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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
Am J Orthopsychiatry. Author manuscript; available in PMC 2016 July 1.
Published in final edited form as:
PMCID: PMC4503386
NIHMSID: NIHMS646911

Acculturative Heterogeneity among Asian/Pacific Islanders in the United States: Associations with DSM Mental and Substance Use Disorders

Abstract

Extant studies on the links between acculturation and mental and substance use disorders among Asian/Pacific Islanders have been based on the assumption that acculturation is a homogeneous construct. However, emerging evidence suggests that the various components of acculturation do not manifest independently, but rather cluster in ways that reflect distinct profiles. We employ data on Asian/Pacific Islanders from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 968). Latent profile analysis is used to identify acculturation subgroups on the basis of indicator variables related to cultural identification, language ability and preference, and social engagement. Subsequently, the distribution of outcome variables in the domains of DSM disorders (lifetime history of clinical, personality, and substance use disorders) is examined across latent subgroups. We identified a five class solution: Class 1: “Separated” (12.91%), Class 2: “Partial Bilingual/Bicultural” (30.06%), Class 3: “English Dominant/Asian Oriented” (12.29%), Class 4:”Full Bilingual/Bicultural” (19.42%) and Class 5: “Assimilated” (25.31%). The highest rates of clinical disorders were observed among members of the two classes characterized by a strong preference for the use of the English language (Classes 3 and 5). The highest prevalence of nicotine (12%) and illicit drug use (15%) disorders was observed among members of the “Assimilated” class. Consistent with prior research, findings suggest that risk of morbidity is greater among more acculturated individuals; however, findings also suggest that an important level of nuance can be observed with respect to acculturative subtypes identified on the basis of cultural identification, language ability and preference, and social engagement.

Asian/Pacific Islanders are the fastest growing racial/ethnic group in the United States (US). Indeed, according to the US Census Bureau (2010), the number of Asian/Pacific Islanders grew by 40% from 2000 to 2010, increasing at a rate four times faster than that of the total US population. However, despite this rapid rate of growth, relatively little is known about the health and well-being of Asian/Pacific Islanders, particularly with respect to the risk and protective factors associated with mental and substance use disorders (Sorkin, Nguyen, & Ngo-Metzger, 2011).

Although limited, accrued research suggests that the prevalence of mental and substance use disorders among Asian/Pacific Islanders may be higher than previously believed. For instance, while estimates of the lifetime prevalence of mood (9.1–12.8%), anxiety (9.8–10.9%), and substance use (4.0–11.9%) disorders among Asian Americans in general tend to be relatively low compared to other racial/ethnic subgroups (Bresleau & Chang, 2006; Takeuchi et al., 2007), evidence suggests that the prevalence of psychiatric morbidity may vary substantially among Asian Americans across sociodemographic differences such as income and immigrant generation (Chung et al., 2003; Kalibatseva & Leong, 2011; Salas-Wright, Kagotho, & Vaughn, 2014; Salas-Wright & Vaughn, 2014). Moreover, it has been estimated that Asian/Pacific Islanders with mental disorders utilize psychiatric services at rates far below the national average (Wang et al., 2005). With respect to substance use disorders, the prevalence among Asian/Pacific Islanders in general tends to be lower than that of the national average; however, substantial variation exists within Asian/Pacific Islander subgroups (Price, Risk, Wong, & Klingle, 2002). For instance, Korean adults have been found to report levels of binge alcohol use that exceed that of the general population (Substance Abuse and Mental Health Services Administration, 2010). Similarly, rates of illicit drug use have been found to be markedly elevated among Hawaiians and other Pacific Islanders compared to other subgroups (Cochran et al., 2007). Due to the lack of a comprehensive study examining the prevalence of mental illness and substance use among Asian/Pacific Islanders, reported rates may be underestimated (Kohn et al., 2004).

