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1.  Reducing liver cancer disparities: a community-based hepatitis-B prevention program for Asian-American communities. 
OBJECTIVES: Several Asian-American groups are at a higher risk of dying of liver diseases attributable to hepatitis-B infection. This culturally diverse community should be well informed of and protected against liver diseases. The present study assesses the knowledge of hepatitis B before and after a hepatitis-B educational program and determines the infection status of an Asian community. METHODS: Nine Asian communities of Montgomery County, MD, enrolled in the hepatitis-B prevention program between 2005 and 2006. They attended culturally tailored lectures on prevention, completed self-administered pre- and posttests, and received blood screening for the disease. RESULTS: More than 800 Asian Americans participated in the study. Knowledge of prevention was improved after educational delivery. The average infection rate was 4.5%, with Cambodian, Thai, Vietnamese, Chinese and Korean groups having higher infection rates. The age group of 36-45 had the highest percentage of carriers (9.1%). CONCLUSION: Many Asian groups, particularly those of a southeast Asian decent, were subject to a higher probability of hepatitis-B infection. At an increased risk are first-generation Asian immigrants, groups with low immunization rates and those aged 36-45. The findings provide potential directions for focusing preventive interventions on at-risk Asian communities to reduce liver cancer disparities.
PMCID: PMC2574302  PMID: 17722668
2.  Assessing the Mental Health Needs and Barriers to Care Among a Diverse Sample of Asian American Older Adults 
ABSTRACT
BACKGROUND
Asian Americans represent a mix of cultures and immigration experiences, which may put them differentially at risk for mental health problems. Yet, little is known about the mental health needs of older adults from various Asian subgroups compared to non-Hispanic whites.
OBJECTIVES
To compare the prevalence rates of mental distress of Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese older adults (aged 55 and older) to that of non-Hispanic whites; and to examine subgroup differences in utilization of mental health services.
METHODS
A cross-sectional analysis of a population-based sample of California adults responding to the 2007 California Health Interview Survey. Multivariable logistic regression analysis was used to examine subgroup differences in mental health status and use of mental health services among the six different Asian subgroups and non-Hispanic whites, adjusting for respondents’ demographic and health characteristics, socioeconomic status, and English-language proficiency.
RESULTS
A total of 20,712 respondents were included. Filipino [aOR=2.25; 95% CI=1.14-4.47] and Korean Americans [aOR=2.10; 95% CI=1.06-4.17] were more likely to report symptoms indicative of mental distress compared to non-Hispanic whites, yet were less likely to have seen a primary care provider [Filipino: aOR=0.41; 95% CI=0.18-0.90; Korean: aOR=0.24; 95% CI = 0.08-0.69] or have taken a prescription medication [Filipino: aOR=0.20; 95% CI=0.10-0.40; Korean: aOR=0.15; 95% CI=0.05-0.40], even after adjusting for indicators of respondents’ demographic and health characteristics, socioeconomic status, and English-language proficiency. In contrast, Japanese Americans were less likely to report symptoms indicative of mental distress [aOR=0.43; 95% CI=0.21-0.90], and were less likely to make use of mental health services compared to non-Hispanic whites.
DISCUSSION/CONCLUSIONS
The findings from this study not only highlight the unmet mental health needs among older Asian Americans, but also illustrate significant variations among the various Asian subgroups. Clinicians who work closely with these patients should regularly screen and assess older Asian adults for symptoms related to their mental health needs.
doi:10.1007/s11606-010-1612-6
PMCID: PMC3101977  PMID: 21321793
Asian Americans; mental health; aging; distress; California Health Interview Survey (CHIS)
3.  Physical, Behavioral, and Mental Health Issues in Asian American Women: Results from the National Latino Asian American Study 
Journal of Women's Health  2011;20(11):1703-1711.
Abstract
Aims
Asian American women's health has been understudied while the Asian American population is increasing. The purpose of this study was to examine the physical, behavioral, and mental health of Asian American women.
Methods
Using a nationally representative sample (n=1097) from the National Latino Asian American Study (NLAAS), the first comprehensive epidemiologic survey in the United States, we examined the annual rates of behavioral, physical, and mental healthcare service use, including general medical, specialty mental health, and any medical services, in three major subgroups of Asian American women.
Results
Health problems varied with three major subgroups of Asian American women. In physical health, Chinese American women reported the highest rates of headache, other pain, hypertension, heart diseases, heart attacks, chronic lung diseases, and asthma. Vietnamese American women reported the highest rates of ulcer, stroke, and diabetes. Filipino American women had the highest rates of cancers and epilepsy. In behavioral health, Filipino women ranked highest on all types of drug use and cigarette smoking, compared with their counterparts. In mental health, Filipino American women reported significantly better mental health self-rating compared with their Chinese and Vietnamese American counterparts. Asian American women from each ethnic group sought health services at distinct rates. However, the help-seeking patterns of health services are similar.
