Cultural value similarities and differences among Asian American ethnic groups

Supportive Care Needs in Chinese, Vietnamese, and Korean Americans With Metastatic Cancer: Mixed Methods Protocol for the DAWN Study

BACKGROUND

Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer.

OBJECTIVE

This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals).

METHODS

CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs.

RESULTS

Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024.

CONCLUSIONS

Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50032.

Validation of the Appearance-Related Social Media Consciousness Scale with Chinese adolescents and young adults

Research has revealed a negative association between appearance-related social media consciousness (ASMC) and mental health, but the impact of this association in the Chinese population remains understudied. This study examined the psychometric properties of the ASMC scale among Chinese adolescents and young adults and to further investigate the scale's measurement invariance and differences in ASMC across gender and age groups. Exploratory and confirmatory factor analyses were conducted to examine the ASMC scale's factorial structure among Chinese adolescents and young adults, including 1109 adolescents (50.0% boys) aged 12-18 (mean, 14.89) years and 457 young adults (42.5% men) aged 18-25 (mean, 20.75) years. The measurement invariance across gender and age groups, internal consistency and convergent validity were examined. ASMC scale was found to have a unidimensional structure and to be invariant across gender and age groups. It exhibited excellent internal consistency and strong construct validity. Moderate gender differences and pronounced age differences in ASMC scale scores were observed. Our findings support the validity of the ASMC scale as an effective instrument for the measurement of appearance-related social media consciousness experience among Chinese young adults and adolescents. Further study is required to evaluate the status of ASMC as a risk factor for disordered eating and target for preventive interventions within Chinese samples.

The effects of a multimedia intervention on help-seeking process with a Chinese college student sample

Little is known about encouraging help-seeking in non-English speaking settings and relatively little research has been directed to facilitate help-seeking among Chinese-speaking people. This study examined the effects of a multimedia intervention on barriers, attitudes, and intentions for seeking counseling in China. The multimedia intervention was informed by prior empirical research on models of help-seeking for counseling. A total of 200 participants were randomly assigned to one of the two conditions: (1) a help-seeking media-exposed intervention group and (2) a control group, who watched a hospital advertisement that was unrelated to mental health help-seeking. Results indicated that the intervention was effective at increasing both positive attitudes toward therapy and intentions to seek therapy. The intervention also improved participants' perceptions about treatment accessibility. This intervention is available and can be a resource for Chinese language populations (both within China and other countries), especially for immigrants, rural, and persons who might benefit from mental health treatments such as psychotherapy.

Understanding ADHD in AAPI College Students: Prevalence, Comorbidities, Impairments, and Treatment Utilization

OBJECTIVE

Asian American and Pacific Islander (AAPI) students with ADHD may face increased risk for college maladjustment due to cultural factors and a tendency to delay treatment. This is the first study to examine ADHD prevalence, ADHD-related impairments and comorbidities, and ADHD treatment utilization in AAPI college students.

METHOD

AAPI, White, Hispanic, and Black undergraduates (n = 258,005) from the American College Health Association-National College Health Assessment II survey were included in the study.

RESULTS

AAPI students had lower ADHD prevalence rates than White and Black students, and similar prevalence to Hispanic students. AAPI students with ADHD had significantly higher risk for comorbidities and social and academic impairments, compared to White students with ADHD. Approximately half of AAPI students with ADHD did not utilize treatment despite experiencing psychiatric comorbidities and functional impairments.

CONCLUSION

AAPI college students with ADHD are underutilizing treatment despite elevated psychiatric comorbidities and functional impairment.

The Moderating Role of Self-Rated Oral Health on the Association Between Oral Health Status and Subjective Well-Being: Findings From Chinese Older Adults in Hawai'i and Taiwan

This paper aims to address the research questions of whether individual's oral health status is associated with subjective well-being, as well as if there is possible moderating role of self-rated oral health among two groups of Chinese older adults (≥55 years old) in Honolulu, Hawai'i and Taichung, Taiwan. Using survey data collected in 2018 (N = 430, Honolulu) and in 2017 (N = 645, Taichung), ordinary least square regressions were applied. Results showed that, for both samples, oral health status was negatively and significantly associated with subjective well-being, and both associations were moderated by self-rated oral health. In addition, the moderating effects were more salient for the Honolulu sample, who enjoyed higher levels of self-rated oral health and life satisfaction. These results suggest the significant associations of both oral health status and self-rated oral health on individual health and well-being for Chinese older adults residing in different cultural contexts.

