Social support as a buffer for perceived unfair treatment among Filipino Americans: differences between San Francisco and Honolulu

"What support?": A qualitative study on social support for Asian American victims of racism during the COVID-19 pandemic

Since the COVID-19 pandemic, anti-Asian racism has surged, yet little is known about Asian Americans' experiences of social support. Therefore, we designed a qualitative, intrinsic, revelatory case study to examine the nature and quality of social support for Asian Americans during the first 6 months of the pandemic. Our sample consisted of 193 Asian Americans (from over 32 U.S. states) disclosing their experiences of inadequate social support. They described their support network as (1) Being unable to relate, (2) Encouraging their silence, (3) Minimizing anti-Asian racism, (4) Denying anti-Asian racism, and (5) Victim-blaming. Regarding our participants' recommendations for increasing social support for Asian Americans, a total of seven recommendations emerged: (1) Legitimize anti-Asian racism, (2) Teach Asian American history, (3) Destigmatize mental health resources to make them accessible for Asian American families (4) Promote bystander intervention trainings, (5) Build solidarity with and beyond Asian Americans to dismantle racism, (6) Increase media attention on anti-Asian racism, and (7) Elect political leaders who will advocate for Asian Americans. Altogether, our findings underscore the need for systemic forms of advocacy to combat anti-Asian racism, and shed light on the injurious nature of social support for Asian American victims of racism.

The impact of interaction with children on internet addiction in older adults: A moderated mediation model

Internet addiction among older adults is a new problem in many countries. However, previous studies on excessive Internet use have focused more on young people, and only few studies have focused on Internet addiction in older adults. There is a need to continue to expand research on Internet addiction in older adults. This paper aimed to fill the gap in exiting literature. We adopted a self-reported questionnaire to assess the elderly’s interaction with children, loneliness, life satisfaction and Internet addiction among old adults. A total of 241 old people were obtained from data collection in China via online survey with the help of a professional research company. We used OLS regression analysis and bootstrap method to test the hypothesis. The results of the empirical analysis indicated that (1) interaction with children was significantly negatively associated with the Internet addiction of old people; (2) loneliness mediated the relationship between interaction with children and old adults’ Internet addiction; and (3) life satisfaction moderated the effect of interaction with children, and the indirect effect between interaction with children and old adults’ addiction via loneliness was stronger for those with low life satisfaction. Finally, we discussed the theoretical significance, practical implications, limitation of this research. Interventions to improve family function systems especially for older people with low life satisfaction can help prevent the development of Internet addiction.

Experiences of Stress and Help-Seeking Behaviors in Filipino Americans

A qualitative study using basic interpretive design identified the experiences of stress and barriers to professional help seeking among Filipino Americans (N = 12). Filipino Americans employed both engagement and disengagement strategies in response to stress characterized by Indigenous, religious, and cultural responses. Filipino Americans preferred to seek support from friends, family, and community leaders and described individual, cultural, and community barriers to pursuing professional mental health services.

Racial Discrimination and Health-Related Quality of Life: An Examination Among Asian American Immigrants

OBJECTIVES

We aimed to examine the relationship between everyday and major racial discrimination with health-related quality of life (HRQOL), which consists of self-rated health, days of poor physical health, mental health, and activity limitation.

DESIGN

In a cross-sectional analytic sample of 524 foreign-born Asian adults, aged 18 years and older, we conducted multivariable logistic regression and multivariable negative binomial regression to examine associations between discrimination and HRQOL. Furthermore, potential effect modification was tested by gender, ethnicity, and social support.

RESULTS

Associations were found between everyday racial discrimination and days of poor physical health (incidence rate ratio, IRR = 1.05), mental health (IRR = 1.03), and activity limitation (IRR = 1.05). Stronger significant associations were observed between major racial discrimination and days of poor physical health (IRR = 1.21), mental health (IRR = 1.16), and activity limitation (IRR = 1.53), adjusting for all covariates. Racial discrimination was not associated with poor self-rated health. In addition, gender significantly modified the relationship between continuous racial discrimination and activity limitation days with associations of greater magnitude among men, while social support significantly modified the association between categorized major racial discrimination and physically unhealthy days. When stratified, the association was only significant among those with low social support (IRR = 3.04; 95% CI: 1.60, 5.79) as opposed to high social support.

