent
andem
otionaland
socialsupp
ort
Taing
2017
[37]
sing
le-group
repe
ated
-measures
Prom
oted
:1)Increasing
amou
ntof
mod
erateto
vigo
rous
intensity
aerobic(150
min/w
eek)
andprog
ressive
resistance
training
(60
min/w
eek)to
210min/
NA
Assistedteleph
one
interview
survey
was
completed
atbaseline
and12
mon
ths;2)1.5-h
individu
alinitial
consultatio
nwith
interven
tionist.2)Three
NA
NR
Con
sultatio
nswith
anAdvisoryGroup
resulted
in1)
Con
ductingthe
prog
ram
entirelyin
Mandarin
;2)Translatin
gallresou
rces
and
materialsto
Mandarin
;3),
Waistcircum
ference,
totalcho
lesterol
andfat
intake
sign
ificantly
improved
at12-m
onths.
Beasley et al. BMC Public Health (2020) 20:1019 Page 16 of 25
Table
4Interven
tioncharacteristics,adults(Con
tinued)
Autho
r,year
(ref)
Stud
yde
sign
Interven
tiongrou
pconten
tCom
parison
grou
pconten
tInterven
tiongrou
pde
livery
Com
parison
grou
pde
livery
Theo
reticalBasis
CulturalStrateg
ies
Major
Find
ings
week;2)
Redu
cing
percen
ttotalene
rgy
from
fatandsaturated
fatintake
toless
than
30and10%,respe
ctively;3)
Con
sumingat
least15
g/1000
kcalof
dietaryfib
erintake;4)R
educingbo
dyweigh
tby
5%after12
mon
ths.
2-hlifestylegrou
pses-
sion
s;3)Threefollow-up
health
coaching
phon
ecalls,lastin
g20–30min
each,at3,6,and9-
mon
ths4)
Face-to-face
individu
alreview
at12
mon
ths
Havingtw
obilingu
alinterven
tionists.
Taylor-
Piliae
2006
[44]
sing
le-group
repe
ated
-measures
Yang
Style24-posture
short-form
TaiC
hiwas
taug
htby
aninstructor
with
expe
rienceteaching
olde
radu
lts.The
Yang
Style24-posture
short-
form
iseasier
tolear-
nand
remem
berthan
theclassicalY
angstyle
108-po
sturelong
form
,thou
ghstillcontains
the
essentialTaiChi
principles.
NA
1)60-m
inTaiC
hiexer-
cise
class3tim
espe
rweekfor12
weeks,lo-
catedat
thecommun
itycenter;2)Instructio
nto
practiceat
homeat
least
twoo
ther
days;3)C
D-
Romof
theinstructor
perfo
rmingTaiC
higiven
at12-w
eeks.Sub
jects
weremon
itoredfor
safety
with
correctio
nsgivenas
need
ed.
NA
NR
Culturally
relevant
and
approp
riate
form
sof
physicalactivity
and
exercise
may
contrib
ute
tobe
tter
adhe
rence.Tai
Chi
isatradition
alform
ofexercise
amon
gChine
sepo
pulatio
ns.
Interven
tionwas
offered
atcommun
itycenter
inbo
thEnglishand
Cantone
se
Clinicallyandstatistically
sign
ificant
redu
ctions
inbloo
dpressure
atrest
(131/77),and
inrespon
seto
thestep
-test
(164/82)
werefoun
dover
12weeks
ofTC
(p<0.01).Nosign
ificant
change
inhe
artrate
was
observed
.
Wang
2019
[45]
sing
le-group
,pre-po
sttest
design
Amod
ified
andtailored
12-w
eek,DPP
lifestyle
mod
ificatio
ncourse
was
develope
dbasedon
iden
tifiedtopics
from
Chine
seem
ployees
NA
Thecourse
was
adjusted
tobe
delivered
weekly
onan
individu
albasisto
accommod
atedifferent
worksche
dules.The12-
weekcourse
was
deliv-
ered
inChine
seby
the
projectleader;edu
ca-
tionalm
aterialsin
Chin-
esewerehand
edou
tat
each
sessionto
facilitate
learning
.The
course
was
conven
edge
nerally
dur-
ingthefirstshift’slunch
breakor
before
thebe
-ginn
ingof
thesecond
shift.