Intolerance of uncertainty and future career anxiety among Chinese undergraduate students during COVID-19 period: Fear of COVID-19 and depression as mediators

Uncertainty is mushrooming throughout COVID-19, and intolerance of uncertainty (IoU) nudges people into mental health difficulties involving fear, depression, and anxiety. The objective of this study was to investigate the role of depression and fear of COVID-19 (FoC) in the association between IoU and future career anxiety (FCA) among Chinese university students during the COVID-19 pandemic. This study involved 1,919 Chinese undergraduate students from 11 universities in eight Chinese cities with an online self-administered survey that included demographic information, IoU, FoC, depression, and FCA completed by all participants. Our study demonstrated a positive relationship between IoU and FCA and the chain mediation effect of FoC and depression. Thus, understanding how FoC affects FCA not only informs university career professionals and assists students in preparing for employment, but also motivates schools to offer career opportunities workshops and, most importantly, provides mental health support to help students effectively cope with uncertainty and overcome COVID-19-related stress.

CHATogether: a novel digital program to promote Asian American Pacific Islander mental health in response to the COVID-19 pandemic

BACKGROUND

In response to the COVID-19 pandemic and the associated rise in anti-Asian hate crimes, we developed the Compassionate Home, Action Together program, (CHATogether) to support the mental health of the Asian American and Pacific Islander (AAPI) community. CHATogether is a culturally informed and virtually delivered support program that harnesses the talents of AAPI teens, young adults, parents, and mental health professionals who share a commitment to serve their local communities.

METHODS

Our objective was to identify the active components, optimal utilization, potential benefits, and pertinent limitations of the CHATogether program during the 3 years since its inception in 2019. By that time, the program had developed six distinct component arms: interactive theater, mental health education, research, peer support and community outreach, collaboration, and AAPI mentorship. To work towards this objective, we conducted a qualitative study using thematic analysis and an inductive approach based on grounded theory (GT), in which we analyzed anonymized transcripts of four focus groups, comprised of 20 program participants (11 females; 9 males).

RESULTS

We developed a model of two overarching domains, each with three underlying themes: I. Individual stressors: (1) Family conflict; (2) Cultural identity; and (3) Pandemic impact; and II. Collective stressors: (1) Stigma related to mental health and illness; (2) Pandemic uncertainty; and (3) Xenophobia and societal polarization. Strengths of the CHATogether program include its role as a conduit toward AAPI connectedness and pride as well as purpose in building community. Through support and mentorship, the program cultivates a unique platform that promotes healing and resiliency in response to pandemic stressors and beyond.

CONCLUSIONS

CHATogether creates a safe space for the AAPI community. Through its methods of storytelling and encouraging creativity, CHATogether facilitates the discussion of challenging topics specific to the AAPI community. Given the national mental health crisis that is further being exacerbated by the COVID-19 pandemic, a digital prevention program such as CHATogether holds promise towards providing access to mental health resources and supporting early help-seeking behaviors for individuals in the AAPI community.

Two Sides to Face: Integrity- and Achievement-Centered Face-Saving, Parental Psychological Control, and Depressive Symptoms in Chinese American Adolescents

Depressive symptoms can be serious, but often overlooked, health risk factors, especially for Asian Americans who are vulnerable to acculturation stress but tend to underreport mental health problems. The present study examines how specific cultural values and parenting practices are associated with Chinese American adolescents’ depressive symptoms. One hundred and nine Chinese American adolescents (61% females; Mage = 15.93 years, SDage = 1.39 years) and their parents completed online surveys about their endorsement of traditional Chinese cultural values that reflect integrity and achievement as two forms of face-saving, parents’ use of psychological control, and adolescents’ depressive symptoms. Parents’ endorsement of Conformity To Norms was positively associated with adolescents’ endorsement of the same value, which further correlated positively with adolescents’ depressive symptoms. However, adolescents’ endorsement of Family Recognition Through Achievement was neither associated with parents’ endorsement of the value nor with adolescents’ depressive symptoms. In addition, while parental psychological control was positively related to adolescents’ value belief in Conformity To Norms and depressive symptoms, parental psychological control was negatively related to adolescents’ value belief in Family Recognition Through Achievement. The findings suggest the richness and complexities of the face-saving cultural values and the usefulness of unpacking parenting dimensions in understanding familial processes and developmental specificity among immigrant youth.