Conclusions
Asian American women encountered various physical, behavioral, and mental health problems, yet they had low rates of seeking healthcare services. Hence, it is critical to further examine factors associated with the underestimation of physical and mental health problems and underuse of health services by Asian American women.
doi:10.1089/jwh.2010.2726
PMCID: PMC3253389  PMID: 21777144
4.  Binge Drinking and Alcohol-Related Problems among U.S-Born Asian Americans 
Binge drinking (five drinks or more in a 2-hour sitting for men, or four or more drinks in a 2-hour sitting for women) and alcohol-related problems are a growing problem among Asian American young adults. The current study examines the socio-cultural (i.e., generational status and ethnic identity) determinants of binge drinking and alcohol-related problems across U.S.-born, young adult, Asian American ethnic groups. Data were collected from 1,575 Asian American undergraduates from a public university in Southern California. Chinese Americans consisted of the largest Asian ethnicity in the study followed by Vietnamese, Filipino, Korean, South Asian, Japanese, Multi-Asian, and “other Asian American”. Participants completed a web-based assessment of binge drinking, alcohol-related problems, ethnic identity, descriptive norms (i.e., perceived peer drinking norms) and demographic information. An analysis of variance was used to determine potential gender and ethnic differences in binge drinking and alcohol-related problems. Negative binomial regression was selected to examine the relationship between the predictors and outcomes in our model. There were no gender differences between Asian American men and women in regards to binge drinking, however men reported more alcohol-related problems. Japanese Americans reported the highest number of binge drinking episodes and alcohol-related problems, followed by Filipino, and Multi-Asian Americans (e.g., Chinese and Korean). Living off-campus, higher scores in descriptive norms, Greek status, and belonging to the ethnic groups Japanese, Filipino, Multi-Asian, Korean, and South Asian increased the risk of engaging in binge drinking. Quantity of alcohol consumed, Greek status, gender, Filipino, South Asian “Other” Asian, and lower ethnic identity scores were related to alcohol-related problems. Using one of the largest samples collected to date on socio-cultural determinants and drinking among U.S.-born Asian American young adults, the findings highlight the significant variability in drinking patterns between Asian American ethnic groups.
doi:10.1037/a0028422
PMCID: PMC3489163  PMID: 22686146
Asian Americans; U.S-Born; binge drinking; alcohol-related problems
5.  Cerebral Palsy Among Asian Ethnic Subgroups 
Pediatrics  2012;129(4):e992-e998.
OBJECTIVE:
Asians have a reduced risk for cerebral palsy (CP) compared with whites. We examined whether individual Asian subgroups have a reduced risk of CP and whether differences in sociodemographic factors explain disparities in CP prevalence.
METHODS:
In a retrospective cohort of 629 542 Asian and 2 109 550 white births in California from 1991 to 2001, we identified all children who qualified for services from the California Department of Health Services on the basis of CP. Asians were categorized as East Asian (Chinese, Japanese, Koreans), Filipino, Indian, Pacific Islander (Guamanians, Hawaiians, and Pacific Islanders), Samoan, or Southeast Asian (Cambodian, Laotian, Thai, Vietnamese).
RESULTS:
Overall, CP prevalence was lower in Asians than whites (1.09 vs 1.36 per 1000; relative risk = 0.80, 95% confidence interval [CI] = 0.74–0.87) and ranged from 0.61/1000 in Thai children to 2.08/1000 in Samoan children. Several Asian subgroups had low risk profiles with respect to maternal age, educational attainment, and birth weight. However, after we adjusted for maternal age and education, infant gender, and birth weight, the adjusted risk of CP remained lower in East Asians (odds ratio [OR] = 0.75, 95% CI = 0.65–0.87), Filipinos (OR = 0.87, 95% CI = 0.75–0.99), Indians (OR = 0.59, 95% CI = 0.44–0.80), Pacific Islanders (OR = 0.62, 95% CI = 0.40–0.97), and Southeast Asians (OR = 0.68, 95% CI = 0.57–0.82) compared with whites.
CONCLUSIONS:
Most Asian national origin subgroups have a lower rate of CP than whites, and this disparity is unexplained. Additional studies that focus on the cause of ethnic disparities in CP may provide new insights into pathogenesis and prevention.
doi:10.1542/peds.2011-2283
PMCID: PMC3313638  PMID: 22430449
cerebral palsy; racial disparity; epidemiology; sociodemographic
6.  English Language Proficiency and Smoking Prevalence among California's Asian Americans 
Cancer  2005;104(12 Suppl):2982-2988.
