Model Minority Stereotype: Influence on Perceived Mental Health Needs of Asian Americans

Adult Mental Health Associated with Adverse and Positive Childhood Experiences Among 1st and 2nd Generation Asian Americans

BACKGROUND

Adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) impact adult health. However, differences in ACEs, PCEs, and mental health have not been extensively studied among Asian Americans.

OBJECTIVE

To examine the association between childhood experiences and adult mental health in first and second generation Asian Americans.

DESIGN

This study used data from the 2021-2022 California Health Interview Survey (CHIS), an address-based sampling of noninstitutionalized Californians conducted online or by phone.

PARTICIPANTS

Asian American respondents aged 18-65 years.

EXPOSURE

Fifteen different ACEs and seven different PCEs.

MAIN MEASURES

Adjusted prevalence ratios (aPR) of severe psychological distress for each generation. Survey weights were applied to all analyses for population-based representation.

KEY RESULTS

5,744 Asian Americans (48.0% male, 16.4% aged 18-25) were included in the current study. We found that second generation Asian Americans experienced a greater prevalence of ACEs (65.4% reported ≥1 ACE vs 47.5% in first generation Asian Americans) and lower prevalence of PCEs (32.1% reported ≤2 PCEs vs 22.6% in first generation Asian Americans). Second generation Asian Americans were more likely to report ≥4 ACEs (aPR, 1.46; 95% CI, 1.13 to 1.88) and ≤2 PCEs (aPR, 1.51; 95% CI, 1.29 to 1.78) relative to first generation Asian Americans. Second generation Asian Americans with ≥4 ACEs or ≤2 PCEs were more likely to report severe psychological distress (aPR, 2.54; 95% CI, 1.55 to 4.17 and aPR, 1.48; 95% CI, 1.03 to 2.13, respectively) relative to first generation Asian Americans. When examining ACEs and PCEs individually, domestic, physical, and verbal abuse; divorce; racism; and lacking support systems were significantly associated with severe psychological distress in second generation Asian Americans.

CONCLUSIONS

Second generation Asian Americans are more likely to experience more ACEs, fewer PCEs, and poorer mental health as a result. Our study indicates that physicians should screen for childhood experiences and leverage trauma-informed care among Asian American subpopulations.

Assessing mental health treatment receipt among Asian adults with limited English proficiency using an intersectional approach

US Asian adults and people with limited English proficiency (LEP) confront mental health treatment receipt disparities. At the intersection of racial and language injustice, Asian adults with LEP may face even greater disparity, but studies have not assessed this through explicitly intersectional approaches. Using 2019 and 2020 National Survey of Drug Use and Health data, we computed disparities in mental health treatment among those with mental illness comparing: non-Hispanic (NH) Asian adults with LEP to NH White adults without LEP (joint disparity), NH Asian adults without LEP to NH White adults without LEP (referent race disparity), NH Asian adults with LEP to those without LEP (referent LEP disparity), and the joint disparity versus the sum of referent disparities (excess intersectional disparity). In age- and gender-adjusted analyses, excess intersectional disparity was 26.8% (95% CI, -29.8 to 83.4) of the joint disparity in 2019 and 63.0% (95% CI, 29.1-96.8) in 2020. The 2019 joint disparity was 1.37 (95% CI, 0.31-2.42) times that if the race-related disparity did not vary by LEP, and if LEP-related disparity did not vary by race; this figure was 2.70 (95% CI, 0.23-5.17) in 2020. These findings highlight the necessity of considering the intersection of race and LEP in addressing mental health treatment disparities. This article is part of a Special Collection on Mental Health.

Contributors to Underdiagnosis of ADHD among Asian Americans: A Narrative Review

OBJECTIVE

Rates of ADHD are lowest among Asian American children (1-6.1%) compared to all other major ethnic and racial groups in the US, but there is limited literature on reasons for the disparity in estimated prevalence rates.

METHOD

We conducted a narrative review to integrate the literature on ADHD in children in Asian countries with that on ADHD among Asian American youth to highlight potential explanations for disparities in ADHD diagnosis and treatment among Asian American children relative to other racial and ethnic groups.