Upholding Familism Among Asian American Youth: Measures of Familism among Filipino and Korean American Youth

Although it is one of the core cultural values of Asian American families and an influential determinant of youth development, familism remains under-studied among Asian Americans and, despite crucial within-group heterogeneity, lacks subgroup specificity. This study describes the ways in which two major Asian American subgroups of youth, i.e., Filipino Americans and Korean Americans, maintain traditional familism. Specifically, this study constructed six self-report subscales of familism utilizing underused and new survey items and tested their psychometric properties. Using data collected from Filipino American (n=150) and Korean American (n=188) adolescents living in a Midwest metropolitan area, the measures were examined for validity and reliability for each group and, when appropriate, for measurement invariance across the groups. The main findings are that the finalized scales demonstrated solid reliability and validity (e.g., content and construct) in each group and some invariance and that core traditions, in the form of familism values and behaviors, persevere among second-generation Asian Americans, although familism was more evident among Filipino American youth than in Korean American youth. In both groups, subdomains of familism were not as discrete as found among their parents, who were predominantly foreign-born first-generation immigrants. The finalized familism scales were associated differently with several correlates including acculturation variables and youth outcomes. The findings are discussed with a call for further empirical research of diverse ethnic groups and immigrant generations to more accurately account for how family process interacts with cultural origin and acculturation.

A person-centered examination of acculturation and psychological functioning among Chinese and Korean immigrant mothers in the United States

Objectives: The present research used a person-centered approach to examine the acculturation styles of Chinese and Korean immigrant mothers in the United States and demographic characteristics and psychological functioning associated with each acculturation style. Method: The sample comprised 240 first-generation Chinese immigrant mothers (CIMs; M = 37.80 years, SD = 4.55) and 222 first-generation Korean immigrant mothers (KIMs; M = 36.00 years, SD = 3.69) of preschool children. Latent profile analysis was used to identify latent acculturation styles among CIMs and KIMs. We further examined whether mothers' acculturation styles were associated with their sociodemographic characteristics and psychological functioning within each cultural group. Results: Four acculturation styles were revealed among CIMs: (a) behaviorally undifferentiated/psychologically assimilated, (b) behaviorally marginalized/psychologically separated, (c) behaviorally psychologically assimilated, and (d) behaviorally integrated/psychologically undifferentiated. Three acculturation styles were uncovered among KIMs: behaviorally psychologically separated, behaviorally psychologically assimilated, and behaviorally psychologically integrated. Chinese behaviorally integrated/psychologically undifferentiated mothers and Korean behaviorally psychologically separated perceived the highest levels of coethnic concentration in their communities. Chinese behaviorally marginalized/psychologically separated mothers reported poorer psychological functioning than other Chinese mothers. Korean behaviorally psychologically separated mothers had poorer psychological functioning than other Korean mothers. Conclusions: Findings revealed the significant role of participation in the American mainstream culture for Asian immigrant mothers' psychological adjustment. The heterogeneity in the acculturation experiences of Asian immigrants in the United States was highlighted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

College women's sexual and reproductive health screening behaviors and the role of mother-daughter communication

Objective: The study investigated the role of mother-daughter communication and race in college women's decisions to pursue sexual health screening services. Participants: Participants were 301 college women who primarily identified as White and Asian American (M_age = 19 years). Methods: Participants completed an online survey that assessed mother-daughter communication about sex and responded to items pertaining to pursuing sexual health screening services. Results: Maternal communication predicted daughters' screening behaviors and sexual anxiety mediated the negative association between conservative communication from mothers and screening behaviors. Asian American college women were less likely than White college women to report that they received frequent and open communication about sex from their mothers and reported higher levels of sexual anxiety. Conclusions: Mothers should be aware of the implications their communication patterns may have on their daughters' sexual and reproductive health, and college women's sexual anxiety should be addressed in order to increase utilization of screening services.

iCOPE, a multi-level, cluster randomized, 36-month, parallel-group study to assess the efficacy of HIV disclosure intervention in HIV parental disclosure among parents living with HIV in China

Objectives:

Parents living with HIV who disclose their HIV status to their children could benefit from the parental HIV disclosure. However, it is also very challenging because of persistent stigma and discrimination against HIV. This report describes the study design and protocol of the “Interactive Communication with Openness, Passion, and Empowerment (iCOPE)” randomized controlled trial aimed at assisting parents living with HIV in conducting culturally and developmentally appropriate disclosure to their uninfected children in China through trainings among both parents living with HIV and healthcare providers.

Methods:

A total of 791 parents living with HIV with children aged between 6 and 15 years and 357 healthcare providers were randomized into either the intervention group or control group. Intervention package for parents consisted of five 2-h sessions focusing on positive coping, disclosure decision making, developing a developmentally appropriate disclosure plan, and accessing social support and post-disclosure counseling. The intervention for healthcare providers was made up of two 45-min sessions organized around two primary themes: knowledge of child cognitive development and effective parent–child communication skills in the context of parental disclosure. The control group received nutritional education of either five 2-h sessions (parents) or two 45-min sessions (healthcare providers). The outcome assessments were conducted at baseline, 6, 12, 18, 24, 30, and 36 months.