NA
NR
Educationalm
aterials
weretranslated
into
Chine
seandadjusted
tousecommon
words,
avoidmed
ical
vocabu
lary,b
reak
down
long
senten
cesto
short
phrases,andinclud
epictures
tofacilitate
learning
.
Participantsshow
edan
averageredu
ctionof
nonfastin
gbloo
dglucoseof
30mg/
dL(1.7mmol/L),anda
redu
ctionof
HbA
1cby
0.32
points(3mmol/
mol).
Wang
2013
[31]
RCT
Foreach
stud
yarm
(brownandwhite
rice),all
subjectswereprovided
freerice.Subjectswere
encouraged
toprep
arericeitemsin
theirdaily
mealswith
thefood
itemsprovided
forthe
duratio
nof
thestud
yandthey
werealso
advised
notto
change
theirusualp
atternsof
cookingand
eatin
g.
Foreach
stud
yarm,the
supp
lies
provided
wereen
ough
tomeetthe
calculated
totalene
rgyrequ
iremen
tsfora4-weekpe
riod.
Noricewas
pro-
vide
dforthefamily
orothe
rho
useh
old
mem
bers.
NR
NR
Sign
ificant
decreasesin
weigh
tandsystolicand
diastolic
bloo
dpressure
amon
gbrow
nrice
(interven
tion)
grou
pon
ly.Insulin
andHOMA,
serum
AGEs
and8-
Beasley et al. BMC Public Health (2020) 20:1019 Page 17 of 25
Table
4Interven
tioncharacteristics,adults(Con
tinued)
Autho
r,year
(ref)
Stud
yde
sign
Interven
tiongrou
pconten
tCom
parison
grou
pconten
tInterven
tiongrou
pde
livery
Com
parison
grou
pde
livery
Theo
reticalBasis
CulturalStrateg
ies
Major
Find
ings
isop
rostanede
creased,
whileSIRT1mRN
Ain-
creasedin
thebrow
nricegrou
pas
compared
tothewhite
ricegrou
p
Wang
1998
[46]
sing
le-group
,pre-po
sttest
design
Con
sultatio
nwith
adiabetes
nurseed
ucator
foran
individu
alized
mealp
lan,exercise
plan,
preven
tiveplan
for
hype
rglycemiaand
hypo
glycem
ia,and
foot
care.
NA
Cou
nselingby
diabetes
nurseed
ucator;b
i-weeklychecks
ofbloo
dpressure
and/or
bloo
dglucoseforon
eyear
NA
Orem’stheo
ryof
self-
care
Con
ducted
inChine
se;
individu
alized
mealp
lan
perdietarypreferen
ces
Eigh
type
rcen
tof
participantshad
decreasedtheirdiastolic
bloo
dpressure
from
above95
mmHgto
below
90mmHgand
systolicbloo
dpressure
from
above155mmHg
tobe
low
140mmHg.
Rang
eof
participants’
bloo
dglucoselevelsalso
decreasedfro
m126mg/
dL–277g/dL
to85
mg/
dL–226mg/dL
after
participatingin
the
prog
ram
Wang
2005
[47]
sing
le-group
repe
ated
-measures
Interven
tiontopics
includ
ed1)
Nutrition2)
Exercise
3)Med
ication
compliance;4)Stress
managem
ent;and5)
Foot
andskin
care
activities.
NA
Duringthe10
weeks
oftheprog
ram,fou
rsessions
wereofferedon
different
days
ofthe
weekto
accommod
ate
participants`sche
dules.
Theinvestigator
anda
registered
nurse
delivered
thegrou
psessions
forup
to10
peop
le.