RESULTS

Factors possibly contributing to the low estimated prevalence rates of ADHD among Asian American children include: a higher proportion of Inattentive ADHD presentation among Chinese, Malaysian, and Indian children; racial bias and the influence of the Model Minority Myth; cultural differences in classroom identification; mental health stigma in Asian American communities; parent perception of ADHD as misbehavior rather than a neurodevelopmental disorder; and parent support for children's academic activities that may mask impairment.

CONCLUSION

We offer recommendations to inform individual and community-level psychoeducation, and new directions for research to address this health disparity.

Differential prevalence of psychiatric disorders and mental health characteristics associated with lifetime suicide attempts in the Asian American and Pacific Islander adult population

BACKGROUND

Asian American and Pacific Islander (AAPI) adults are an understudied group in terms of their mental health and mental healthcare needs. This has been complicated by the difficulty of recruiting adequate national samples of AAPI adults for research.

OBJECTIVE

This study aimed to analyze national data to examine the lifetime prevalence of major psychiatric disorders among AAPI adults relative to non-AAPI adults, as well as to identify and compare sociodemographic and clinical characteristics associated with lifetime suicide attempts among AAPI and non-AAPI adults.

METHODS

Cross-sectional data on 36,109 adults, including 1801 AAPI adults, from the National Epidemiological Survey of Alcohol and Related Conditions-III (NESARC-III), were analyzed with a series of chi-square and logistic regression analyses.

RESULTS

We found a significantly lower lifetime prevalence of mental health disorders in the AAPI versus the non-AAPI population nationally, including 2% of AAPI adults reporting lifetime suicide attempts as compared to about 5% of non-AAPI adults. Female sex and a history of major depressive disorder diagnosis were associated with lifetime suicide attempts in the AAPI and non-AAPI populations. Several unique factors were associated with having a history of suicide attempts in only the AAPI population, including a military service history and a diagnosis of panic disorder.

DISCUSSION

Our analysis demonstrated the significant sectors of the AAPI population that merit research, support, and intervention, including the AAPI veteran population. This study identifies several characteristics among AAPI adults that may make them particularly vulnerable to psychiatric problems and suicide risk, which may inform targeted prevention and efforts to provide culturally competent care to this population.

Trends and Disparities in Mental Health Use Among Asian American Sub-groups, 2013-2019

OBJECTIVE

The objective of this study was to characterize and compare national estimates of mental healthcare use among White and Asian American groups to provide an update using post Affordable Care Act data.

METHODS

We analyzed yearly cross-sectional data from the 2013-2019 Medical Expenditure Panel Survey, including White (n = 112,590) and Asian American (n = 10,210) individuals, and examined rates of mental healthcare use for Asian (overall), Asian Indian, Chinese, Filipino, and Other Asian individuals relative to White individuals. Using multivariable logistic regression models and predictive margin methods, we estimated overall Asian disparities and Asian subgroup disparities compared to White group rates in mental health care (outpatient, specialty, psychotropic medication) among adults with and without elevated risk for mental illness. Regression models were adjusted for variables related to need for treatment, demographic, and socioeconomic status variables.

RESULTS

Asian individuals had lower rates of mental healthcare use than White individuals. Unadjusted results and adjusted regression model predictions are consistent in identifying wide disparities in mental health care treatment across risk for mental illness, Asian subgroups, and types of treatment.

CONCLUSIONS

Asian Americans have significantly lower rates of mental healthcare use than White Americans, even among those with elevated risk for mental illness. There is small variation by Asian subgroups but disparities persist across subgroups and types of treatment. Our results imply interventions are needed to improve linguistically, culturally, and ethnically tailored outreach and engagement in treatment services, as well as examining treatment and its effectiveness for Asian American individuals living with psychological distress.

Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review

The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.

Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review

OBJECTIVES

Research indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher SES, in part due to health professional (HP) bias. We conducted a scoping review of the impact of HP bias about SES on clinical decision-making and its effect on the care of adults with lower SES.

