UC Davis

Introduction: The unique sociocultural context of Hmong people in United States has historically contributed to health and public health challenges for this community. This study was among the first to investigate contextual and sociocultural factors associated with COVID-19 illness and mitigation behaviors in Hmong Americans. The goals of this study were to: 1) describe COVID-19 health seeking and mitigation behaviors, and related information, motivation, and behavioral skills among Hmong American adults, and 2) to examine contextual and sociocultural factors that may be associated with masking, social distancing, group gatherings, and vaccination uptake in Hmong Americans.

Methods: A cross-sectional web survey was conducted between April 8, 2021, to June 1, 2021, with Hmong Americans aged 18 and over. Descriptive statistics were used to summarize the overall characteristics and COVID-19 related behaviors of Hmong Americans. Chi-square and Fisher’s Exact Test were computed to describe COVID-19 mitigation behaviors by gender and generational status (a marker of acculturation).

Results: The sample included 507 participants who completed the survey. Most of the participants reported participating in mitigation interventions to keep themselves safe from COVID-19. Mitigation behavior assessment shows that 88.9% (449 of 505) of the participants masked all the time, 55.3% (270 of 496) maintained 6 feet when leaving home all the time, 68.32% (345 of 505) avoided group gatherings or crowds the last 30 days, 72.3% (366 of 506) avoided public spaces, gatherings or crowds the last 30 days, and 69.17% (350 of 506) received the COVID-19 vaccine. Different patterns of behaviors surfaced for generation and gender. Hmong American women were more likely to avoid family (P=.005) and social gatherings (P=.009) and stay 6 feet from people outside their household (P=.005) compared to men. Third generation individuals were more likely to avoid gatherings of 10 or more (P=.010) and first-generation individuals were more likely to avoid public spaces, gatherings, or crowds (P=.003). Hmong community leaders were social influencers to masking (P=.029), social distancing (P=.022), group gatherings (P=.026), and vaccination (P=.037) for Hmong American men. Government officials and healthcare providers were social influencers for Hmong American women for masking and social distancing. Government officials were social influencers on masking behaviors for first generation individuals (P<.000), family were social influencers on social distancing for second generation individuals (P=.038), and family were social influencers for group gatherings (P=.041) and vaccination uptake (P=.011) in third generation individuals. Participants and their families trying to stay healthy reported seeking care from a medical doctor. However, when trying to prevent and treat COVID-19, participants reported preferring to use Hmong medicine and traditional approaches.

Conclusion: Social influences play a significant role in COVID-19 mitigation behaviors including masking, social distancing, avoiding group gatherings, and vaccination uptake. Hmong Americans reported using both Western medical and traditional Hmong approaches to manage and treat symptoms of COVID-19. These findings have implications for identifying and implementing culturally appropriate health messages, future public health interventions, policy development, and ongoing research with this population.