A Nurse First

A hunch

• Sigma Nursing • Season 5 • Episode 4

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Jyu-Lin Chen began her nursing career with a passion for working with children, which led her to a pediatric ICU. Her curiosity and commitment to evidence-based practice shifted her focus to researching obesity trends among Chinese American immigrant children. Despite initial skepticism, she pursued her inquiry based on clinical observations and a need for data. Her pioneering research earned her induction into Sigma's 2023 International Nurse Researcher Hall of Fame.

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I really like working with people, especially the little people. So that's how I entered nursing. Then when I was working in a pediatric ICU for three, four years, I realized what I really want to do is research because there's so many unanswered questions. I would ask, why are we doing this? What evidence do we have to do this? Can we do something better? But when we do something better, is it really better? So that triggered me to get my PhD at University of California, San Francisco. It Welcome to A Nurse First. This is Jyu-Lin Chin, I always wondered, why are we doing this? Is there any evidence to show us something should be done this way, or why is something not working? For example, talk a lot about social determinants of health, which is a broader term about things you can control or not control. You are in the context of somebody's life, which includes culture. My work has always related to the health of pediatric population as well as their family. I'm very into use of technology to improve the health services as well as parenting skill among parents of children with different age groups. Clinically, I'm trying to be acute care provider. I work at ICU. That's my clinical training. So when I enter the PhD, I would think about hand management, especially in ICU. Many kids are sedated or unconscious. How do I help them to feel more comfortable in a stressful time? When I try to figure out my research, then I came across an article that's back in 19, early 2000. That just started the wave of recognition of obesity. Then I thought, what can we do to prevent things from happening when they are in ICU? Then I switched my topic. I'm very much interested in public health issues, which is not. Nurses have a lot to do. We can work on. Then I work with some providers and they all tell me about, they've been seeing kids, the Chinese American immigrant kids, are getting bigger. and they're worried, but they don't, it's just a hunch, right? There's no data evidence out there to show them that. That's how it triggers me, my idea about, let me look into this. It's really my partnerships with my clinical partners to figure out what are the most clinically relevant questions that I can engage in solving and understanding. And as an immigrant, I'm really interested in immigrants' experience and their health outcomes. So that's really how I got started to move my acute care background to very much a public health nursing background. Because I had to do a different review of literature and there was not much out there. But I also have like the hunch, a feeling that something's there. It's just nobody studied that. That's the science, right? There's not much out there. But I know that somebody must be able to produce some evidence for me to see. So that's how I decided to be. I'm going to be the one providing evidence for other people to see because there wasn't much out there at that point of time. Well, the evidence was really trying to look at the other country, right? You can see when there was not much data here, you look at other countries and you also look at the adult population, right? What do we see in adults? So you see the pediatric tend to follow the adult trajectory. So you see the adult here, you see the search. My hypothesis is that you probably see a surge in pediatric population because they're family, right? You probably see the same pattern. So that's sort of how I came about is to look at what we know from other countries. Did they start seeing that? As well as adult population, do we see a surge? Then use that hypothesis. If you see a surge in adult, will we see the same pattern in pediatric population? My own background coming from Taiwan, I learned a lot from sort of understand both culture and go between the cultures. So this I feel like I can be a good global citizen and really bring nursing and science to Ju Lin is the first nurse scientist in the United States to specialize in the prevention of childhood obesity in Asian immigrants. For her groundbreaking research, Sigma inducted Jyu-Lin into the 2023 International Nurse I'm very proud to be the first one and I have seen others start doing the work focused on the immigrant population as well. I feel that I'm able to contribute something very different and significantly in immigrant health. The challenge for establishing my program research is in the area of obesity, specifically in Chinese immigrants. The challenge is to increase awareness and use all the data points to demonstrate why this is an issue in this particular population, as this is contradictory to what people think. Many people have the perception that Chinese are always little tiny people, right? So the point of trying to educate, even reviewer, But I have the great support from my colleagues in clinical settings where they provide lots of care to the immigrants. They themselves told me they have seen a surge of obesity, they just don't know what to do. I'm actually very grateful for my advisor at that point, PhD advisor, now he's the dean at Rush University, Dr. Christine Kennedy. She's the one who empowered me and said, go for it. That's how the science had breakthrough. Somebody had to start with something that we don't know, right? Because without the person to start something, you're never going to move forward. So she encouraged me to realize this is a good idea. And that's what the science is about, to study the unknown. When I started my journey as a neuroscientist focused on obesity in Chinese-American children, I learned the prevalence is not very different than, they say, the typical European American wife. However, the study also demonstrated that if you do a body scanning, use MRI, that's the best way to know the distribution of fat because it matters. The way we quantify obesity, at least in the US, is using formula. Try to use all the kids we have, regardless of their ethnicity. Put it all together. then smooth the curve. So you have the bell curve, right? 