Conclusion:

The iCOPE study is among the first efforts to develop and evaluate a theory-based and multi-level intervention to promote culturally and developmentally appropriate parental HIV disclosure in China. It has implications for healthcare providers, social workers, and policy makers as it will provide efficacy data on how to enhance appropriate parental HIV disclosure and will shed light on developing a clinical guideline regarding parental HIV disclosure in China and other low- and middle-income countries.

Stigmatizing Beliefs About Depression in Diverse Ethnic Groups of Asian Americans

Focusing on diverse ethnic groups of Asian Americans, the present study examined the prevalence, ethnic variations, and predictors of stigmatizing beliefs about depression (beliefs that associate depression with a sign of weakness, shame to the whole family, and family disappointment, and beliefs that antidepressant medicines are addictive). Data were drawn from 2609 participants (age range 18-98) in the 2015 Asian American Quality of Life survey that includes Chinese, Asian Indian, Korean, Vietnamese, Filipinos, and other Asians. Results of a series of logistic models indicated that age, gender, ethnicity, length of stay in the U.S., English proficiency, and acculturation were significantly associated with stigmatizing beliefs about depression. Ethnic variations in beliefs were also observed. Implications for research and practice are discussed.

A cross-sectional study of self-rated health among older adults: a comparison of China and the United States

OBJECTIVES

We used nationally representative samples of China and the US older population to investigate (1) whether factors influencing self-rated health among older Chinese were similar to those among older Americans; and (2) whether there was a significant cross-national difference in self-rated health between China and the USA after controlling those available influencing factors.

DESIGN

A cross-sectional study. Data came from the 2014 Health and Retirement Study and China Health and Retirement Longitudinal Study conducted from 2014 to 2015.

PARTICIPANTS

Our final sample size totaled 8905 older adults in the USA and 4442 older adults in China.

OUTCOME

The response variable was self-rated health. Ordered logistic regression models were conducted to investigate factors influencing self-rated health among older adults.

RESULTS

More than three-fourths (78%) of older adults in China reported fair or poor health status, while almost 74% of older adults in the USA reported excellent, very good or good health status. In the overall ordered logistic regression model, when controlling statistically for sociodemographics, family structure, functional limitations, cognition, chronic conditions, mental health and health-related behaviours, the Chinese survey respondents were much more likely to rate their health as being poorer than the US respondents. The odds of having better versus poorer health was almost five times greater in American older adults than those in China (OR=4.88, 95% CI 4.06 to 5.86). Older adults in China living alone rated their health better than those living with spouse/partner; however, no significant difference was found between these two living arrangements in older Americans. In contrast, older adults in the USA living with others rated their health worse compared with those living with spouse/partner. In addition, older adults who had more activities of daily living limitations, poorer self-reported memory, worse mental health and chronic health conditions had lower self-rated health in both countries.

CONCLUSIONS

We found a striking difference in self-rated health between China and the USA even after controlling for measures of disease, functional status and other influencing factors. Relative to their American counterparts, Chinese elders were much more likely to report worse health.

Older Filipino immigrants' reconfiguration of traditional filial expectations: a focus ethnographic study

BACKGROUND

One of the many socio-cultural issues impacting older immigrants in host countries is the cultural expectations of filial piety from their adult children.

OBJECTIVE

To understand older Filipino immigrants' beliefs and values towards filial expectations.

DESIGN

Focused ethnography.

RESULTS

Two major themes were identified. The first theme 'moving away from filial expectations' drew out older Filipino's changing views of cultural expectations from their adult children. The second theme 'maintaining cultural values through good family relationships' highlighted the importance of acknowledging the cultural values considered to be most important by older Filipinos, which was having harmonious relationships and avoiding family conflict.

CONCLUSION

The reconfigured expectation was salient with participants' who identified 'not being a burden' to their adult children and the ardent desire to maintain positive family relationships. Impact Statement: Nurses need to be aware of changes to our current understanding of filial piety when providing care to older Filipinos.

A Rosier Reality: Incongruency in Stated and Revealed Ingroup Preferences among Young Asian American Speed Daters

Several studies have identified inconsistencies between “stated” interpersonal attitudes and those “revealed” after an interaction. The authors used the speed-dating paradigm to examine stated and revealed attitudes in ingroup preferences among Asian American subgroups (Chinese, Korean, Vietnamese, and Filipino Americans). Young single Asian Americans ( n = 198) reported preferences for dating different ethnicities and went on speed dates, after which they could offer second dates to their partners. As expected, all four ethnic subgroups showed clear ingroup biases in stated preferences. Ingroup bias in revealed preferences (measured through date offers and ratings of partners’ mate desirability), however, were minimal. At the individual level, stated ingroup preferences did not significantly predict revealed ingroup preferences. In summary, among young Asian Americans, ingroup preferences may not hold in an interactive scenario. The findings suggest that in the presence of personal cues provided through a brief interaction, people may be less prone to make judgments on the basis of ethnicity, even when consequences extend beyond the laboratory. Furthermore, mechanisms for selecting a partner may differ in “hot” (affective) versus “cold” (cognitive) states.