DESIGN

JBI scoping review methods were used to perform a systematic comprehensive search for literature. The scoping review protocol has been published in BMJ Open.

DATA SOURCES

Medline, Embase, ASSIA, Scopus and CINAHL were searched, from the first available start date of the individual database to March 2023. Two independent reviewers filtered and screened papers.

ELIGIBILITY CRITERIA

Studies of all designs were included in this review to provide a comprehensive map of the existing evidence of the impact of HP bias of SES on clinical decision-making and its effect on the care for people with lower SES.

DATA EXTRACTION AND SYNTHESIS

Data were gathered using an adapted JBI data extraction tool for systematic scoping reviews.

RESULTS

Sixty-seven papers were included from 1975 to 2023. 35 (73%) of the included primary research studies reported an association between HP SES bias and decision-making. Thirteen (27%) of the included primary research studies did not find an association between HP SES bias and decision-making. Stereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load. There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making. HP implicit bias may be mitigated through the assertiveness of the patient with low SES.

CONCLUSION

HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities. Research that focuses on decision-making when the HP has a high cognitive load, would help the health community to better understand this potential influence.

Behavioral Addiction from the Asian Americans Perspective: Exploration of Public and Help-Seeking Stigma

Asian Americans have been unlikely to seek mental health services despite their needs for treatment, particularly when experiencing significant gambling or Internet gaming problems. Stigma is often considered to be a barrier to seeking help. To understand how stigma impacts Asian Americans' willingness to seek mental health services, the present study used an online survey to investigate the public stigma associated with addictive behaviors and help-seeking stigma among Asian Americans. Participants (N = 431) who self-identified as Asian American, reside in the US. Using a between-groups vignette study design, it was found that the individual with a behavioral addiction received more stigma compared to the individual who experienced a financial crisis. In addition, participants were more likely to seek help if they experienced addictive behavioral problems rather than financial problems. Lastly, this study did not reveal a significant relation between public stigma attached to addictive behaviors and Asian Americans' willingness to seek help, but it found that participants' willingness to seek help was positively associated with public stigma of help seeking (β = 0.23) and negatively associated with self-stigma attached to help-seeking (β = - 0.09). Based on these findings, recommendations are provided to inform community outreach to reduce stigma and promote mental health service utilization among Asian Americans.

Incidence and Correlates of Emergency Department Visits for Deliberate Self-Harm Among Asian American Youth

PURPOSE

This study examined the epidemiology of self-harm emergency department (ED) visits among Asian American and Pacific Islander (AAPI) youth, and associated factors.

METHODS

We used California ED visit records in 2010 and 2011 to calculate incidence rates of self-harm ED visits for AAPI versus non-Hispanic White (NHW) patients aged 10-29 years. Demographic and clinical characteristics were compared for AAPI versus NHW patients presenting with self-harm. We used modified Poisson regression models to estimate the relative risk of recurrent ED self-harm visits for AAPI versus NHW patients and examined the association of insurance type and gender with recurrent self-harm among AAPIs.

RESULTS

Rates of self-harm ED visits for young AAPI patients were 38 and 26 per 100,000 among females and males, respectively. Although AAPI patients presenting with self-harm were equally or less likely than NHW patients to have comorbid psychological and substance use diagnoses at their index visit, they were 25% more likely to be admitted to hospital. However, they were 40% less likely to have a recurrent ED self-harm visit. Among AAPI patients, those who used Medicaid were significantly more likely than those with other insurance to be admitted as inpatients.

DISCUSSION

Young AAPI patients presenting to EDs with deliberate self-harm have different sociodemographic and clinical profiles compared to NHW patients. Our study also demonstrates significant heterogeneity in risk of recurrent self-harm by gender and insurance type among AAPI patients. This information may be useful for future intervention programs among self-harming AAPI youth.