95% you're obese, right? Under 5% you are underweight, as a weight. But think about the kids in US. There's huge variation, right, of us kids in there. So you're using everybody to curve the bell, which, you know, plus or minus. In a population-based study, they look like it's normal, right? It looks fine. But the study also showed that if you put the kids, like, the same age, Gender matters, the same age and gender. Age really matters in terms of how you look at the percentage of body weight. And the study showed that put the same age, gender, and the BMI of a child. They grouped them in typical European white, African American, and Asian Chinese. Through the scanning, they realized with the same BMI, the same body structure, compared to white, the Asian, the Chinese American has one percent more body fat. then they're your PMY. So 1% actually you think is not significant, but it is significant in terms of body fat distribution. On the other hand, the African-American has 1% less body fat, even with the same body structure. So we know we're not built the same. And we know genetically we're not built the same. So because of that, then we know that if you look at the WHO recommendation, the cutoff for adult is different. in terms of BMI, as overweight and obesity. For Asians, they typically have lower cut-off. A study already showed with lower BMI, you're at increased risk for cardiovascular disease and cancer, as example. So you will see that how we quantify, classify United States kids based on the bell curve, right, can be misleading. Ten minutes ago, I just read a CDC report coming out about the increased prevalence of severe obesity among young children aged 2 to 4 years old. And in the report, it says that 20 states see a surge of increased severe obesity among those young children, which is a red flag, right? You think about children aged 2 to 4. Imagine if they're obese at that age, severely obese, the likelihood of them being obese in teenagers and adults is very high. And imagine that your body has to take all those. There's a burden from obesity for longer for the young age until you grow up. Right. So that's increased your risk for cancer, diabetes and other conditions significantly compared to kids who have not experienced obesity in their life. So the challenge is sort of the population base is to increase the awareness as well as not have to think about the culturally. How do you tell parents? Right. As we know, Providing food, comfort food, is a sign of love. There's many cultures, not just Chinese, right? It's a sign of love. What do we do on Christmas holiday? What do we do on Thanksgiving? We eat, right? What do we do at a party? We eat. That's part of, we share love. And not to say take that away, it's consciously how do we eat and balance it. And also that the way you gain weight is not overnight either. So those kind of perspective as not working with the family, it's a family intervention, not the child intervention. I think the challenge is to really understand culturally, right? Even though I grew up in Taiwan, but I've been here for so long. So it's this different perspective and also perspective on the parents, right? What they see as the way they should engage and can engage intervention that to help to to promote what we call healthy weight management, not just weight loss. I always say it's what is healthy weight management to help you to reduce risk for other potential conditions down the road. So it's the environment, not only genetic, but environment will create a healthy, you call it, an organic environment, which is the environment will create, promote obesity. So what I learned is that especially immigrants, when you have this stress as a new immigrant, right? But there are lots of things the family experience. in the transition immigrant to a country, right? Assimilation. As we know that stress also tied to increase uptake of food, which is a normal body mechanism to protect oneself. So coupled with not understand the new environment, like the old stressful, not just the child, but the parents, the family experiencing in the immigration processes. So that's why I'm interested in understanding not just healthy food and to be active. It's not as simple as just go eat and just go move, right? It's a lot to do with their life and how so many of my program has a significant component about stress management. And even for the parents, life is stressful. Living in the new environment is stressful. Trying to raise a kid in a different culture is even more stressful. There's going to be conflict between you and the child. Not just normal conflict, but additional cultural conflict, right? So my work has a significant component. They say mindful eating and mindful activity to help parents and kids to reduce stress. I always tell the parents, even in my research, it's not about you not eating right. It's not about you not going to exercise. It's not just you. It's where we live. And bio-behavior model is that when you're hungry, what do you do? When you're stressed, what do you do, right? So because this body mechanism typically trigger when you're stressed. They make people go just eat, right? It's a protection mechanism when you're stressed. So the bio-behavior mechanism that we try to do is try to, just like cognitive behavior therapy, you have to recognize, are you hungry, truly hungry, or are you stressed? Because once you recognize what your body tells you and your brain tells you, you can then reverse that. I have the urge to eat. It's not because I'm hungry. I have urge to eat because I'm stressed. So you have to then flip around and say, what can I do? It's not I'm hungry, right? It's I'm stressed. So the biobehavior is really trying to recognize the sign that what the body is trying to tell you and use the cognitive cognitive ability to really tell yourself, okay, this is what I'm going to do. Also that we learn how long it takes for the brain to recognize I'm full and the speed of eating. So we really encourage family meal, meaning you chat and talk and eat. You slow down the eating process to allow the signal from the stomach go to the brain. So obesity cells It's an issue, but many times it's not the only issue that a person experiences, a child experiences, a family experiences. Obesity, I feel, is a sign symptom of a condition. It is the diagnostic criteria now as a disease, but it is truly a sign symptom of something else that makes the person ill. It could be genetically, it could be environmentally, right? The thing we should do is prevent it from happening. Prevention is much better than intervention. So I think the most challenging part is how can we prevent that from happening, start early, build a healthy, happy environment for this population, so Did being the first to specialize in this area of research present you with some unique challenges? How have you navigated So the roadblock, I think, really is trying to convince people that this is a significant public health issue in a very unique population. Many people don't see it as an issue. If this is not your big population, major population, why should we care? But I think every population matters here, even just 1% of the population. If 1% was not well, the 99% probably would not do too well either. The first person is always difficult to do it because the first person has to stand up to do it right. But once you start doing that, you have a follower, you have two, then you will have your portfolio research. And it matters. I would say resilience is the key here. You just have to follow your passion. You have abundant opportunity in front of you in the profession. Not only can be a great clinical nurse, you can be an educator, you can be a frontier scientist. There are so many pathways for everybody in nursing. You just have to find your path. And you can detour your path. You can integrate those paths together. I integrate my clinical and my research and my love for education. And I feel that our ability, given the scientific knowledge we have and caring, purpose of, you know, the purpose of my work is really for my humanistic care, right? And I think that I feel very honored Thank you for listening to A Nurse First from Sigma. 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