NA
Empo
wermen
tmod
elClasses
werecond
ucted
inCantone
se,M
andarin
,or
Taiwanese.Because
theChine
setranslation
fordiabetes
issugar
urinedisease,many
participantstook
the
term
literallyand
thou
ghtthat
they
hadto
avoidon
lysw
eettasting
food
s.Manyparticipants
repo
rted
that
theirphysicians
instructed
them
toconsum
eless
rice;
subseq
uently,som
eparticipantsavoide
drice
butconsum
edothe
rcarboh
ydrates(e.g.,
nood
lesor
buns).Hen
ce,
thedietaryed
ucation
compo
nent
ofthe
prog
ram
emph
asized
theconcep
tof
carboh
ydrates.
43.6%
oftheparticipants
lostmorethan
5po
undsandmosthada
redu
ctionin
bloo
dpressure
at3mon
ths
aftercompletionof
the
prog
ram.M
eanHbA
1cde
creasedfrom
7.11
to6.12
post-in
terven
tion.
Beasley et al. BMC Public Health (2020) 20:1019 Page 18 of 25
Table
4Interven
tioncharacteristics,adults(Con
tinued)
Autho
r,year
(ref)
Stud
yde
sign
Interven
tiongrou
pconten
tCom
parison
grou
pconten
tInterven
tiongrou
pde
livery
Com
parison
grou
pde
livery
Theo
reticalBasis
CulturalStrateg
ies
Major
Find
ings
Yeh
2016
[32]
RCT
TheDiabe
tesPreven
tion
Prog
ram
curriculum
was
adaptedbasedon
feed
back
from
three
focusgrou
psof
Chine
separticipantswith
pre-
diabetes
andon
eadvis-
orygrou
pmeetin
g.
Diabe
tespreven
tion
inform
ationprovided
throug
hmailings
12bi-w
eeklycore
ses-
sion
sandsixmon
thly
follow-upsessions
con-
ducted
bytraine
dlife-
stylecoache
sat
acommun
itysite
that
couldaccommod
atean
exercise
prog
ram.
Quarterly
mailings
RE-AIM
Sessions
were
cond
uctedin
Mandarin
orCantone
se.Session
swereadaptedto
includ
emoreinform
ationabou
tAsian
diabetes
risk
disparity,followingeach
interven
tionwith
aph
ysicalactivity
session
(e.g.w
alking
grou
por
tai
chi),invitin
gfamily
mem
bersto
attend
sessions,p
roviding
measurin
gcups
(especially
ricebo
wlsfor
portioncontrol),as
well
ascultu
rally
and
lingu
isticallytailorin
g.
Therewas
asign
ificantly
greaterpe
rcen
tweigh
tloss
intheinterven
tion
grou
p(3.5vs.0.1%;P
=0.0001)at
6mon
ths,
which
was
largely
maintaine
dat
12mon
ths
(3.3vs.0.3%;P
=0.0003).