Applying the Health Belief Model and an Integrated Behavioral Model to Promote Breast Tissue Donation Among Asian Americans

An important part in the effort to prevent, treat, and cure breast cancer is research done with healthy breast tissue. The Susan G. Komen for the Cure Tissue Bank at Indiana University Simon Cancer Center (KTB) encourages women to donate a small amount of healthy breast tissue and then provides that tissue to researchers studying breast cancer. Although KTB has a large donor base, the volume of tissue samples from Asian women is low despite prior marketing efforts to encourage donation among this population. This study builds on prior work promoting breast cancer screenings among Asian women by applying constructs from the Health Belief Model (HBM) and the Integrated Behavioral Model (IBM) to investigate why Asian-American women are less inclined to donate their healthy breast tissue than non-Asian women and how this population may be motivated to donate in the future. A national online survey (N = 1,317) found Asian women had significantly lower perceived severity, some lower perceived benefits, and higher perceived barriers to tissue donation than non-Asian women under HBM and significantly lower injunctive norms supporting breast tissue donation, lower perceived behavioral control, and lower intentions to donate under IBM. This study also compares and discusses similarities and differences among East, Southeast, and South Asian women on these same constructs.

Acculturative Family Distancing, Mother–Daughter Relationship, and Well-Being Among Asian Americans

This study examined how mother–daughter connectedness may moderate: (a) the effect of acculturative family distancing (AFD) on psychological well-being (PWB), (b) the effect of mother–daughter conflict on PWB, and (c) the mediation effect of AFD on PWB through mother–daughter conflict. Four hundred and ten Asian American students completed an online survey. Our first hypothesis was not supported; the relation between AFD and PWB was significantly negative for those with higher connectedness but not significant for those with lower connectedness. We found support for the second and third hypotheses, whereby the associations were significantly negative at very low levels of connectedness, significantly positive at very high levels of connectedness, and not statistically significant at low, moderate, or high levels of connectedness. Our findings highlight the protective nature of connectedness in the mother–daughter relationship, which challenges the notion that cultural differences within Asian American families are necessarily associated with negative outcomes.

Is expressive suppression harmful for Chinese American breast cancer survivors?

Emotion regulation strategies are important for cancer survivors' adjustment. Expressive suppression, defined as the active effort of inhibiting the expressive component of an emotional response, has been found to be a maladaptive emotion regulation strategy. These studies, however, have been limited to cross-sectional designs and primarily European American samples. Chinese culture encourages emotion suppression to preserve interpersonal harmony and therefore it may be important to test these emotion regulation processes with this population. This study aimed to examine the longitudinal effects of expressive suppression, ambivalence over emotional expression (i.e., inner conflict over emotional expression), and cognitive reappraisal on quality of life among Chinese American breast cancer survivors. 103 participants completed a questionnaire assessing expressive suppression, ambivalence over emotional expression, cognitive reappraisal, and quality of life at baseline and a questionnaire assessing quality of life eight weeks later. Consistent with our hypotheses, baseline ambivalence over emotional expression was associated with lower follow-up quality of life above and beyond the effect of expressive suppression. Furthermore, cognitive reappraisal moderated the relations between expressive suppression and follow-up quality of life, such that expressive suppression may be less detrimental for Chinese American breast cancer survivors who are able to regulate their emotions using cognitive reappraisal. Implications for informing interventions for Chinese American breast cancer survivors are discussed.

Differences in alcohol use patterns between adolescent Asian American ethnic groups: Representative estimates from the National Survey on Drug Use and Health 2002-2013

OBJECTIVE

Studies have suggested that alcohol use prevalence is increasing among Asian American adolescents and there may be significant differences between specific adolescent Asian American ethnicities.

METHOD

Data from the National Survey on Drug Use and Health (2002-2013) were used to estimate prevalence of alcohol use (lifetime, past-month, past-year) and problem (binge drinking, alcohol use disorder [AUD], and early initiation of use) outcomes among adolescent Asian American ethnicities.

