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October 6, 2008 PA

Chinese proverb says, “Walking 100 steps leads to a long life of 99 years.” But many older Chinese immigrants to the U.S. are not getting their “100 steps” and are demonstrating low bonemineral density and high osteoporosis risk, says Bing Bing Qi, RN, MSN, PhD, assistant professor at Villanova University College of Nursing in Philadelphia. Qi devoted her doctoral dissertation to the study and prevention of osteoporosis in older Chinese immigrants in Philadelphia. “In China, older people bike, walk, and do Tai Chi every day. There is a very high value on moving ‘qi’ (pronounced “chee”), or life force, through the body,” Qi says. “When Chinese immigrants first come to America, they are often afraid to go outside, or they work all the time and don’t have time to exercise.” But reduced activity levels are only one reason for the depleted BMD of older Chinese immigrants. They eat little to no dairy in the traditional Chinese diet. Many are lactose-intolerant and they seldom take any calcium or vitamin D supplements. Additionally, many

of these immigrants suffered malnutrition during their bone-developing years, caused by food shortages in China, Qi says.

Health Education Lacking

For her doctoral dissertation at the University of Maryland, Qi developed self-efficacy interventions for Philadelphia’s older Chinese immigrant population, including screening and educational tools targeted at osteoporosis prevention. Participants included 81 women and 29 males. The mean age was 64, and the annual household income was less than $20,000. The majority spoke little to no English; almost half had no health insurance. “This community has been underserved,” Qi says. “Most of them go to free clinics where they are treated, but not educated, about preventing osteoporosis and other chronic diseases. They say, ‘No one has ever told us this before.’ One man had been using an inhaler for 40 years, and this was the first time he learned steroids could increase his risk of developing osteoporosis.” Qi advertised free BMD screenings in Chinese newspapers and through flyers distributed in Chinatown. The immigrant clinic at Holy Redeemer Chinese Catholic Church in Philadelphia’s Chinatown offered space for the recruitment of participants, the Sahara quantitative ultrasound heel scan BMD screenings, and educational sessions. Qi reviewed the results of the BMD scans. About 42% of participants had high risk and 22.9% had moderate risk for developing osteoporosis. She mailed letters written in Mandarin to the participants, which invited them to an educational presenta-

Researcher teaches about building stronger bones in Philadelphia’s Chinatown


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tion on osteoporosis prevention that she offered on weekdays and weekends. Her educational presentation included a PowerPoint lecture and brochures about osteoporosis prevention written in Mandarin and English, which participants could take to their physicians or show their children. Participants also received a calciumrich lunch, including green, leafy vegetables, fish, yogurt, and calcium-enriched rice and orange juice. Additionally, Qi encouraged participants to get support from spouses and children to reinforce preventive measures, such as taking calcium and vitamin D supplements and prescription osteoporosis medications. Also, she instructed them to increase bone-building exercises, including brisk walking, jogging, dancing, weight lifting, and stair climbing. Procter & Gamble Pharmaceuticals and the Pi Chapter of Sigma Theta Tau International at the University of Maryland School of Nursing funded Qi’s study. Results of a follow-up study two weeks after the educational intervention showed participants were better educated in osteoporosis, and self-efficacy for exercise and osteoporosis medication use improved. Qi is tabulating one-year follow-up assessment results, which she will submit for publication. She expects compliance to be high because participants were eager to learn about preventive measures they could do on their own, she says.

Giving Back to her Community

Leslie Flowers is a freelance writer. To comment, e-mail

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Qi has become somewhat of a celebrity in Philadelphia’s Chinatown, she says. Several of the study participants have informally adopted her, inviting her to their homes or calling to chat. “They appreciate the attention,” she says. “They treat me like a granddaughter.” Qi also is a Chinese immigrant. She received her BSN at Beijing Medical University and then came to the U.S. to earn an MSN at Villanova University as a full-scholarship recipient of Project HOPE-The People-to-People Health Foundation Inc. She and her husband, a general surgeon, and their three children have settled in the Philadelphia area. Qi says her research goal is to give to and help her native community. “From my heart, I want to do something for this population — not just use them for a research project,” she says. “It’s not too late for them to build their bones and avert osteoporosis, but they can’t do it without culturally appropriate information and education.”

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