Zou
2017
[33]
RCT
Interven
tion
compo
nentswereusual
care
plus
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Beasley et al. BMC Public Health (2020) 20:1019 Page 19 of 25
Fig. 4 a Meta-analysis of mean change in cardiometabolic outcomes from baseline to post-intervention for Chinese migrant children/adolescents. b Meta-analysis of mean change in cardiometabolic outcomes from baseline to post-intervention for Chinese migrant adults
Beasley et al. BMC Public Health (2020) 20:1019 Page 20 of 25
Table 5 Cardiometabolic outcomes- children
Intervention group Control group
Baseline Post-intervention Baseline Post-intervention
Author, year Mean SD n Mean SD n Mean SD n Mean SD n
BMI (kg/m2) Chen 2010 19.74 3.58 35 19.48 3.48 33 18.65 2.63 32 18.14 2.60 24
Chen 2011 20.79 3.12 26 20.76 3.08 26 20.25 3.21 24 20.21 3.13 24
Chen 2013 25.53 3.65 21 25.16 3.91 21 23.17 1.22 20 23.18 1.28 20
Chen 2015 24.03 3.47 70 23.67 3.52 70
Chen 2016 23.7 3.6 115 23.4 3.5 115
Chen 2018 27.37 3.26 23 26.93 3.43 21 28.35 4.36 17 29.18 3.88 15
Sun 2017 16.86 1.57 16 16.58 1.43 16 16.24 1.28 16 16.25 1.34 16
WC (cm) Chen 2013 82.63 11.25 21 81.33 10.77 21
WHR Chen 2010 0.88 0.04 35 0.88 0.04 33 0.89 0.06 32 0.91 0.06 24
Chen 2011 0.91 0.04 26 0.90 0.04 26 0.89 0.04 24 0.89 0.04 24
Chen 2015 0.92 0.06 70 0.91 0.06 70
Chen 2016 0.95 0.09 115 0.94 0.09 115
LDL (mg/dL) Chen 2016 101.92 34.23 115 100.69 36.29 115
HDL (mg/dL) Chen 2016 47.83 10.39 115 50.94 10.24 115
SBP (mmHg) Chen 2010 105.74 9.01 35 104.97 9.10 33 99.87 5.81 32 99.65 6.63 24
Chen 2011 102.02 5.9 26 101.92 6.05 26 101.13 4.55 24 100.59 5.86 24
Chen 2013 106.9 5.75 21 95.52 14.49 21 101.33 4.56 20 99.64 2.80 20
Chen 2015 104.5 8.8 70 98.3 11.8 70
Chen 2016 104 8.8 115 99.8 10.9 115
DBP (mmHg) Chen 2010 63.23 12.91 35 61.52 9.62 33 57.70 11.31 32 57.43 10.95 24
Chen 2011 63.26 8.19 26 61.31 8.39 26 60.43 9.98 24 61.14 11.44 24
Chen 2013 62.73 7.11 21 52.86 9.83 21 59.92 11.2 20 59.27 10.51 20
Chen 2015 61.9 8.7 70 57.0 12.1 70
Chen 2016 62.7 8.3 115 59.1 11.1 115
FBG (mg/dL) Chen 2016 85.89 5.24 115 85.52 6.21 115
Beasley et al. BMC Public Health (2020) 20:1019 Page 21 of 25
For the three single group design studies, Chen 2008only reported changes in BMI stratified by overweightstatus [34], while the other two reported minor improve-ments in BMI and blood pressure (Table 5) [35, 36].Among adults, sufficient data were available for meta-
analysis for BMI, weight, WC, SBP, DBP, LDL, HgBA1c,and FBG. The pooled effect including three studiesshowed significant changes in BMI (effect size = − 1.14 kg/m2; 95%CI − 2.06, − 0.21) (Fig. 4b). In contrast, among thetwo studies reporting weight, the effect was null (effectsize = − 1.96 kg; 95%CI -4.70, 0.77). For waist circumfer-ence, there were also no significant changes over time be-tween groups (three pooled studies with an effect size −2.39 (95%CI -5.57, 0.80)). There were significant effects ofintervention in terms of changes in SBP and DBP, as thepooled effect across three studies was − 6.08mmHg(95%CI − 9.42, − 2.73) and − 3.81mmHg (95%CI − 6.34,− 1.28), respectively. Finally, there was no significant effectof intervention on LDL (effect size = − 10.28mg/dL;
95%CI -33.01, 12.45), HgBA1c (effect size = − 0.02%;95%CI -0.21, 0.18), or FBG (effect size = 0.65mg/dL;95%CI -6.56, 7.87). Results did not substantively change insensitivity analyses using 0.5 and 0.8 as the correlation be-tween baseline and follow-up measures (data not shown).For the eleven studies that were not randomized con-
trolled trials (Table 6), minor improvements were docu-mented in BMI, weight, LDL, SBP, DBP, FBG, andHgbA1c. However, without a rigorous comparisongroup, the effects cannot be attributed to the interven-tions delivered with certainty. Data from one of thestudies was not included in Table 6 due to incompatibil-ity of the scales used to measure outcomes [45].