The authors documented California's tobacco control initiatives for Asian Americans and the current tobacco use status among Asian subgroups and provide a discussion of the challenges ahead. The California Tobacco Control Program has employed a comprehensive approach to decrease tobacco use in Asian Americans, including ethnic-specific media campaigns, culturally competent interventions, and technical assistance and training networks. Surveillance of tobacco use among Asian Americans and the interpretation of the results have always been a challenge. Data from the 2001 The California Health Interview Survey (CHIS) were analyzed to provide smoking prevalence estimates for all Asian Americans and Asian-American subgroups, including Korean, Filipino, Japanese, South Asian, Chinese, and Vietnamese. Current smoking prevalence was analyzed by gender and by English proficiency level. Cigarette smoking prevalence among Asian males in general was almost three times of that among Asian females. Korean and Vietnamese males had higher cigarette smoking prevalence rates than males in other subgroups. Although Asian females in general had low smoking prevalence rates, significant differences were found among Asian subgroups, from 1.1% (Vietnamese) to 12.7% (Japanese). Asian men who had high English proficiency were less likely to be smokers than men with lower English proficiency. Asian women with high English proficiency were more likely to be smokers than women with lower English proficiency. Smoking prevalence rates among Asian Americans in California differed significantly on the basis of ethnicity, gender, and English proficiency. English proficiency seemed to have the effect of reducing smoking prevalence rates among Asian males but had just the opposite effect among Asian females.
doi:10.1002/cncr.21523
PMCID: PMC1810894  PMID: 16276539
public health; epidemiology; cancer; statistics
7.  Physician contact by older Asian Americans: the effects of perceived mental health need 
Objective:
The use of physicians is more common than of behavioral specialists, especially in underserved Asian American communities. Despite a rapidly aging Asian American population, research has overlooked older people. This study examines the way mental health need affects the number of physician contacts by older Asian Americans.
Method:
This study uses data on self-identified Asian Americans aged over age 50 years derived from the 2001 California Health Interview Survey. A total of 1191 Asian Americans from Chinese, Filipino, Korean, and Vietnamese backgrounds were studied. Replicate weights were applied to account for the survey’s complex sampling methods. Linear regression was used to identify the number of physician contacts.
Results:
Overall, respondents had seen a doctor an average of five times in the previous 12 months; 7% perceived that they had a mental health need. Perceiving a mental health need was associated with a decreased number of physician contacts for Filipino and Korean Americans.
Conclusion:
This study revealed interethnic differences among older Asian Americans’ contact with physicians. As older Filipino and Korean Americans who perceive a mental health need have fewer contacts with their physician, correctly identifying mental health needs in the health care system for these groups is crucial. Health and mental health professionals can work toward reducing mental health disparities by accounting for older Asian Americans’ help-seeking patterns when designing evidence-based interventions.
doi:10.2147/CIA.S14273
PMCID: PMC3010168  PMID: 21228898
minority groups; Asians; health service use
8.  Differences in Neonatal Mortality among whites and Asian-American Subgroups: Evidence from California 
Objective
To obtain information about newborn health outcomes among nine subgroups of the Asian population in the United States.
Design
Cross-sectional comparison of outcomes for births to Cambodian-, Chinese-, Filipino-, Indian-, Japanese-, Korean-, Laotian-, Thai-, and Vietnamese-origin mothers, and births to non-Hispanic white mothers. Regression models are used to compare neonatal mortality rates across groups, before and after controlling for a range of risk factors.
Setting
All California births between 1991 and 2001
Participants
2,304,301 newborns
Main Exposure
Racial and ethnic groups
Outcome Measure
Neonatal mortality (death within 28 days of birth)
Results
Unadjusted mortality rates in some Asian-American subgroups are significantly different from rates for non-Hispanic whites (non-Hispanic white rate=2.0 per 1,000 births; Chinese=1.2, Japanese=1.2, Korean=2.7; all p<0.05). For infants of Chinese mothers, observed risk factors explain the differences observed in unadjusted data. For Cambodian, Japanese, Korean, and Thai newborns, differences persist or even widen after risk factors are taken into account. After risk adjustment, infants of Cambodian, Japanese, and Korean mothers have significantly lower neonatal mortality rates than those born to non-Hispanic whites (adjusted OR=0.58 for Cambodian, 0.67 for Japanese, 0.69 for Korean, all p<0.05), and infants of Thai mothers have higher rates (adjusted OR 1.89, p<0.05).