Addressing workplace gender inequality: Using the evidence to avoid common pitfalls

In this Landmark article I outline four common missteps that are made when designing and implementing workplace gender equality initiatives: (1) when we don't go beyond describing the numbers; (2) when we try to 'fix' women rather than fix systems; (3) when we are overly optimistic about the progress we have made; and (4) when we fail to recognise the intersectionality of the experiences that women face. I will briefly consider each of these missteps in term, presenting research that suggests alternative ways of approaching gender equality initiatives.

Intersection of anxiety and negative coping among Asian American medical students

Purpose

Asian Americans comprise 21% of matriculating medical students in the United States but little is known about their mental health. With the growing focus on addressing the mental health of medical students, this systematic, nationwide survey assesses the relationship between anxiety and depression symptoms and coping skills among Asian American medical students.

Materials and methods

A survey tool comprised of Patient Health Questionnaire-9, General Anxiety Disorder-7, and questions related to coping were emailed to members of the Asian Pacific American Medical Students Association enrolled in a United States medical school during the 2016–2017 academic year. We evaluated associations between anxiety and coping as well as depression and coping.

Results

A total of 511 Asian American medical students completed the survey. Anxiety symptoms were positively correlated with an increase in negative coping skills. Depressive symptoms were not correlated with an increase in negative coping skills.

Conclusion

Professionals and medical schools that aim to improve the mental health of medical students should be aware of the needs of specific populations. Asian American students who experience anxiety were more likely to utilize avoidant or negative coping strategies. In addition, Asian American students who experience depressive symptoms were not more likely to utilize these negative coping strategies. Further research must be done to evaluate the factors that influence the use of negative coping strategies to better address anxiety within the Asian American medical student population.

Acknowledging Anti-Blackness, Overlooking Anti-Asian Racism: Missed Developmental Opportunities for Chinese American Youth

This paper explores the pathways and barriers to critical consciousness development for Chinese American youth. Thirty-five interviews conducted in 2020 with high-school-aged students in Chicago were analyzed to better understand young people's experiences developing an understanding of anti-Asian racism and anti-Blackness. Results indicated that participants overwhelmingly engaged in sustained conversations about Black Lives Matter and/or made efforts to address anti-Blackness within their families, but engaged in limited conversations about anti-Asian racism. Furthermore, conversations at home and school often failed to contextualize anti-Asian racism, specifically in relation to the experiences of other oppressed groups. Findings highlight a need for research on and practice with Chinese American adolescents to recognize the unique racial positioning of Asian Americans under White supremacy.

Factors Associated with Mental Health Help-Seeking Among Asian Americans: a Systematic Review

OBJECTIVE

Asian Americans are underutilizing mental health services. The aim of the current systematic review was to identify protective and risk factors of mental health help-seeking patterns among the disaggregated Asian Americans and to classify types of help.

METHODS

A systematic literature review was conducted using the PRISMA guidelines. The Health Belief Model served as the theoretical framework for this review. Thirty-four articles were reviewed, and the studies investigated one of the following Asian ethnic subgroups: Chinese, Filipino, Asian Indian, Korean, or Vietnamese. Data were extracted based on the study characteristics, sample characteristics, and protective and risk factors to mental health help-seeking patterns.

RESULTS

Predisposing factors like female gender, higher levels of English proficiency, and history of mental illness increased the likelihood for help-seeking across several ethnic groups. Interestingly, cues to action and structural factors were under-examined. However, cues to action like having a positive social network did increase the likelihood of using formal support services among Chinese and Filipinx participants. Structural factors like lacking ethnic concordant providers and access to healthcare served as barriers for Korean and Vietnamese participants.

DISCUSSION

The findings showed a need for ethnic tailored approaches when supporting mental health help-seeking patterns. Asian ethnic group's immigration status, acculturation level, and psychological barriers to help-seeking should continue to be emphasized. Psychoeducational groups can be beneficial to expand the knowledge base surrounding mental illness and to link group members to culturally responsive resources.

