Exploring women's experiences and needs during the climacteric to enhance positive mental health and self-care.

Breast cancer is the most diagnosed cancer in American women, with racial/ethnic disparities in late-stage presentation, suboptimal treatments and mortality risks. Vietnamese American (VA) women are predicted to have greater increase in breast cancer incidence at 2.1% annual increase (vs 0.5% White, 0.7% Black women) and exhibit higher rates of human epidermal growth factor receptor 2 subtypes, with a lower screening rate (64% vs national average 76%). Numerous studies have shown associations between tobacco exposure and elevated breast cancer risk. A meta-analysis reported increased breast cancer risk associated with active smoking (OR=1.08–1.13) and with passive smoking (OR=1.07–1.30). Recent literature on biomarkers derived from carcinogens has shown that secondhand smoke exposure (SHSe) can result in epigenetic modifications, including changes in DNA methylation. Furthermore, studies have shown that SHSe through premenarche up to the first childbirth has greater impact compared to later-life exposure. Subgroup racial/ethnic variations in breast cancer risk and related risk factors add further complexity for women who have immigrated at different points of their lives and have experienced differential exposure to SHSe across their lifespan. The prevalence of smoking among VA men is higher than all Asian American and US men in general (25–37% vs 20.1% and 17.3%, respectively). The smoking rates are higher among VA men with limited English-proficiency, reaching up to 45% – one of the highest in the US. These disparities place VA women at heightened risk for SHSe, despite low active smoking rates (2.8–7.9%). One past study documented that ~45% of VA women experience SHSe at home, and 42.4% are exposed in indoor workplaces, relative to the national average of 24.3%. However, a gap remains in research on SHSe in relation to breast cancer risk among VA women, 60% of whom are immigrants.