DiscussionAs of February 2020, there were 21 published studies de-scribing behavioral diet and physical interventions inChinese migrants living in high-income countries. Themajority were conducted in adults (n = 13), and just
Table 6 Cardiometabolic outcomes- Adults
Intervention group Control group
Baseline Post-intervention Baseline Post-intervention
Author, year Mean SD n Mean SD n Mean SD n Mean SD n
BMI (kg/m2) Chesla 2016 29.4 3.6 25 27.5 4.5 25
Deng 2019 23.2 3.6 50 23.86 4.5 50
Lu 2014 25.1 3.4 98 24.7 3.3 88
Sun 2017 24.67 2.89 16 22.77 2.71 16 25.3 2.57 16 25.59 2.56 16
Wang 2013 26.5 3 28 25.8 3 28 24.9 2 29 25 3 29
Yeh 2016 26.3 2.4 30 25.5 2.9 30 25.8 2.3 30 25.6 4.3 28
Weight (kg) Chesla 2016 78.1 12.8 25 73.0 13.6 25
Lu 2014 64.1 9.5 98 63.2 9.4 88
Taing 2017 66.9 9.4 78 -0.5 0.4 78
Wang 2005 63.3 12.1 33 55.8 22.2 33
Wang 2013 64.9 8 28 63.4 8 28 63.3 10 29 63.8 10 29
Yeh 2016 69.9 11.5 30 67.6 11.5 30 66.4 9.8 28 66 10.2 28
WC (cm) Sun 2017 86.33 8.69 16 90.17 19.71 16 85.04 6.45 16 85.62 7.44 16
Wang 2013 87 6 28 82 6 28 84 8 29 84 8 29
Yeh 2016 36.1 3.4 24 34.9 3.1 30 35.3 3.3 27 35.7 3 28
WHR
LDL (mg/dL) Chesla 2016 114.6 36.8 25 98.8 28.7 25
Taing 2017 3.2 0.9 74 -0.36 0.1 74
Wang 2013 101 28 28 98 24 28 104 20 29 108 29 29
Yeh 2016 107.2 38.1 30 87.9 27.7 29 108.1 30.6 30 91.2 27.8 28
HDL (mg/dL) Wang 2013 51 14 28 52 12 28 55 16 29 54 14 29
SBP (mmHg) Lu 2014 130.2 12.3 98 124.6 9.8 88
Taylor-Piliae 2006 150 20 38 131.1 15.1 38
Wang 1998 155.1 15.9 75 142.8 15.3 75
Wang 2005 131.5 13.6 33 118.9 42.1 33
Wang 2013 123 10 28 114 13 28 118 12 29 118 18 29
Yeh 2016 127.1 13.6 30 124 14.7 30 126.6 18.3 30 125.2 15.8 28
Zou 2017 145.6 11.1 28 135.1 14.7 28 146.4 8.6 29 139.7 11.6 29.000
DBP (mmHg) Chesla 2016 82.2 12.2 25 78.4 7.1 25
Lu 2014 79.2 8 98 76.1 7.2 88
Taylor-Piliae 2006 85.8 9.3 38 76.9 8.4 38
Wang 1998 93.1 4.2 75 83.1 5.8 75
Wang 2005 69.4 10.9 33 63.4 23.4 33
Wang 2013 75 6 28 72 6 28 75 8 29 76 8 29
Yeh 2016 78.6 9.5 30 75.6 9.2 30 78.1 9.7 30 74.8 8.3 28
Zou 2017 90.5 7.5 28 84.8 11.8 28 87.6 9.8 29 84.5 9 29
HgBA1c Chesla 2016 5.91 0.27 25 5.89 0.2 25
Sun 2012 7.87 0.97 19 7.11 0.62 19
Wang 2013 5.9 0.2 28 5.8 0.2 29 5.8 0.2 29 5.8 0.2 29
Wang 1998 7.11 1.1 33 6.12 2.4 33
Yeh 2016 6.2 0.4 30 6.2 0.4 30 6 0.3 30 6.2 0.5 28
Beasley et al. BMC Public Health (2020) 20:1019 Page 22 of 25
Table 6 Cardiometabolic outcomes- Adults (Continued)
Intervention group Control group
Baseline Post-intervention Baseline Post-intervention
Author, year Mean SD n Mean SD n Mean SD n Mean SD n
FBG (mg/dL) Chesla 2016 96.4 6.7 25 93.1 5.6 25.000
Wang 2013 91 8 28 93 9 28 91 8 29 89 7 29
Yeh 2016 109.7 8.8 30 104.5 13.3 30 103.3 11.7 30 101.5 14.5 28
HOMA-IR Wang 2013 1.5 1.2 28 1.3 1.2 28 1.1 1 29 1.1 0.8 29
*Results from Taing 2019 omitted, as post-intervention means and standard deviations weren’t provided by the authors. Yeh 2016 results were obtained from thelead author
Beasley et al. BMC Public Health (2020) 20:1019 Page 23 of 25
three of the adult interventions were conducted outsidethe United States (Australia, Canada, South Korea).Eight were conducted in children/adolescents; of these,seven were conducted by the same research group inSan Francisco.There were clinically meaningful changes in BMI [48]