Intersectional Invisibility in Women's Diversity Interventions

Many diversity interventions for women are ineffective. One reason for this may be that the field that diversity interventions are usually based on, the social sciences, often do not consider intra-group differences among women. Specifically, differences by racialization may be excluded from such diversity interventions. The present research examines whether racially marginalized women have different diversity interventions needs than White women, and whether organizations are less likely to represent those needs (i.e., intersectional invisibility). Across an open-ended coding (n = 293) and a ranking study (n = 489), Black women noted a need to incorporate intersectional differences, Asian women prioritized methods to address challenges to their authority, and White women indicated a need to address agency perceptions. Improving work-life balance and networks was a shared concern among participants, though we theorized different racially gendered reasons for why these intervention needs are relevant to each group. In Study 3 (n = 92 organizations), we analyzed organizations’ websites using word count and textual analysis. Organizations— including the Education, Science, and Research sector— most readily advocated for women through enhancing agency. They were also less likely to mention dealing with perceptions of excessive agency or addressing intersectional considerations. The organizations broadly mentioned other marginalized groups besides women, but rarely did they do so intersectionality. Taken together, our findings demonstrate different intervention priorities across differently racialized groups. We found evidence of intersectional invisibility where organizations were more likely to address agency-enhancing intervention needs while failing to include other intervention needs relevant for Black women and Asian women. We discuss the implications of these findings for organizations, in general, as well as potential implications for the field of academic social sciences.

The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment

The COVID-19 pandemic has resulted in an alarming increase in hate incidents directed toward Asian Americans and Pacific Islanders (AAPIs), including verbal harassment and physical assault, spurring the nationwide #StopAsianHate movement. This rise in anti-Asian sentiment is occurring at a critical time of racial reckoning across the United States, galvanized by the Black Lives Matter movement, and of medical student calls for the implementation of antiracist medical curricula. AAPIs are stereotyped by the model minority myth, which posits that AAPIs are educated, hardworking, and therefore able to achieve high levels of success. This myth acts as a racial wedge between minorities and perpetuates harm that is pervasive throughout the field of medicine. Critically, the frequent aggregation of all AAPI subgroups as one monolithic community obfuscates socioeconomic and cultural differences across the AAPI diaspora while reinforcing the model minority myth. Here, the authors illustrate how the model minority myth and data aggregation have negatively affected the recruitment and advancement of diverse AAPI medical students, physicians, and faculty. Additionally, the authors discuss how data aggregation obscures health disparities across the AAPI diaspora and how the model minority myth influences the illness experiences of AAPI patients. Importantly, the authors outline specific actionable policies and reforms that medical schools can implement to combat anti-Asian sentiment and support the AAPI community.

COVID-19 and Asian Americans: Reinforcing the Role of Community-Based Organizations in Providing Culturally and Linguistically Centered Care

Introduction

Community-based organizations (CBOs) have provided critical resources during the pandemic, particularly for marginalized communities, and are trusted liaisons who connect socially and linguistically isolated community members, such as the highly diverse Asian American population, to care during public health emergencies. Stereotypes such as the model minority myth have permeated public perception of Asian Americans' health status and health care access needs, fueling widespread belief that Asian Americans do not experience health disparities, and mask the high rates of coronavirus disease 2019 (COVID-19) infection, hospitalization, and mortality among Asian Americans. The unequal burden of COVID-19 on Asian American communities has largely remained absent from the public health and national discourse, with exceptions such as community voices that have directed news media coverage and leading roles of CBOs in offering culturally adapted, in-language programming on COVID-19 infection prevention and control.

Methods

CBOs and their staff are well-equipped with the cultural acuity, language capacity, and familiarity with local norms to improve structural gaps affecting health outcomes and support health care delivery.

Results

We discuss the roles and responsibilities of CBOs in strengthening the health care workforce and expanding community-clinic linkages and provide two case studies illustrating the efforts of two community organizations serving Asian American and immigrant communities, who have been disproportionally affected by the COVID-19 pandemic.

Discussion

CBOs are essential to supporting health service coordination and care delivery for structurally vulnerable populations, and are vital to sustaining the coordinated, multilevel public health response to improving community health.

Conclusion

Bolstering the current infrastructure to support CBOs is necessary to facilitating immediate responses to serve community needs.