RESULTS

Filipino Americans had the highest prevalence of lifetime (29.3%) and past-month (10.3%) use; Korean Americans had the highest prevalence of past-year use (22.7%). Asian Indian Americans had the lowest prevalence of all three use indicators: 14.6%, 11.9%, and 4.9% for lifetime, past-year, and past-month, respectively. Korean Americans had the highest prevalence of binge drinking (5.4%), Filipino Americans had the highest prevalence of AUD (3.5%), and Vietnamese Americans had the highest prevalence of early initiation of use (13.5%). Asian Indian Americans had the lowest prevalence for all three alcohol problem indicators: 2.6%, 1.0%, and 4.9% for binge drinking, AUD, and early initiation of use, respectively.

CONCLUSIONS

Prevalence estimates of alcohol outcomes among Korean, Japanese, and Filipino American adolescents were high and similar to other racial groups that are often considered higher risk racial groups. Estimates among large subgroups with low alcohol use prevalence, Chinese and Asian Indian Americans, may mask high rates among other Asian ethnicities when alcohol use estimates are presented among Asians overall. When feasible, researchers should present alcohol use estimates disaggregated by specific Asian American ethnicities and investigate differences in risk factors across groups.

Psychometric evaluation of the Caregiver Self-Efficacy Scale with Korean Americans

This study evaluated the psychometric properties of a Korean version of the Caregiver Self-Efficacy Scale (CSE-K). The sample included 145 Korean American caregivers. Confirmatory factor analyses (CFA) were conducted to examine the factor structure of the CSE-K. We tested convergent validity of the CSE-K by examining its relationships with caregiver depression and burden. Internal consistency reliability of the CSE-K was also tested. The initial model of CFA based upon the structure of the original CSE revealed the poor model fit; however, the revised model produced the excellent model fit. Convergent validity was established, and excellent internal consistency reliability was found in the CSE-K. The results of this study show that the CSE-K is a reliable and valid measurement to assess caregiver self-efficacy for Korean American caregivers.

Coping as a Mediator Between Losing Face and Depressive and Social Anxiety Symptoms Among Asian Americans

Applying the proximal–distal framework, we were interested in whether the relationship between loss of face (LOF) concerns to depression and social anxiety were mediated by coping among 154 Asian Americans (AA). Utilizing a convenience sample from an online survey of AA, we ran ordinary least squares (OLS) regressions to examine whether direct and indirect coping explained the relationship between LOF concerns, depression, and social anxiety. LOF was positively associated with both direct and indirect coping. LOF also was positively associated with depression and social anxiety. The relationship between LOF and depression was significantly mediated by indirect coping but not direct coping. Higher levels of indirect coping explained the relationship between LOF and depression. In addition, the relationship between LOF and social anxiety was significantly mediated by indirect coping and direct coping. The relationship between LOF and social anxiety was partially explained by lower levels of direct coping and higher levels of indirect coping. LOF, however, continued to significantly predict social anxiety even after accounting for coping strategies. These results suggest that the LOF has a distal relationship to depression and social anxiety. Coping has a more proximal relationship to depression and social anxiety. By identifying proximal factors to depression and social anxiety, it is possible to reduce symptoms of depression and social anxiety among AA without mitigating the endorsement of traditional cultural values.

Asian Cultural Values, Attitudes toward Seeking Professional Psychological Help, and Willingness to See a Counselor

The purpose of this study was to examine the relationships among Asian American adherence to Asian cultural values, attitudes toward seeking professional psychological help, and willingness to see a counselor. Based on the data from 242 Asian American college students, the results revealed that adherence to Asian cultural values inversely predicted both attitudes toward seeking professional psychological help and general willingness to see a counselor, above and beyond the effects of related demographic variables. The results also indicated that attitudes toward seeking professional psychological help were a perfect mediator on the relationship between adherence to Asian cultural values and willingness to see a counselor in general and between adherence to Asian values and willingness to see a counselor for personal and health problems in particular.

Life satisfaction among European American, African American, Chinese American, Mexican American, and Dominican American adolescents

This study examined contextual and personality factors and their relation to perceived life satisfaction among adolescents in five sociocultural groups. Variations in the contribution of specific predictors were noted for the five groups, but no one factor accounted for a large amount of variance in any group. Among the most consistent predictors were marital status, self-efficacy beliefs, and adolescent health status. Somewhat surprisingly, neither the amount of family conflict, adolescent academic achievement, nor observed socioemotional support from parents was strongly correlated with life satisfaction. The effect of study variables on adolescent quality of life was dependent upon other variables in the analysis. For example, considerate behaviour on the part of the adolescent was suppressed by task-orientation.

Longitudinal Effects of Acculturation on Alcohol Use among Vietnamese and Cambodian Immigrant Women in the USA

AIMS

Recent studies indicate that alcohol use is increasing among Asian American populations and that acculturation impacts alcohol use among immigrants in the USA. We investigated the longitudinal relationship between three domains of acculturation (traditionalism, biculturalism, assimilation) and alcohol use among 302 Vietnamese and Cambodian women in Washington State.