Acculturation and Mental and Substance Use Disorders

A robust body of literature points to a relationship between acculturation and mental disorders among ethnic minority groups in the US (Koneru, Weisman de Mamani, Flynn, & Betancourt, 2007). Studies suggest that risk for psychiatric morbidity is significantly greater among more acculturated individuals (Salas-Wright, Clark, Vaughn, & Córdova, 2014; Schwartz, Unger, Zamboanga, & Szapocznik, 2010). Recent evidence indicates that this pattern can be observed for a variety of mental and substance use disorders among Asian/Pacific Islanders in the US (Burnett-Zeigler, Bohnert, & Iglen, 2013). It should be noted, however, that most studies on acculturation and health are cross-sectional in nature and, consequently, are limited in terms of their capacity to disentangle the causal relationship between acculturation and health outcomes. Nevertheless, the current evidence suggests that individuals at higher levels of acculturation into mainstream American culture may be at increased risk for mental health and substance use morbidity.

The vast majority of studies on acculturation have conceptualized the process of cultural and psychological change either as a unidimensional or bidimensional construct; however, emerging evidence suggests this approach may be less than optimal. Recent studies suggest that acculturation is comprised of various conceptually distinct subcomponents that range from cultural practices to ethnic identity (Schwartz et al., 2013). Indeed, a process of “rethinking” the concept of acculturation is currently underway as leading researchers have proposed a multidimensional model of acculturation which takes into account the practices, values, and cultural identifications made by individuals in the process of transitioning from heritage to receiving cultures (Schwartz et al., 2010). In such an approach, constructs such as ethnic identity are conceptualized not as distinct from acculturation, but rather as essential subcomponents of this broader construct.

While much information can be gleaned from examining the links between the particular subcomponents of acculturation and mental disorders, it has become increasingly understood that the various components of acculturation do not manifest independently, but rather cluster together in ways that reflect distinct acculturative profiles. For instance, drawing from the basic conceptual framework of Berry’s (1980, 1997) seminal typology, Schwartz and Zamboanga (2008) identified numerous subgroups among a sample of Hispanic college students, including the “Assimilated” and the “Separated” as well as various bicultural subgroups (i.e., “Partial Bicultural”, “American-Oriented Bicultural”, “Full Bicultural”). Salas-Wright and colleagues (2014) conducted a similar analysis with a nationally representative sample of Hispanic adults in the US and examined the links between latent subgroups and substance use disorders. Findings from this study suggest that, compared to monolingual/bicultural and assimilated English speakers, immigrants who are both bilingual and bicultural are substantially less likely to meet criteria for substance use disorders.

Gaps in the Literature

Although advances have been made in terms of our understanding of the relationship between acculturation and mental disorders among Asian/Pacific Islanders, important shortcomings persist. Most notably, extant studies that have examined the links between acculturation and mental disorders have done so under the assumption that acculturation is a homogeneous construct. That is, we are unaware of any previous studies that have modeled the heterogeneity of the various subcomponents of acculturation and, in turn, examined the relationship between particular acculturative subtypes and clinical, personality, and substance use disorders among Asian/Pacific Islanders in the US. Additionally, relatively few studies have systematically examined the relationship between acculturation and mental disorders while drawing from nationally representative samples of Asian/Pacific Islanders. Specifying the heterogeneity is important in order to more accurately assess relations between acculturation components vis-à-vis mental health and substance use disorders.

The Present Study

We address the aforementioned shortcomings by drawing from a population-based longitudinal study (i.e. the National Epidemiologic Survey of Alcohol and Related Conditions [NESARC]). The NESARC is an advantageous data source given its far-reaching scope and generalizability; inclusion of a large sample of Asian/Pacific Islander adults; diagnostic assessment of clinical, personality, and substance use disorders; and inclusion of salient variables of relevance to acculturation. Specifically, we utilize a finite mixture modeling approach in order to model the heterogeneity of acculturation among Asian/Pacific Islander adults in the US. Additionally, we examine the relationship between membership in acculturative subgroups and the prevalence of mental and substance use disorders. This two-step procedure allows us to advance the current understanding of the relationship between acculturation and mental and substance use disorders among a large and rapidly growing minority population in the US.