Conclusions
There are significant variations in neonatal mortality between subgroups of the Asian-American population that are not entirely explained by differences in observable risk factors. Efforts to improve clinical care that treat Asian-Americans as a homogeneous group may miss important opportunities for improving infant health in specific sub-groups.
doi:10.1001/archpedi.161.1.69
PMCID: PMC2376811  PMID: 17199070
9.  Performance of the U.S. Office of Management and Budget’s Revised Race and Ethnicity Categories in Asian Populations* 
Objectives
The U.S. Office of Management and Budget (OMB) guidelines for collecting and reporting race and ethnicity information recently divided the “Asian or Pacific Islander” category into “Asian” and “Native Hawaiian or Other Pacific Islander”. The OMB’s decision to disaggregate the “Asian or Pacific Islander” category was the first step toward providing these communities with information to better serve their needs. However, whether individuals who formerly made up the combined group categorize themselves as the new guidelines intend is a question analyzed in this report.
Methods
A subset of adults participating in the Hemochromatosis and Iron Overload Screening Study completed both the OMB-minimum and the expanded race and ethnicity measure used in the National Health Interview Survey. We compared responses on the expanded measure contained within the OMB “Asian” definition (Filipino, Korean, Vietnamese, Japanese, Asian Indian, Chinese, and/or Other Asian) to “Asian” responses on the OMB-minimum measure.
Results
Mixed heritage Asians less often marked “Asian”. Among mixed heritage Japanese, Chinese, and Filipinos, 27%, 49%, and 52% did not mark “Asian” on the OMB measure, respectively. Eleven percent of single-heritage Filipinos did not mark “Asian.”
Conclusions
Many individuals formerly making up the combined “Asian or Pacific Islander” group do not categorize themselves as the revised OMB guidelines intend. This is particularly evident among Filipinos and among Asians of mixed heritage. This research illuminates the reliability and utility of the broad “Asian” category and points to possible consequences of collapsing groups into a single category, i.e., missed information and/or erroneous generalization.
doi:10.1016/j.ijintrel.2007.02.001
PMCID: PMC2084211  PMID: 18037976
10.  ALDH2, ADH1B, and ADH1C Genotypes in Asians: A Literature Review 
Alcohol Research & Health  2007;30(1):22-27.
Variants of three genes encoding alcohol-metabolizing enzymes, the aldehyde dehydrogenase gene ALDH2 and the alcohol dehydrogenase genes ADH1B and ADH1C, have been associated with reduced rates of alcohol dependence. The genotype prevalence of these genes varies in general samples of different Asian ethnic groups. The ALDH2*2 allele appears to be most prevalent in Chinese-American, Han Chinese and Taiwanese, Japanese, and Korean samples. Much lower rates have been reported in Thais, Filipinos, Indians, and Chinese and Taiwanese aborigines. ADH1B*2 is highly prevalent among Asians, with the exception of Indians. ADH1C*1 also is highly prevalent in Asians, but has only been examined in a few studies of Chinese and Korean samples.
PMCID: PMC3860439  PMID: 17718397
Alcohol dependence; ethanol metabolism; ethanol-to-acetaldehyde metabolism; alcohol dehydrogenase (ADH); aldehyde dehydrogenase (ALDH); acetaldehyde; ALDH2; ADH1B; ADH1C; risk factors; protective factors; genetic factors; ethnic groups; Asians; Chinese; Filipino; Indian; Japanese; Korean; Malaysian; Thai
11.  Hepatitis B and Liver Cancer Among Three Asian American Sub-Groups: A Focus Group Inquiry 
Prevalence of hepatitis B among Asian Americans is higher than for any other ethnic group in the United States. Since more than 50% of liver cancer is hepatitis B related, the burden of morbidity and mortality is extremely high among Asian Americans, highlighting the need for culturally appropriate interventions. We conducted focus groups (n = 8) with a total of 58 Korean, Vietnamese, and Chinese immigrants in Maryland to explore knowledge, awareness and perceived barriers toward hepatitis B screening and vaccinations. Thematic analysis uncovered generally low levels of knowledge and awareness of hepatitis B risks, screening, and vaccination; inter-generational differences; and barriers to prevention. Some differences arose across ethnic groups, particularly toward perceived orientation to preventive activities and the role of religious groups. High rates of hepatitis B infection among Asian Americans highlight the need for tailored interventions. These findings may assist policy strategists in implementing interventions that will facilitate the integration and scale-up of hepatitis B education, screening, and vaccination campaigns.
doi:10.1007/s10903-011-9523-0
PMCID: PMC3804298  PMID: 21901445
Hepatitis B risk; HBV screening and vaccinations; Asian Americans; Qualitative; Immigrant health
12.  Seizing the Moment 
Cancer  2005;104(12 Suppl):2962-2968.