METHODS

Data were obtained from the Cross Cultural Families Project (CCF), a 5-year longitudinal investigation of a random sample of Vietnamese and Cambodian immigrant families living in Washington State. Alcohol use was measured with a three item scale assessing frequency and quantity of use, and binge drinking. Acculturation was measured with the Suinn-Lew Asian Self-Identity Acculturation Scale. Linear mixed effects regression models were estimated to assess the impact of acculturation on alcohol use among the overall sample and among a sub-sample of only women who consumed any alcohol.

RESULTS

A majority of the sample, 73.2%, reported no alcohol use. In the overall sample, none of the three acculturation domains were significantly associated with drinking. Among a sub-sample of only those who reported any alcohol use, however, a greater degree of traditional cultural identification (β = -0.94, SE= 0.44, P= 0.03) and a greater degree of biculturalism (β = -1.33, SE= 0.53, P =0.01) were associated with lower levels of use.

CONCLUSIONS

Our findings suggest that acculturation did not impact alcohol use prevalence but that it did affect the drinking pattern among alcohol consumers. Clinicians should be cognizant that certain aspects of cultural identification are important contributors to drinking behavior among alcohol consumers in these populations.

AIDS impact special issue 2015: interpersonal factors associated with HIV partner disclosure among HIV-infected people in China

HIV partner disclosure may facilitate social support, improve psychological well-being among HIV-infected individuals, and promote HIV testing and HIV prevention among their sexual partners. A growing literature emphasizes the critical role of interpersonal factors may play in decision-making and practice regarding HIV partner disclosure. However, there is a dearth of empirical studies that investigate how interpersonal factors may be associated with HIV partner disclosure. Using cross-sectional data collected from 791 HIV-infected people in Guangxi China, we examined the associations between these two interpersonal factors (quality of relationship with partner and family communication) and HIV partner disclosure. Descriptive analysis, t-test analysis, and gender stratified GLM analysis were conducted. We find that disclosing HIV status to partners was significantly related to better quality of relationship with partners and open and effective family communication. Gender and partner HIV status might moderate the associations between interpersonal factors and HIV partner disclosure. Our findings suggest the importance of considering relationship quality and enhancing open and comfortable family communication in HIV disclosure interventions. Gender difference and partner HIV status should be also considered in HIV disclosure intervention to address the diverse needs of HIV-infected people.

English Proficiency, Threshold Language Policy and Mental Health Service Utilization among Asian-American Children

This paper explores the role of English proficiency, ethnicity, and California's threshold language policy in the rates of discontinuing mental health services among Asian-American children. We used data from the 2001-2006 Client and Services Information (CSI) System, which contains county-level information about service users in public mental health systems. Our data included 59,218 service users under the age of 18. We used logistic regression to determine the likelihood of discontinuing services, while controlling for sociodemographic and clinical characteristics. English-speaking Asians were 11% more likely than English-speaking Whites to discontinue mental health services. Non-English-speaking Asians were 50% significantly more likely to stay in services. The results also revealed some inter-ethnic variations in the discontinuation patterns; however, the patterns of mental health service utilization appear to be driven by the availability of mental health services in Asian-ethnic languages in county of residence. Further research is needed to understand the intake and referral processes that Asian children go through within the mental health service system.

"Shattering culture": perspectives on cultural competence and evidence-based practice in mental health services

The concept of culture as an analytic concept has increasingly been questioned by social scientists, just as health care institutions and clinicians have increasingly routinized concepts and uses of culture as means for improving the quality of care for racial and ethnic minorities. This paper examines this tension, asking whether it is possible to use cultural categories to develop evidenced-based practice guidelines in mental health services when these categories are challenged by the increasing hyperdiversity of patient populations and newer theories of culture that question direct connection between group-based social identities and cultural characteristics. Anthropologists have grown concerned about essentializing societies, yet unequal treatment on the basis of cultural, racial, or ethnic group membership is present in medicine and mental health care today. We argue that discussions of culture-patients' culture and the "culture of medicine"-should be sensitive to the risk of improper stereotypes, but should also be sensitive to the continuing significance of group-based discrimination and the myriad ways culture shapes clinical presentation, doctor-patient interactions, the illness experience, and the communication of symptoms. We recommend that mental health professionals consider the local contexts, with greater appreciation for the diversity of lived experience found among individual patients. This suggests a nuanced reliance on broad cultural categories of racial, ethnic, and national identities in evidence-based practice guidelines.