Method

Sample and Procedures

Study findings are based on data (n = 34,653) from Wave II (2004–2005) of the NESARC. Using a multistage cluster sampling design, the NESARC is a nationally representative sample of non-institutionalized US residents aged 18 years and older (Grant et al., 2003; Grant & Dawson, 2006). The NESARC utilized a multistage cluster sampling design, oversampling young adults and racial/ethnic minorities in the interest of obtaining reliable statistical estimation in these subpopulations, and to ensure appropriate representation of racial/ethnic subgroups. The survey gathered background data and extensive information about mental and behavioral health from individuals living in households and group settings (e.g. shelters, college dormitories, and group homes) in all 50 states and the District of Columbia. The current study restricted analyses to Asian/Pacific Islander adults (n = 968) ages 18 years or older, including respondents who reported that their ethnic/national heritage was Chinese (23%), Filipino (16%), Indian/ Afghan/Pakistani (17%), Japanese (8%), Korean (7%), Vietnamese (8%), and from other Asian and Pacific Islander ethnic/national groups (21%).

Multistage cluster sampling design is a commonly used design when attempting to provide nationally representative estimates. This is because interviewing all participants is not feasible so larger units (i.e., clusters) are identified and randomly selected from. With respect to the NESARC, 709 primary sampling units (PSUs) provided by the Census Supplementary Survey were selected (stage one). Within the sample PSUs, households were systematically selected (stage two). An individual age 18 or older was randomly selected from each household. The response rate for wave I data was 81% and for wave II was 86.7% (N = 34,653) with a cumulative response rate of 70.0% for both waves. Data were weighted at the individual and household levels to adjust for oversampling and non-response on demographic variables (i.e., age, race/ethnicity, sex, region, and place of residence). Data were also adjusted to be representative (based on region, age, race, and ethnicity) of the U.S. adult population as assessed during the 2000 Census. Study participants provided fully informed consent. The U.S. Census Bureau and the U.S. Office of Management and Budget approved the research protocol and informed consent procedures.

Diagnostic Assessment

Data were collected through face-to-face structured psychiatric interviews conducted by US Census workers trained by the National Institute on Alcohol Abuse and Alcoholism and the US Census Bureau. Interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV version (AUDADIS-IV), which has been shown to have good-to-excellent reliability in the diagnosis of mental disorders in the general population (Grant et al., 1995; Hasin et al., 1997). Participants had the option of completing the NESARC interview in English, Spanish, or one of four Asian languages (Mandarin, Cantonese, Korean and Vietnamese). The sample and procedures are described here in a summarized form; however, a more detailed description of the NESARC procedures is available elsewhere (Grant et al., 2003; Grant & Dawson, 2006).

Measures

Acculturation

Consistent with prior research (Salas-Wright et al., 2014) and theory (Schwartz et al., 2010), items measuring the overlapping but distinct constructs of acculturation and ethnic identity were used as indicator variables in the latent modeling. Specifically, twelve items representing cultural identification, language ability and preference, and social engagement were utilized from the language orientation and ethnic social relations subscales from the Short Acculturation Scale (Marin et al., 1987) as well as items the Ethnic Identity Scale (Guarnaccia et al., 2007). Cultural identification represents the degree to which respondents identified with their Asian/Pacific Islander orientation, and includes items on heritage, interpersonal comfort, identity, and shared values. Sample questions are: “Your race/ethnic heritage is important in your life” and “You identify with other people from your race/ethnic group”. Likert scale response options for these questions ranged from (1) strongly agree to (6) strongly disagree. With respect to language ability and preference, items examined the linguistic capacity and preference of participants in general and in various social situations, including the language they typically read/speak, languages spoken at home, the language of thought, and the language used with friends. Sample items include: “In general, what languages do you read and speak?” and “Which languages do you usually speak with your friends?” Likert scale response options ranged from (1) only Asian/Pacific Islander language to (5) only English. Measures of social engagement included preferences relating to visitors, friendships, social gatherings, and close friends. The prompts for the measures of social engagement include: “The persons you visit, or who visit you” and “Please tell me who your close friends are”. Response options for these measures ranged from (1) all from my race/ethnic group to (5) all from other racial/ethnic groups.