Asian Americans and Pacific Islanders (AAPI) have the fastest growing rate of overweight and obese children. Aggressive programs are urgently needed to prevent unhealthy acculturation-related changes in diet and physical activity and to promote the healthier aspects of traditional lifestyle habits. We conducted focus groups and key informant interviews to explore knowledge, attitudes, dietary practices, and physical activity levels among three low-income Asian American ethnic groups, Chinese, Vietnamese, and Hmong, in California. Content analysis was used to identify similarities and differences among the groups. Several common health beliefs clearly emerged. Participants noted the importance of fresh (not frozen) fruit and vegetable consumption and physical activity for general health. The concept of good health included having a harmonious family, balance, and mental and emotional stability. All groups also expressed the general belief that specific foods have hot or cold properties and are part of the Yin/Yang belief system common to Asian cultures. The lure of fast food, children’s adoption of American eating habits, and long work hours were identified as barriers to a healthy, more traditional lifestyle. A California campaign for Asian Americans using multilevel strategies is recommended to counter the alarming rise of obesity among AAPI youth. Strategies directed to individual, community, and policy levels should emphasize maintenance of healthy traditional diets, informed selection of mainstream U.S. foods, and promotion of active lifestyles to prevent an impending burden from cancer and nutrition-related chronic diseases in AAPI populations.
doi:10.1002/cncr.21514
PMCID: PMC1810968  PMID: 16276535
Five A Day; Asian Americans; Chinese; health disparities; Hmong; nutrition; obesity; physical activity; Vietnamese
13.  Health Risk Behaviors among Five Asian American Subgroups in California: Identifying Intervention Priorities 
This analysis assessed the prevalence of excess body weight, physical inactivity and alcohol and tobacco use in Asian American subgroups. Using 2005 California Health Interview Survey data, we estimated the prevalence of body mass index (BMI) categories using both standard and World Health Organization-proposed Asian-specific categories, physical inactivity, and alcohol and tobacco use for Chinese (n=1285), Japanese (n=421), Korean (n=620), Filipino (n=659) and Vietnamese (n=480) Americans in California. About 80% of Japanese and Filipino American men and 70% of Korean American men were “increased/high risk” by Asian-specific BMI categories. Most Asian American subgroups were more likely to walk for transportation than non-Hispanic whites, but less likely to report other physical activities. Highest smoking and binge drinking prevalences were among Korean, Vietnamese and Filipino American men and Japanese and Korean American women. These results suggest risk profiles for each Asian American subgroup to consider when setting priorities for health promotion programs.
doi:10.1007/s10903-011-9552-8
PMCID: PMC3298627  PMID: 22089979
Asian American subgroups; California Health Interview Survey; Body Mass Index; Health risk behaviors
14.  Re-examining the relationships among dementia, stigma, and aging in immigrant Chinese and Vietnamese family caregivers 
Prior literature emphasizes that Asian Americans with dementia may be particularly vulnerable to the stigma of chronic mental illness. However, there is a dearth of empirical research to support this claim. This study examines the relationship of stigma and dementia in 32 qualitative interviews with Chinese and Vietnamese family caregivers. Stigma was a common theme in the interviews (91%). Further analysis of stigma revealed two sources: chronic mental illness stigma and stigma reflecting negative stereotypes of aging or the aged. Chinese and Vietnamese cultural views of normal aging are not a unitary category but accommodate different trajectories of aging, some more and some less desired. When applied to persons with dementia, a “normalized” but negative trajectory of aging carried with it significant stigma that was distinct from but in addition to the stigma of chronic and severe mental illness. Older Chinese and Vietnamese with dementia are thus at risk of experiencing multiple stigmas that include but go beyond the stigma associated with chronic and severe mental illness.
doi:10.1007/s10823-008-9075-5
PMCID: PMC2958058  PMID: 18665444
15.  Asian Americans Have Greater Prevalence of Metabolic Syndrome Despite Lower Body Mass Index 
Objective
To examine the relationship between body mass index and metabolic syndrome for Asian Americans and non-Hispanic Whites, given that evidence shows racial/ethnic heterogeneity exists in how body mass index predicts metabolic syndrome.
Research Design and Methods
Electronic health records of 43 507 primary care patients aged 35 years and older with self-identified race/ethnicity of interest (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or non-Hispanic White) were analyzed in a mixed-payer, outpatient-focused healthcare organization in the San Francisco Bay Area.
Results
Metabolic syndrome prevalence is significantly higher in Asians compared to non-Hispanic Whites for every body mass index category. For women at the mean age of 55 and body mass index of 25 kg/m2, the predicted prevalence of metabolic syndrome is 12% for non-Hispanic White women compared to 30% for Asians; similarly for men, the predicted prevalence of metabolic syndrome is 22% for non-Hispanic Whites compared to 43% of Asians. Compared to non-Hispanic White women and men with a body mass index of 25 kg/m2, comparable prevalence of metabolic syndrome was seen at body mass index of 19.6 kg/m2 for Asian women and 19.9 kg/m2 for Asian men. A similar pattern was seen in disaggregated Asian subgroups.