and blood pressure [49] among adults, but evidence wasweak for other cardiometabolic outcomes (weight, WC,LDL, HgbA1c, and fasting glucose), and among children,there was no evidence of effect for any cardiometabolicoutcomes. The intervention having the largest change inBMI among adults (− 2.19) had a much smaller effect onthe offspring (− 0.29) [26]. Several explanations may helpexplain the differences in effects observed betweenadults and children in this study and others. First, post-intervention measures were collected 3 months later inchildren, while mothers’ BMI was collected immediatelyfollowing the intervention. Second, BMI z-scores, whichbetter account for growth stage compared to BMIamong children, were not reported by the authors. Fur-thermore, most of the adult intervention periods werelonger-term (6–12months) whereas most of the studiesconducted among children were 2 months in duration.This report fills a gap in our understanding of the evi-
dence base for behavioral diet and physical activity inter-ventions conducted in Chinese migrants and theirdescendants living in high-income countries. Other re-views have examined diet and physical activity behaviorsamong African [50] and South Asian [51] migrants tohigh-income countries. For example, a review of the ef-fects of diet and physical activity interventions onweight, BMI, and waist circumference among SouthAsian migrants including 29 studies also observed nosignificant differences among children but a significantimprovement in weight only among adults (mean differ-ence − 1.8 kg, 95% CI − 2.5 to − 1.2 kg) [51].Limitations must be acknowledged in interpreting these
findings. Despite searching seven databases and referencelists for all identified articles, it is possible that relevantstudies were missed, if for example, the title or abstractdidn’t describe analyses specific to Chinese migrants. Al-though the characteristics of each intervention as are
described in this review in order to help identify whichintervention components might be effective, given thesmall sample size and heterogeneity of the studies, the re-view cannot definitively summarize successful strategiesfor behavioral diet and physical activity interventions tar-geted at Chinese-origin groups [52–55].Most studies conducted a complete case analysis ra-
ther than accounting for loss to follow-up incorporatingmissing data methods such as multiple imputation.Complete case analyses would overestimate any effect ofthe intervention if, for example, participants whodropped out lost less weight compared to those whocompleted the study. We did not make any adjustmentfor how studies accounted for attrition in our analysis,but attrition bias was accounted for in the quality assess-ment. In summary, a major limitation of our analyseswas having a relatively small number of controlled trialsthat were suitable for meta-analyses. We only includedcontrolled trials, as opposed to single arm pre-post stud-ies, in the meta-analyses to minimize the likelihood thatobserved changes in cardiometabolic outcomes were dueto factors other than the intervention, particularly ingrowing children.Suggestions for improvement include increased atten-
tion to (1) how interventions are culturally adapted; (2)the types of behavior change techniques and theoriesthat are used to underpin interventions; (3) loss tofollow-up by study arm; (4) variability within theChinese-origin population, particularly with respect togenerational differences that may be important for thedesign of interventions; and (5) contextual factors, suchas whether the setting is rural or urban. These recom-mendations would enable reviewers to assess how be-havior change techniques and theories moderateeffectiveness, to assess the equity impacts of interven-tions, and to examine explanations for heterogeneity be-tween interventions.