DSM Disorders

Lifetime history of clinical (e.g., major depressive disorder, generalized anxiety disorder) and personality disorders (e.g., antisocial personality disorder, and schizotypal personality disorder) was assessed. Additionally, three substance use disorders were examined: nicotine dependence and lifetime alcohol or any illicit drug (e.g. cannabis, opiates) use disorder (abuse/dependence). Although the use of past 12 month of measures for substance use disorders would be optimal, we relied on lifetime measures due to problems with cell size and model stability. Consistent with the original NESARC coding, each item was dichotomously scored (0 = no, 1 = yes).

Sociodemographic Variables

The following sociodemographic variables were also examined and included as indicator covariates in the latent modeling: age, gender, household income, education level, and immigrant status. It should be noted that both “native-born” and “second-generation” respondents were born in the United States and therefore these terms are slightly imprecise. Nevertheless, we elected to use of these terms are they are consistent with the work of scholars in prior research on immigration and health (e.g., Escobar, Nervi, & Gara, 2000; Glaesmer et al., 2011; Salas-Wright, Vaughn, Clark, Terzis, & Córdova, 2014).

Statistical Analyses

This study utilized latent profile analysis (LPA) to identify latent acculturation subgroups on the basis of twelve indicator variables related to cultural identification, language ability and preference, and social engagement. Sociodemographic indicator covariates were also included in the modeling of the latent subgroups. Subsequently, the distribution of outcome variables in the domains of mental and substance use disorders was examined in relation to the latent subgroups identified in the LPA analysis.

Beginning with the LPA, a sequence of latent class models were identified between 1 and 6 classes using Latent GOLD® 4.5 (Vermunt & Magidson, 2008) software. Five statistical criteria were used to identify the best fitting model: the Bayesian Information Criterion (BIC), Akaike’s Information Criterion (AIC), Consistent Akaike’s Information Criterion (CAIC), Log Likelihood, and entropy. In interpreting these criteria, lower BIC, AIC, and CAIC values and higher log likelihood and entropy values reflect better model fit. In addition to these quantitative criteria, the parsimony and substantive interpretability of the latent class solutions also function as key criteria for the selection of the final model. After identifying latent subgroups and assigning subjects to classes on the basis of the probability of membership, the distributions of outcome variables were examined by means of contingency tables and chi-square tests. Consistent with previous studies of Asian/Pacific Islanders using the NESARC data (Bresleau & Chang, 2006), we exclusively examined respondents from this subgroup and made use of Taylor series linearization using Stata 13.1 SE software (StataCorp, 2013) to adjust for standard errors of estimates for complex survey sampling design effects. Additional information about the sampling weights used in the NESARC is described in greater detail elsewhere (Grant, Kaplan, Shepard, & Moore, 2003).

Results

Modeling of Latent Subgroups

As seen in Table 1, the statistical criteria suggest that a five class solution was the optimal modeling of the data. While the values for the fit indices suggest that the addition of a sixth class would slightly improve model fit, these differences are relatively minor. Moreover, the accelerated flattening of the differences in the log likelihood, BIC, AIC and CAIC values between the five and six class solutions suggests that the addition of a sixth class would not be parsimonious. Additionally, the conceptual fit of the latent class models was examined by plotting the mean values of the twelve indicator variables across each of the latent classes. As illustrated in Figure 1, the five class solution provides a clearly distinguishable and conceptually coherent modeling of the heterogeneity of the data.