Conclusions
Despite lower body mass index values and lower prevalence of overweight/obesity than non-Hispanic Whites, Asian Americans have higher rates of metabolic syndrome over the range of body mass index. Our results indicate that body mass index ranges for defining overweight/obesity in Asian populations should be lower than for non-Hispanic Whites.
doi:10.1038/ijo.2010.152
PMCID: PMC2989340  PMID: 20680014
Obesity; Metabolic Syndrome; Racial Differences; Asian; Population Study
16.  Comparing Selected Measures of Health Outcomes and Health-Seeking Behaviors in Chinese, Cambodian, and Vietnamese Communities of Chicago: Results from Local Health Surveys 
We describe how local community organizations partnered to conduct a survey in the Chinese, Cambodian, and Vietnamese populations of Chicago to compare health outcomes and assess progress toward Healthy People 2010 goals. Interviews were conducted with 380 randomly selected Chinese adults through door-to-door sampling, and with 250 Cambodian adults and 150 Vietnamese adults through respondent-driven sampling. Data on 14 key health outcomes are described for this analysis. The three surveyed communities were generally poorer, less educated, more often foreign-born, and had less English proficiency than Asians nationally. There were few significant variations among the three populations, but there were notable differences in the burden of tuberculosis, obesity, diabetes, and arthritis. Insurance coverage and cancer-screening utilization were also significantly lower than for US Asians. Health information about Chinese, Cambodian, and Vietnamese populations in Chicago are available for the first time and serve as baseline data for community interventions. Findings highlight important health concerns for these populations and have implications for funders and policy makers in allocating resources, setting health priorities, and addressing health disparities.
doi:10.1007/s11524-010-9469-x
PMCID: PMC2937130  PMID: 20625846
Asian American; Chinese; Cambodian; Vietnamese; Health disparities
17.  U.S. Mental Health Policy: Addressing the Neglect of Asian Americans 
Although Asian Americans are proportionally the fastest-growing ethnic group in the United States, federal mental health policies have neglected their special needs. U.S. federal mental health policy has shifted in the past 50 years from an emphasis on increasing accessibility to treatment to improving the quality of care and focusing on the brain as the basis of mental illness. However, the mental health needs of Asian Americans have been a relatively low priority. Myths about Asian Americans that have led to the general neglect of their mental health needs are that they: (a) are a small group; (b) are a successful group and do not experience problems; and (c) do not experience mental health disparities. Nevertheless, Asian Americans are a significant proportion of the population which experiences acculturative stress and discrimination that are often associated with psychopathology. However, Asian Americans who experience psychopathology are less likely than other groups to use mental health services. Political efforts must be made to get Asian Americans into positions of leadership and power in which they can make decisions about mental health policy priorities.
doi:10.1037/a0029950
PMCID: PMC3905325  PMID: 24490000
Asian Americans; mental health policy; acculturative stress; discrimination; ethnic identity
18.  Older Asian Americans and Pacific Islanders with Activities of Daily Living (ADL) Limitations: Immigration and Other Factors Associated with Institutionalization  
This study determined the national prevalence and profile of Asian Americans with Activities of Daily Living (ADL) limitations and identified factors associated with institutionalization. Data were obtained from 2006 American Community Survey, which replaced the long-form of the US Census. The data are nationally representative of both institutionalized and community-dwelling older adults. Respondents were Vietnamese (n = 203), Korean (n = 131), Japanese (n = 193), Filipino (n = 309), Asian Indian (n = 169), Chinese (n = 404), Hawaiian/Pacific Islander (n = 54), and non-Hispanic whites (n = 55,040) aged 55 and over who all had ADL limitations. The prevalence of institutionalized among those with ADL limitations varies substantially from 4.7% of Asian Indians to 18.8% of Korean Americans with ADL limitations. Every AAPI group had a lower prevalence of institutionalization than disabled Non-Hispanic whites older adults (23.8%) (p < 0.001). After adjustment for socio-demographic characteristics, Asian Indians, Vietnamese, Japanese, Filipino, and Chinese had significantly lower odds of institutionalization than non-Hispanic whites (OR = 0.29, 0.31, 0.58, 0.51, 0.70, respectively). When the sample was restricted to AAPIs, the odds of institutionalization were higher among those who were older, unmarried, cognitively impaired and those who spoke English at home. This variation suggests that aggregating data across the AAPI groups obscures meaningful differences among these subpopulations and substantial inter-group differences may have important implications in the long-term care setting.