ConclusionsGiven our mixed findings, more work is needed to sup-port the design of successful interventions, particularlythose targeting children and their families. The
Beasley et al. BMC Public Health (2020) 20:1019 Page 24 of 25
development of effective interventions may well requirea great deal of qualitative and quantitative research onknowledge, attitudes, behaviors, and perceptions. Moreresearch is needed into the differential effects of lifestyleinterventions for Chinese immigrants compared withother ethnicities.
Supplementary informationSupplementary information accompanies this paper at https://doi.org/10.1186/s12889-020-08805-3.
Additional file 1: Supplemental Table 1 Ovid Medline DatabaseSearch Strategy.
AbbreviationsBMI: Body mass index; CA: California; CABI: Commonwealth AgriculturalBureaux International; CI: Confidence Interval; D: Diet; DASH: DietaryApproaches to Stop Hypertension; DBP: Diastolic blood pressure;FBG: Fasting blood glucose; HDL: High density lipoprotein;HgbA1c: Hemoglobin A1c; HOMA-IR: Homeostatic Model Assessment ofInsulin Resistance; kg: Kilogram; LDL: Low density lipoprotein; m: Meter; mg/dL: Milligram per deciliter; mmHg: Millimeters of mercury; MD: Meandifference; NR: Not reported; NYC: New York City; PA: Physical activity;PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROSPERO: PROSPective Register Of systematic reviews;RCT: Randomized, controlled trial; RE-AIM: Reach, Effectiveness, Adoption,Implementation, Maintenance; SBP: Systolic blood pressure; SD: Standarddeviation; SL-ASIA: Suinn-Lew Asian self-identity acculturation scale;UK: United Kingdom; USA: United States of America; WC: Waistcircumference; WHR: Waist hip ratio
AcknowledgementsThe authors would like to thank Agnes Park and Muhammad El Shatanofyfor assistance with tables and figures.
Authors’ contributionsJMB, NA, TP, and JW conceived the study design and developed thePROSPERO protocol. TR developed the search strategy and conducted thesearch on all databases. JMB, JW, NA, and TP reviewed abstracts. JMB and JWextracted study details and outcome information. TP resolved discrepanciesin quality assessment, and NA resolved discrepancies in outcomes extraction.NA conducted the outcomes analysis, and JMB drafted the manuscript. Theauthors read and approved the final manuscript.”
FundingThis work was supported by a Durham Senior Research FellowshipCOFUNDed between Durham University and the European Union undergrant agreement number 609412. The role of the funding body in thedesign of the study and collection, analysis, and interpretation of data and inwriting the manuscript should be declared.
Availability of data and materialsThe datasets used and/or analysed during the current study are available inthe published literature.
Ethics approval and consent to participateNot applicable.
Consent for publicationNot applicable.
Competing interestsThe authors declare that they have no competing interests.
Author details1Department of Medicine, NYU Grossman School of Medicine, 462 FirstAvenue CD 673, New York, NY 10016, USA. 2Department of Anthropology,Durham University, South Road, Durham DH1 3LE, UK. 3NYU Health Sciences
Library, NYU Grossman School of Medicine, 550 First Avenue, New York, NY10016, USA.
Received: 21 October 2019 Accepted: 29 April 2020
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