Toward a moral commitment: Exposing the covert mechanisms of racism in the nursing discipline

Recent Canadian and international events have sparked dialogue and action to address racism within the nursing discipline. While the urgency to seek and implement antiracist solutions demands the attention of nurses, we contend that a contemporary analysis of the mechanisms that continue to perpetuate racism within nursing's theoretical foundation is required first. This study reconsiders the perceived functions of racism within the current state of nursing concepts and theories. In particular, we expose the role that covert racism plays by inadvertently sustaining racism through nursing's theoretical foundation, and how this process strengthens white supremacy. We argue that, in the absence of exposing these covert mechanisms, the development of solutions will be futile in dismantling racism. By making visible the covert mechanisms of racism within nursing's theoretical foundation, we attempt to establish an opportunity for the nursing discipline to dismantle its racist foundation and engage in sustained antiracist action. Lastly, this study demonstrates the need to equip the discipline with a moral commitment to antiracism in an effort to emancipate nursing from its racist legacies.

Overcoming constraints of the model minority stereotype to advance Asian American health

Asian Americans are the fastest growing U.S. immigrant group, projected to become the largest immigrant group by 2065, but the quantity of research on Asian Americans' health has not mirrored changing demographics. Asian Americans have been understudied for more than 25 years, with only 0.17% of National Institutes of Health (NIH) expenditures allocated to projects including Asian American, Native Hawaiian, and Pacific Islander populations (Ðoàn et al., 2019). This disproportionality may result in part from the model minority stereotype (MMS) being extended to health, perpetuating the ideas that Asian Americans are well-positioned with regard to health status and that associated research is not essential. Accordingly, the aims for this article are threefold: (a) bring attention to the inadequate representation of the Asian American population in health-related science, (b) question the MMS in health, and (c) outline potential pathways through which the MMS limits what is knowable on Asian American health issues and needs. We discuss the limited meaningfulness of nonrepresentative aggregated statistics purporting the model minority image and provide counterexamples. We also present a stereotype-constraints model with the MMS contributing to a bottleneck for Asian American health-related knowledge, accompanied by present-day circumstances (e.g., sparse data, few psychologists/behavioral medicine scientists focused on Asian American health). We conclude with initial recommendations for addressing MMS-associated constraints in psychology and more broadly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Educational Attainment and Prevalence of Cardiovascular Health (Life's Simple 7) in Asian Americans

Asian Americans have a high burden of cardiovascular disease, yet little is known about the social patterning of cardiovascular health (CVH) in this population. We examined if education (<high school diploma, high school diploma, some college, and college degree+) was associated with CVH and if this varied by time in the United States (U.S.). Our study population included Asian Americans 20+ years of age sampled in the 2011-16 National Health and Nutrition Examination Survey (n = 1634). Ideal cardiovascular health was based on a composite score of adiposity, total cholesterol, blood pressure, blood glucose, smoking, physical activity, and diet. We fit sequential weighted multivariate logistic regression models for all analyses. The prevalence of ideal cardiovascular (CV) health was 17.1% among those living in the U.S. <10 years, 7.1% for those living in the U.S. >10+ years, and 15.9% for the U.S.-born. All models showed that low education compared to high education was associated with lower odds of having ideal CVH. This pattern remained in adjusted models but became non-significant when controlling for nativity (odds ratio = 0.34, 95% confidence interval: 0.10, 1.13). Models stratified by time in the U.S. were less consistent but showed similar education gradients in CVH. Low education is a risk factor for attaining ideal cardiovascular health among Asian Americans, regardless of time in the U.S.