The experience of Chinese immigrant women in caring for a terminally ill family member in Australia

The Chinese community, a heterogeneous, highly visible non-English speaking ethnic group in Australia, remains mostly hidden and underrepresented in palliative care service delivery along with participation in health research despite being the fastest growing such group in the country. There is a lack of Australian research information concerning the impact of migration on the caregiving experience of women carers within the Chinese cultural framework and the Australian palliative care context. This paper aims to explore the influence of Chinese cultural norms and immigration on the experience of immigrant women of Chinese ancestry caring for a terminally ill family member at home in Sydney. This study also seeks to identify factors that may present access barriers to palliative care support services. A qualitative approach was used in this study. Data were collected from semi-structured interviews with five home-based Chinese women carers and were analysed using thematic analysis. Findings identified that the participants found being a carer is a lonely and isolating experience. Sources of isolation and loneliness included social isolation experienced as a solitary carer without meaningful family and social relationships; loss of familiar cultural understandings and family values; and emotional isolators expressed in response to the physical and emotional role commitment and other constraints. The study results suggest the need for palliative care educational programmes designed to help nurses to understand the impact of cultural background within the palliative care context. Results also indicate that health care professionals should provide culturally appropriate and competent palliative care services, sensitive to the diverse socio-cultural influences and individual needs of Chinese migrants.

Gender differences in factors related to diabetes management in Chinese American immigrants

Chinese American women with type 2 diabetes (T2DM) are more vulnerable to poor diabetes outcomes than men because immigrant status, ethnicity, and economics intersect with gender to diminish disease management opportunities. We explored gender differences in factors associated with diabetes management at intake and after treatment with a behavioral intervention in first-generation Chinese American immigrants. A sample of 178 Chinese Americans with T2DM was enrolled in a single-cohort, repeated-measures delayed-treatment trial. Data were collected at baseline, 8, 16, 24, and 32 weeks with 6-week treatment provided after 16 weeks. Gender differences at baseline and gender by treatment interactions were noted. Women at baseline reported significantly worse depressive symptoms and general health. Significant gender by treatment interactions were observed for diabetes self-efficacy, bicultural efficacy, family instrumental support, and diabetes quality of life-satisfaction. Only women showed improvement, suggesting women benefited more from the intervention in psychosocial factors related to diabetes management.

Korean Americans' prescription drug information seeking and evaluation and use of different information sources

This study examined Korean Americans' prescription drug information seeking, evaluation and use of different information sources, and communication with physicians, and compared the findings with those from the White American population. The results suggest that although Korean and White Americans were similar in extent of drug information seeking, Korean Americans tended to experience relatively greater difficulty finding information. Regarding perceived source usefulness, Korean Americans were significantly more likely to perceive higher usefulness in mass media and direct-to-consumer advertising sources than were Whites. Korean Americans were also more likely to use fewer sources, and less likely to use mass media and printed materials in drug information seeking. However, the hypothesized in-group source preference by Korean Americans was not found.

Binge drinking and alcohol-related problems among U.S.-born Asian Americans

Binge drinking (five drinks or more in a 2-h sitting for men or four or more drinks in a 2-h sitting for women) and alcohol-related problems are a growing problem among Asian American young adults. The current study examines the sociocultural (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 sociocultural determinants and drinking among U.S.-born Asian American young adults, the findings highlight the significant variability in drinking patterns among Asian American ethnic groups.

Influences of personal standards and perceived parental expectations on worry for Asian American and White American college students

The current study examined perceptions of living up to parental expectations (LPE) and personal standards as possible mediators of the relationship between ethnicity and worry in a sample of 836 Asian American and 856 White American college students. Asian Americans reported higher frequency of academic- and family-related worries, but they did not report higher levels of global tendency to worry. Perceptions of LPE of current academic performance and personal standards for preparation for a future career partially explained ethnic differences in frequency of academic worry. Personal standards and perceptions of LPE for respect for the family partially explained ethnic differences in frequency of family worry. The findings highlight the importance of targeting domain-specific personal standards and perceived parental expectations to reduce worry among Asian Americans.

Culturally Sensitive Mentoring for Asian International Students in Counseling Psychology

With growing attention to the internationalization of counseling psychology in the past decade, discussion on effective training of international students is much-needed. In order to provide effective mentorship to international students, the mentor needs to be aware of specific challenges faced by international students and cultural differences that may affect their mentoring relationship. With this in mind, this article discusses ways to provide culturally sensitive mentoring particularly to Asian international students in counseling psychology programs. A brief overview of Asian values is provided as a contextual backdrop to the article, followed by a discussion of culturally sensitive mentoring to Asian international mentees. In particular, the article addresses the mentor’s awareness and knowledge of unique issues faced by Asian international students, the structure and format of mentoring, communication between the mentor and the mentee, and professional development and career-related issues.