Figure 1
Characteristics of Latent Classes
Table 1
Fit Indices for Latent Classes

The five class solution is comprised of Class 1: “Separated” (n = 125; 12.91%), Class 2: “Partial Bilingual/Bicultural” (n = 291; 30.06%), Class 3: “English Dominant/Asian Oriented” (n = 119; 12.29%), Class 4: “Full Bilingual/Bicultural” (n = 188; 19.42%), and Class 5: “Assimilated” (n = 245; 25.31%). Class 1 (Separated) is characterized by universally low levels of acculturation across the domains of cultural identification, language ability and preference, and social engagement. Class 2 (Partial Bilingual/Bicultural) is characterized by a pattern of more moderate scores with respect to the aforementioned domains. For instance, the mean score for languages read/spoken and preference for social gatherings were 2.75 (3 = read/speak non-English and English language “both equally”) and 2.63 (3 = “about half and half” from my racial/ethnic group and other groups), respectively. Class 3 (English Dominant/Asian Oriented), the most variable of all classes in terms of the mean values of the indicator variables, is characterized by strong identification with Asian/Pacific Islander culture and a clear preference for social engagement with Asian/Pacific Islanders in combination with a clear tendency to speak English more than non-English languages. Class 4 (Full Bilingual/Bicultural) represents an incremental increase in acculturation from Class 2 in terms of the mean values for cultural identification, language ability and preference, and social engagement. Class 5 (Assimilated) is characterized, with the exception of heritage, by universally elevated levels of acculturation across all three domains.

Sociodemographic Characteristics of Latent Subgroups

Table 2 displays the bivariate associations between membership in the five latent acculturation subgroups and sociodemographic factors. Significant differences were observed for age (F = 19.66, p < .001) with the highest mean value for age identified among members of Class 1(M = 54.77, SD = 16.35) and a more circumscribed range observed among the remaining classes. In terms of gender, significant differences were also observed (χ2 = 14.02, p < .001). Class 1 (Separated) had the lowest proportion of male respondents (35.04%) and Class 2 (Partial Bilingual/Bicultural) had the highest proportion of male respondents (54.01%). Significant differences were also observed with respect to household income (χ2 = 98.31, p < .001). Class 4 (Full Bilingual/Bicultural) had the highest proportion of respondents residing in households earning more than $70,000 per year (46.09%) which was substantially greater than Class 1 (Separated) which had the lowest percentage of respondents residing in households earning more than $70,000 per year (13.92%). A similar pattern of differences was observed with regard to education level as the highest proportion of respondents with some college education or more was observed among Class 4 (Full Bilingual/Bicultural; 88.01%) and the lowest proportion was observed among Class 1 (Separated; 30.23%) (χ2 = 198.13, p < .001). Finally, with regard to immigrant status, a clear and significant pattern of differences was observed (χ2 = 384.42, p < .001). Among Class 1 (Separated; 99.51%) and Class 2 (Partial Bilingual/Bicultural; 95.43%) the proportion of first generation immigrants was markedly elevated, as was the proportion among Class 4 (Full Bilingual/Bicultural; 88.84%). Far more variability was observed among members of Class 3 (English Dominant/Asian Oriented) and Class 5 (Assimilated) which were comprised of 34.10% and 40.12% first generation immigrants, respectively.

Table 2
Sociodemographic Characteristics by Latent Class

We also examined the characteristics of the latent classes with respect to age at the time of migration, duration in the United States, and ethnic/national heritage. Notably, not all study participants were included in the analyses of age at the time of migration and duration in the United States as roughly one in four (24.1%) Asian/Pacific Islanders in the sample were non-immigrants. Significant bivariate differences were observed respect to the age upon arrival to the United States (F = 74.93, p < .001) and duration in the United States (F = 17.25, p < .001). By far, the age (M = 37.0, SD = 13.8) at the time of arrival was highest among members of Class 1 (Separated) followed by members of Class 2 (Partial Bilingual/Bicultural) with a mean age of 27.0 years (SD = 9.9). Members of Class 1 and 2 also reported the shortest duration in the United States with a mean duration of 17.9 (SD = 11.4) and 17.2 years (SD = 11.2), respectively. Post hoc analyses revealed that the mean values for age upon arrival among members of Classes 3 (English Dominant, Asian Oriented; M = 21.5, SD = 13.8) and 4 (M = Full Bilingual/ Bicultural; 22.6, SD = 11.1) were not significantly different from one another. Similarly, no significant differences were observed between members of Class 3 (M = 21.3, SD = 11.4) and Class 4 (M = 20.1, SD = 11.6) with respect to duration in the United States. Immigrant members of Class 5 (Assimilated) were far and away the youngest upon arrival to the United States (M = 11.8, SD = 9.5). Members of Class 5 also reported the longest duration in United States of any group (M = 28.1, SD = 11.5).