doi:10.3390/ijerph9093264
PMCID: PMC3499866  PMID: 23202683
older adults; Asian Americans; long-term care; immigration; activities of daily living; socio cultural factors; treatment barriers
19.  Psychosocial Adjustment and Substance Use of Cambodian and Vietnamese Immigrant Youth 
Southeast Asians living in the United States are a unique Asian immigrant population. They are considered one of the “newer” Asian immigrant groups, tend to be less affluent compared with their East and South Asian counterparts, and are steadily growing in number (U.S. Bureau of the Census, 2000). Unfortunately, few studies exist specifically about Southeast Asian immigrants. The lack of studies, coupled with the community's growing mental health issues, suggests the need for increased research on this population. This study contributes to the literature by examining the extent to which identification with Vietnamese or Cambodian culture, peer relationships, and coping behaviors affect substance use among Cambodian and Vietnamese immigrant youth. A sample of 102 participants, age 12–18 years, completed self-report measures regarding these variables. Overall, results indicate that identification with one's culture of origin and coping behaviors moderate the relationship between deviant peer association and substance use. Results are discussed within a contextual model of problem behavior among Southeast Asian youth.
doi:10.1177/0022022110362747
PMCID: PMC3002173  PMID: 21170155
20.  Influence of American acculturation on cigarette smoking behaviors among Asian American subpopulations in California 
Using combined data from the population-based 2001 and 2003 California Health Interview Surveys, we examined ethnic and gender-specific smoking behaviors and the effect of three acculturation indicators on cigarette smoking behavior and quitting status among 8,192 Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese American men and women. After adjustment for potential confounders, current smoking prevalence was higher and the quit rate was lower for Korean, Filipino, and Vietnamese American men compared with Chinese American men. Women’s current smoking prevalence was lower than men’s in all six Asian American subgroups. South Asian and Korean American women reported lower quit rates than women from other ethnic subgroups. Asian American men who reported using only English at home had lower current smoking prevalence and higher quit rates, except for Filipino and South Asian American men. Asian American women who reported using only English at home had higher current smoking prevalence except for Japanese women. Being a second or later generation immigrant was associated with lower smoking prevalence among all Asian American subgroups of men. Less educated men and women had higher smoking prevalence and lower quit rates. In conclusion, both current smoking prevalence and quit rates vary distinctively across gender and ethnic subgroups among Asian Americans in California. Acculturation appears to increase the risk of cigarette smoking for Asian American women. Future tobacco-control programs should target at high-risk Asian American subgroups, defined by ethnicity, acculturation status, and gender.
doi:10.1080/14622200801979126
PMCID: PMC3652889  PMID: 18418780
21.  Depression among Asian Americans: Review and Recommendations 
This article presents a review of the prevalence and manifestation of depression among Asian Americans and discusses some of the existing issues in the assessment and diagnosis of depression among Asian Americans. The authors point out the diversity and increasing numbers of Asian Americans and the need to provide better mental health services for this population. While the prevalence of depression among Asian Americans is lower than that among other ethnic/racial groups, Asian Americans receive treatment for depression less often and its quality is less adequate. In addition, the previous belief that Asians somatize depression may become obsolete as more evidence appears to support that Westerners may “psychologize” depression. The cultural validity of the current DSM-IV conceptualization of depression is questioned. In the course of the review, the theme of complexity emerges: the heterogeneity of ethnic Asian American groups, the multidimensionality of depression, and the intersectionality of multiple factors among depressed Asian Americans.
doi:10.1155/2011/320902
PMCID: PMC3180820  PMID: 21961060
22.  Analysis of East Asia Genetic Substructure Using Genome-Wide SNP Arrays 
PLoS ONE  2008;3(12):e3862.
Accounting for population genetic substructure is important in reducing type 1 errors in genetic studies of complex disease. As efforts to understand complex genetic disease are expanded to different continental populations the understanding of genetic substructure within these continents will be useful in design and execution of association tests. In this study, population differentiation (Fst) and Principal Components Analyses (PCA) are examined using >200 K genotypes from multiple populations of East Asian ancestry. The population groups included those from the Human Genome Diversity Panel [Cambodian, Yi, Daur, Mongolian, Lahu, Dai, Hezhen, Miaozu, Naxi, Oroqen, She, Tu, Tujia, Naxi, Xibo, and Yakut], HapMap [ Han Chinese (CHB) and Japanese (JPT)], and East Asian or East Asian American subjects of Vietnamese, Korean, Filipino and Chinese ancestry. Paired Fst (Wei and Cockerham) showed close relationships between CHB and several large East Asian population groups (CHB/Korean, 0.0019; CHB/JPT, 00651; CHB/Vietnamese, 0.0065) with larger separation with Filipino (CHB/Filipino, 0.014). Low levels of differentiation were also observed between Dai and Vietnamese (0.0045) and between Vietnamese and Cambodian (0.0062). Similarly, small Fst's were observed among different presumed Han Chinese populations originating in different regions of mainland of China and Taiwan (Fst's <0.0025 with CHB). For PCA, the first two PC's showed a pattern of relationships that closely followed the geographic distribution of the different East Asian populations. PCA showed substructure both between different East Asian groups and within the Han Chinese population. These studies have also identified a subset of East Asian substructure ancestry informative markers (EASTASAIMS) that may be useful for future complex genetic disease association studies in reducing type 1 errors and in identifying homogeneous groups that may increase the power of such studies.
