In most cases, health promotion would not be a difficult topic to discuss with Japanese American elders, especially, immunizations and maintaining healthy habits of diet and exercise. There may be rare variable receptiveness to the concept of cancer screening, however, which may be seen by some as the equivalent of “looking for something potentially bad.” Clinicians should be mindful that as the incidence of stomach cancer is high, maintaining a high index of suspicion for this group might be beneficial. Although not recommended in the United States, in Japan, stomach cancer screening programs have been effective in mortality reduction (McCracken et al, 2007).
For those Japanese Americans with hypertension or who are at risk for hypertension, educational counseling on a low salt diet may be necessary as the traditional diet is high in salt. Some of the high salt dietary items may not be understood as being very salty, such as soy sauce (shoyu), preserved meat and fish, miso soup, and pickled vegetables. In discussing dietary issues, such as calcium intake for prevention of osteoporosis, it should be noted that the prevalence of lactose intolerance is high, as high as 80 to 90%.
In general, common barriers to health care access such as lack of insurance, low health literacy, and language barrier have not been significant barriers to access, but do exist in some cases.