Table 3 displays the proportion of individuals in each of the ethnic/national heritage groups for each of the five latent classes. Class 1 (Separated) had the highest proportion of Chinese (35.74%) and Vietnamese (15.55%) respondents and the smallest proportion of Filipino (4.22%) and Japanese (1.39%) respondents of all of the latent classes. Class 3 (English Dominant, Asian Oriented) had the largest proportion of respondents classified as “other” (30.79%) and the smallest proportion of Korean (2.60%) and Vietnamese (2.58%) respondents. Class 4 (Full Bilingual/Bicultural) stood out as having the large proportion of Indian/Afghan/Pakistani respondents (25.46%) and the smallest proportion of respondents classified as “other” (12.47%). Finally, Class 5 (Assimilated) had the smallest proportion of Chinese (18.38%) and Indian/Afghan/Pakistani (9.16%) respondents and the largest proportion of Japanese respondents (18.63%).

Table 3
Ethnic/National Heritage across Latent Classes

Mental and Substance Use Disorders among Latent Subgroups

Table 4 displays the bivariate associations between membership in the five latent subgroups and the prevalence of lifetime mental and substance use disorders. With respect to clinical disorders, significant differences were observed across the latent subgroups (χ2 = 11.06, p < .001). Class 3 (English Dominant/Asian Oriented) has the highest proportion of respondents who met criteria for a clinical disorder (30.75%) followed closely by Class 5 (Assimilated) with 27.62% of class members meeting criteria for a clinical disorder. The lowest prevalence of clinical disorders was observed among Class 2 (Partial Bilingual/Bicultural; 18.52%) followed by Class 1 (Separated; 19.70%) and Class 4 (Full Bilingual/Bicultural; 21.29%). In terms of personality disorders, the highest prevalence again was observed among Class 3 (English Dominant/Asian Oriented; 19.73%) followed closely by members of Class 5 (Assimilated; 18.76%) and Class 4 (Full Bilingual/Bicultural; 17.94%). Substantially lower rates of personality disorders were observed among members of Class 1 (Separated; 6.69%) and Class 2 (Partial Bilingual/Bicultural; 11.27%).

Table 4
Mental and Substance Use Disorders across Latent Classes

With regard to DSM substance use disorders, significant differences were observed across subgroups for nicotine dependence (χ2 = 14.30, p < .001), as well as alcohol (χ2 = 77.61, p < .001) and illicit drug use disorders (χ2 = 55.48, p < .001). In terms of nicotine dependence, the highest prevalence was observed among members of Class 5 (Assimilated; 12.47%) and the lowest prevalence observed among Class 2 (Partial Bilingual/Bicultural; 3.91%) followed closely by Class 1 (Separated; 5.90%). As for alcohol and illicit drug use disorders, markedly lower rates of morbidity were observed among members of Class 1 (AUD = 1.19%, IDUD = 0.70%) and Class 2 (AUD = 8.27%, IDUD = 0.84%). The highest rates of alcohol use disorder were observed among Class 5 (Assimilated; 28.11%) followed closely by Class 3 (English Dominant/Asian Oriented; 26.74%). With respect to illicit drug use disorder, the highest prevalence was again observed among Class 5 (Assimilated; 15.30) however, the second highest rates were observed among members of Class 4 (Full Bilingual/Bicultural; 8.49%). Finally, in terms of comorbid mental and substance use disorders, the highest prevalence was observed among members of Class 5 (Assimilated; 18.83%) followed by Class 3 (English Dominant/Asian Oriented; 15.98%).