doi:10.1371/journal.pone.0003862
PMCID: PMC2587696  PMID: 19057645
23.  Factors Associated with Colorectal Cancer Screening Among Cambodians, Vietnamese, Koreans and Chinese Living in the United States 
The purpose of this community-based participatory study was to identify factors associated with colorectal cancer (CRC) screening compliance and non-compliance among Cambodians, Vietnamese, Koreans and Chinese men and women 50 years and older living in the United States. A cross-sectional design was used in the study. The completed sample included 815 Asian Americans which included Cambodians (N=215), Vietnamese (N=195), Koreans (N=94) and Chinese (N=311). A 95-item questionnaire was developed and pilot tested for content validity and reliability. An in-person data collection approach was utilized and participants were given choice in responding in English or their native language. Of the 815 participants, 79.1% (N=645) reported never-screened, 7.9% (N=64), non-compliance, and 13.0% (N=106) compliance. Education was significantly associated with never-screened for CRC for Vietnamese and Chinese; employment status for Cambodians and Koreans; lack of health insurance for Cambodians, Korean and Chinese; English fluency and years lived in the U.S. for Vietnamese, Koreans, and Chinese. Less acculturated Asian Americans were more likely to be never screened, but differentially across ethnic subgroups. Barriers to screening included lack of knowledge, language, transportation, and time. Increased culturally-targeted public awareness and education programs are needed to improve CRC screening and compliance among high risk Asian American ethnic subgroups.
PMCID: PMC3521597  PMID: 23243486
sigmoidoscopy or colonoscopy; fecal occult blood test; Vietnamese; Korean; Chinese; Cambodian; correlates of colorectal cancer screening
24.  Spectrum of Cardiovascular Diseases in Asian-American Racial/Ethnic Subgroups 
Annals of epidemiology  2011;21(8):608-614.
PURPOSE
To compare the prevalence of coronary heart disease (CHD), stroke, and peripheral vascular disease (PVD) across Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and non-Hispanic white (NHW) subjects in a mixed-payer, outpatient health care organization in California.
METHODS
Electronic health records from 2007 to 2010 were examined for 94,423 Asian and NHW patients. Age-adjusted prevalence rates of CHD, stroke, and PVD, defined by physician International Classification of Diseases, Version 9, codes, were directly standardized to the NHW population. Age-adjusted odds ratios were calculated by the use of logistic regression for each Asian subgroup, by sex, compared with NHWs.
RESULTS
The range of age-adjusted prevalence rates were: CHD (1.7%–5.2%), stroke (0.3%–1.8%), and PVD (0.9%–3.4%). The adjusted odds ratios of CHD were significantly higher for Filipino women (1.66; 95% confidence interval; 1.13–2.43) and men (1.47, 1.05–2.06) and Asian Indian men (1.77, 1.43–2.21), and significantly lower for Chinese women (0.72, 0.55–0.94) and men (0.78, 0.65–0.93), compared with NHWs. The odds of stroke were significantly greater for Filipino women (2.02, 1.22–3.34). The odds of PVD were generally lower for all Asian subgroups.
CONCLUSION
There is considerable heterogeneity across Asian subgroups for prevalent CHD, stroke, and PVD. Future research should disaggregate Asian subgroups and cardiovascular outcomes to inform targeted prevention and treatment efforts.
doi:10.1016/j.annepidem.2011.04.004
PMCID: PMC3215504  PMID: 21737048
Asian; Cardiovascular Diseases; Coronary Heart Disease; Peripheral Vascular Disease; Stroke
25.  Discussing Depression with Vietnamese American Patients 
Background Asian patients preferentially seek mental health care from their primary care providers but are unlikely to receive it. Primary care providers need culturally-informed strategies for addressing stigmatizing illnesses. Methods 11 Vietnamese American community members participated in semi-structured interviews. Interviews were audio-taped and transcribed. The grounded theory approach was used for qualitative coding and thematic analysis. Results Vietnamese community members describe experiences with depression under four themes: (1) Stigma and face; (2) Social functioning and the role of the family; (3) Traditional healing and beliefs about medications; and (4) Language and culture. Based on this data, we offer suggestions for improving culturally-informed care for Vietnamese Americans. Disucssion Our study adds to the research aimed at improving communication and health care relationships between physicians and Vietnamese American patients. Physicians should learn to tailor their interviewing style to the increasingly diverse patient population.
doi:10.1007/s10903-009-9234-y
PMCID: PMC2839469  PMID: 19242803
Communication; Depression; Primary care; Vietnamese American

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