Healthcare-Experience Survey Assessment in the Rhode Island Cambodian Community

The Cambodian community is the largest Southeast Asian cultural identity in Rhode Island (RI) with high poverty rates and limited healthcare access. Investigators conducted a cross-sectional observational survey study from 2016 to 2017 on eligible Cambodians to better understand their healthcare experiences. Questions were reviewed by the RI Cambodian Society for cultural sensitivity. 123 surveys were collected; 98 respondents had medical providers. Respondents with providers reported difficulty understanding of their providers (59%) and limited access to medical interpreters (50%). The non-provider group were less likely to have medical insurance (54.2% vs. 88.8%, p = .0001) and more likely to visit the emergency department (47.1% vs. 15.3%; p < .0001). Language barrier and lack of medical interpreters and healthcare insurance were the major barriers to healthcare for surveyed Cambodians. Future studies are needed to assess whether native-language specific community healthcare resources can positively affect their access to care.

Comparison of Ideal Cardiovascular Health Attainment and Acculturation among Asian Americans and Latinos

Objective

To determine the association between language and ideal cardiovascular health among Asian Americans and Latinos.

Design/Study Participants

Cross-sectional study using 2011-2016 National Health and Nutrition Examination Survey of Asian Americans (n=2,009) and Latinos (n=3,906).

Interventions

Participants were classified according to language spoken at home (only/mostly English spoken, both English and native language spoken equally, or mostly/only native language spoken).

Outcomes

Ideal, intermediate and poor cardiovascular health status for smoking, blood pressure, glucose level, and total cholesterol.

Results

The majority of Asian Americans and Latinos had ideal smoking status, but those who only/mostly spoke English were more likely to smoke compared with those who spoke only/mostly spoke their native language. Approximately one third of Asian Americans and Latinos had intermediate (ie, borderline or treated to goal) levels of cardiovascular health for blood pressure, glucose level and total cholesterol. In adjusted models, those who spoke only/mostly their native language were significantly less likely to have poor smoking or hypertension status than those who spoke only/mostly English. Among Latinos, only/mostly Spanish speakers were more likely to have poor/ intermediate glucose levels (PR=1.35, 95% CI =1.21, 1.49) than those who spoke only/ mostly English, becoming statistically non-significant after adjusting for education and income.

Conclusion

We found significant variation in ideal cardiovascular health attainment by language spoken at home in two of the largest immigrant groups in the United States. Findings suggest the need for language and culturally tailored public health and clinical initiatives to reduce cardiovascular risk in diverse populations.

Personality and the Social Environment: Contributions to Psychological Adjustment Among Asian and Euro American Students

Introduction: Although personality and sociocultural experiences shape how people adapt to changing life circumstances, these factors’ contributions to psychological adjustment outcomes may differ across ethnic groups. Previous research has shown that personality traits predict psychological distress and wellbeing, and people's comfort with their social environments and interpersonal relationships also can be instrumental in understanding their psychological adjustment. Research on personality and on environmental characteristics have tended to focus on Euro Americans and on people of color, respectively; the extent to which campus climate and ethnic group contact predict psychological adjustment above and beyond personality remains understudied and unclear.

Method: Relative influences of Big 5 personality and environmental characteristics at a predominantly White college were tested as predictors of psychological adjustment among Asian (N = 412; 48.5% women, Mage = 19.60) and Euro American (N = 277; 47.7% women, Mage = 19.46) students.

Results: Measurement invariance tests showed that only a subset of the NEO Five Factor Inventory was equivalent across groups. Hierarchical multiple regressions showed that personality contributed to depression and anxiety symptoms for both groups, but comfort with campus environment and ethnic social comfort were distinctively important predictors of Asians’ psychological adjustment.

Discussion: Implications for research, professional services, and university practices are discussed.

Trauma Affecting Asian-Pacific Islanders in the San Francisco Bay Area

Trauma is a transgenerational process that overwhelms the community and the ability of family members to cope with life stressors. An anthropologist trained in ethnographic methods observed three focus groups from a non-profit agency providing trauma and mental health services to Asian Americans living in the San Francisco Bay Area of United States. Supplemental information also was collected from staff interviews and notes. Many of the clients were immigrants, refugees, or adult children of these groups. This report consisted of authentic observations and rich qualitative information to characterize the impact of trauma on refugees and immigrants. Observations suggest that collective trauma, direct or indirect, can impede the success and survivability of a population, even after many generations.