Discussion

The relationship between increased acculturation and greater risk for mental and substance use disorders has been well-established among major immigrant populations in the US (Burnett-Zeigler et al., 2013; Koneru et al., 2007). Notably, however, most of this research has examined this link using either composite measures of acculturation or instruments designed to independently measure various subcomponents of acculturation. This is noteworthy in light of an emerging body of evidence that suggests that the various subcomponents of acculturation—such as cultural identification, language ability and preference, and social engagement—tend to be incorporated in the lives of individuals in ways that reflect relatively distinct and stable profiles (Schwartz et al., 2010; Schwartz & Zamboanga, 2008), and confer risk with regard to psychiatric morbidity (Salas-Wright et al., 2014). Cognizant of such shortcomings, we utilized a population-based study with a large population of Asian/Pacific Islanders in the US in the exploration of two interrelated questions. First, can we model the acculturative heterogeneity of Asian/Pacific Islanders in the US such that substantively meaningful subgroups can be identified? Second, if so, can we identify differences with regard to mental and substance use disorders across the acculturative subgroups? Our exploration of these questions provides new evidence on the relationship between acculturation and mental disorders among Asian/Pacific Islanders in the US.

Study results revealed five substantively meaningful acculturative subgroups among Asian/Pacific Islanders in the US. First, roughly one in four (25%) Asian/Pacific Islanders were classified as “Assimilated” to the culture of the US. Members of this class were found to report moderate-to-high levels of Asian/Pacific Islander identity, in combination with elevated levels of linguistic and social acculturation. Additionally, just under half of respondents were categorized into either the partial (30%) or full (19%) bilingual/bicultural classes which were characterized by moderate levels of Asian/Pacific Islander identity in combination with acculturative flexibility with respect to linguistic and social engagement. Approximately one in eight (12%) Asian/Pacific Islanders were classified as “English Dominant, Asian Oriented”. Members of this class reported a strong identification with their Asian/Pacific Islander heritage as well as a strong preference for social engagement with Asian/Pacific Islanders, but tended to either be monolingual English speakers or strongly prefer the use of the English language. Finally, roughly one in eight respondents (13%) were categorized into the “Separated” class which was characterized by universally low levels of acculturation across cultural, linguistic, and social domains. Members of this class tended to be disproportionately first-generation female immigrants who were relatively older, less educated, and economically disadvantaged compared to members of the other classes. Notably, four of the five classes (Classes 1, 2, 4, and 5) identified represent something akin to an acculturative gradient ranging from low to high acculturation; however, the “English Dominant, Asian Oriented” class stands out as categorically distinct inasmuch as members of this group are characterized by high linguistic acculturation in combination with a strong sense of Asian identity and a preference for social engagement with individuals from their same racial/ethnic group.

Study findings also point to a number of noteworthy links between acculturative subtypes and the prevalence of mental disorders. With respect to clinical disorders, the highest rates of morbidity were observed among members of the two classes characterized by a strong preference for the use of the English language (i.e. the “English Dominant, Asian Oriented” [31%] and “Assimilated” [28%] classes). These rates were markedly higher than those observed among the three remaining classes which were clustered closely together ranging from roughly 19% to 21%. This pattern of findings is consistent with prior research suggesting a potential link between linguistic acculturation and psychiatric morbidity (Koneru et al., 2007). Similarly, the highest prevalence of personality disorders was observed among the two English dominant classes (i.e. the “English Dominant, Asian Oriented” [20%] and “Assimilated” [19%] classes); however, the prevalence of personality disorders among the “Full Bilingual/Bicultural” (18%) class was closely aligned with these two classes. Much larger differences were observed among members of the “Separated” (7%) and “Partial Bilingual/Bicultural” (11%) classes. In terms of personality disorders, these findings seem to suggest that risk for personality disorders may be lower among Asian/Pacific Islanders who maintain a separated status from mainstream American culture.

