title: Assessing the impact of behavioral risk factors and known-groups validity of the SF-12 in a US Chinese immigrant population.
abstract: BACKGROUND
  Health status measures are being used in increasingly diverse populations. However, there are no known studies to date that examine the SF-12 in US Chinese populations. This study reports on the performance and validity of the SF-12 among Chinese immigrants residing in New York City, and evaluates the impact of multiple behavioral risk factors on physical and mental health status.
  
  
  METHODS
  We used cross-sectional survey data from a multistage probability sample of 2537 Chinese adults. SF-12 scores were examined according to sociodemographic, cultural, and clinical characteristics. Regression analyses were used to examine associations between health status and co-occurring behavioral risk factors of smoking, risky drinking, physical inactivity, and overweight/obesity.
  
  
  RESULTS
  SF-12 scores were significantly lower among women, those with less education, lower incomes, and more health problems (P < 0.001). Older adults had worse physical but better mental health (P < 0.05). Individuals with 1, 2, 3, and 4 behavioral risk factors reported decreases of 1.91, 2.92, 4.86, and 9.21 points on the PCS-12, respectively, in comparison with the reference group having zero risk factors (P < 0.01). Similar trends up to 2 co-occurring risks were observed with MCS-12 scores (P < 0.01).
  
  
  CONCLUSIONS
  The SF-12 exhibited known-groups validity in a US Chinese immigrant population. Co-occurring behavioral risk factors were associated with progressive declines in physical health, independent of sociodemographic and clinical characteristics traditionally associated with impairments in health status. Targeting patients with multiple risks for behavior change may be effective in improving health across diverse populations.
authors.affiliation: Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA. dh2237@columbia.edu
authors.forename: Dorothy Y
authors.initials: DY
authors.lastname: Hung
authors.forename: Erica I
authors.initials: EI
authors.lastname: Lubetkin
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Fahs
authors.forename: Donna R
authors.initials: DR
authors.lastname: Shelley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology / Q000208:ethnology; D001213:Asian / Q000706:statistics & numerical data*; D002681:China / Q000208:ethnology; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009519:New York City; D009765:Obesity / Q000453:epidemiology / Q000208:ethnology; D050177:Overweight / Q000453:epidemiology; D012016:Reference Values; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000208:ethnology; D011795:Surveys and Questionnaires; D055815:Young Adult