With respect to the links between acculturative subtypes and substance use disorders, a somewhat distinct pattern of findings was observed. Far and away, the highest prevalence of nicotine (12%) and illicit drug use (15%) disorders was observed among members of the “Assimilated” class. This finding is certainly consistent with previous research highlighting a link between greater levels of acculturation and substance use disorders (Burnett-Zeigler et al., 2013; Koneru et al., 2007); however, it is noteworthy that substantially lower levels of morbidity were observed among members of the “English Dominant, Asian Oriented” class (nicotine = 7%, illicit drugs = 6%) as this is in contrast to the pattern observed with respect to mental disorders. A distinct pattern was observed with respect to alcohol use disorder. Namely, the highest rates were still observed among the “Assimilated” class (28%), but very similar rates were observed among the “English Dominant/Asian Oriented” (27%) class. These rates were substantially greater than those observed among the “Separated” (1%), “Partial Bilingual/Bicultural” (8%), and “Full Bilingual/Bicultural” (11%) classes. This pattern of findings is in accordance with previous research pointing to a link between the loss of one’s language of origin and increased risk for substance use disorders (Park, Anastas, Shibusawa, & Nguyen, 2014; Salas-Wright et al, 2014; Unger et al., 2000).

Study Limitations

Study findings should be interpreted in light of several limitations. First, although the study examined acculturation with respect to cultural identification, language ability and preference, and social engagement, prior theorizing have pointed to the importance of considering additional factors of relevance to acculturation (Schwartz et al., 2010). For example, we do not have data on factors such as the consumption of traditional food or the celebration of traditional holidays. Second, due to low base rates, statistical analyses were limited to an examination of lifetime measures of mental and substance use disorders. It is possible that an examination of mental and substance use disorders over the course of a more circumscribed timeframe (e.g., last 12 months, last 30 days) might yield different results. Moreover, this approach does not allow us to discern whether or not substance use morbidity was in reference to a period of time before arrival to the United States which, consequently, limits our capacity to determine whether acculturation played a role in the etiology of disorders. Finally, the NESARC is not a true longitudinal investigation and, consequently, caution should be exercised in the interpretation of the temporal relationships between acculturation and mental and substance use disorders. Fundamentally, ours is a correlational study that examines the cross-sectional association between variables measuring acculturation and substance use disorders. A life course study design with more circumscribed measures of substance use disorders would be necessary in order to truly measure the causal impact of acculturation in the etiology of substance use disorders.

Conclusions

Study findings suggest that an important degree of heterogeneity can be observed in terms of the cultural, linguistic, and social acculturation of Asian/Pacific Islanders in the US. Although we do not formally compare latent class models with more traditional dimensional models of acculturation, study findings are consistent with much of the seminal research on the acculturative typologies (Berry, 1980, 1997) as well as an emerging body of literature that has focused on the distinct profiles of individuals from the nation’s rapidly growing immigrant populations (Salas-Wright et al., 2014; Schwartz et al., 2010; Schwartz & Zamboanga, 2008). Consistent with prior research on the relationship between acculturation and mental and substance use disorders, findings suggest that risk of morbidity is greater among individuals at higher levels of acculturation; however, findings also suggest that an important level of nuance can be observed with respect to acculturative subtypes identified on the basis of cultural identification, language ability and preference, and social engagement. Clinical implications of the current study are that Asian/Pacific Islanders, particularly those who are either monolingual English speakers or prefer the use of English language, should be monitored for potential psychiatric morbidity and targeted in prevention programs designed to address mental health and substance use problems.

Acknowledgments

Funding Information: This research was supported in part by a grant from the National Institute on Drug Abuse at the National Institutes of Health (R25 DA026401 PI: Valdez).

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