CONCLUSIONS

This study supports the association between racial discrimination and worse HRQOL among Asian Americans, which can inform future interventions, especially among men and those with low social support, aimed at improving the quality of life in this population.

Everyday Discrimination and Depressive Symptoms among Gujarati Adults: Gender Difference in the Role of Social Support

Discrimination against Asians in the USA and its impact on their mental health are urgent public health concerns. Most research on discrimination against Asians has used aggregated Asian group samples. Focusing on Gujaratis, a specific subgroup of Asian Indians, the second-largest Asian group in the USA, this study examined the relationships between everyday discrimination and psychological distress and how they vary by gender. Data were collected via computer-assisted telephone interviews with a representative sample of 553 Gujaratis aged 18 to 65 years residing in a Midwestern state. Negative binomial regression analyses were conducted to examine how exposure to unfair treatment and three types of social support, respectively, was associated with depressive symptoms. For both women and men, unfair treatment was positively associated with depressive symptoms, controlling for sociodemographic characteristics. For women, but not for men, the incidence rate ratio became non-significant when adding social support measures to the model. All three social support measures for women, and only satisfaction with social support for men, were significantly associated with lower depressive symptoms. The findings highlight the need for further research on the role of different types of social support and gender differences, which can inform gender- and socioculturally-relevant intervention efforts.

COVID-19 Related Racial Discrimination in Small Asian Communities: A Cross Sectional Study

Since the outbreak of COVID-19, there has been a surge of discrimination against Asians across the globe. However, there is a knowledge gap of COVID-19 related racial discrimination against Asians in smaller Asian populations. A total of 221 adults living in Florida completed an online survey between June-July 2020. Adjusted logistic regression assessed associations between sociodemographic factors and experienced discrimination, hypervigilance of safety, nervousness in public, and anticipated discrimination. Statistical analyses were performed using SPSS. Asian respondents were more likely than non-Asians to experience discrimination during COVID-19 (AOR = 12.58; 95% CI 4.74, 33.38; p ≤ 0.001). Asians were more likely to anticipate discrimination after the pandemic ends (AOR = 4.35, 95% CI 1.33, 14.17; p < 0.05). We found that Asians in smaller Asian populations suffer from a disproportionate level of discrimination due to COVID-19, relative to non-Asians. Our findings support previous research that racial discrimination exists on a continuum of violence and can have severe negative health consequences.

Racial Discrimination as a Cumulative Risk Factor Affecting Parental Stress on the Psychological Distress of Korean Americans (Both US- and Foreign-Born) amid COVID-19: Structural Equation Modeling

This study examined the relationships of parental stress and racial discrimination to the psychological distress of Korean Americans (both US- and foreign-born) during the COVID-19 pandemic. It also explored whether racial discrimination moderated the effect of parental stress on psychological distress. Using primary data collected between May 24, 2020, and June 14, 2020, via an online questionnaire, confirmatory factor analysis and structural equation models were conducted on 339 Korean American parents. Results indicated that parental stress and racial discrimination were associated with parental psychological distress. However, when the sample was divided by parental sex, racial discrimination played as a moderator, the interaction of discrimination, and parenting stress was associated with more psychological distress only for mothers. Based on the study results, we recommended that policymakers should consider policies and programs that can reduce racism to make up for the public health crisis associated with COVID-19; clinical practitioners also need to provide appropriate virtual mental/physical health services and interventions that can decrease parental stress and psychological distress amid COVID-19.

Migration-Related Stressors and Suicidal Ideation in North Korean Refugee Women: The Moderating Effects of Network Composition

Alarmingly high rates of suicidal ideation have been reported in North Korean (NK) refugee women living in South Korea. This population often endures traumatic experiences and violence in North Korea as well as human trafficking and sexual exploitation in intermediary countries. Following resettlement in South Korea, NK refugee women continue facing multiple hardships, such as discrimination, that can negatively affect their mental health and contribute to suicidality. Support from social networks can buffer the harmful impacts of pre- and postmigration stressors on mental health in NK refugee women. Using the stress-buffering hypothesis, the present study examined the moderating effects of network composition (i.e., network diversity and church-based ties) on the associations among premigration trauma, postmigration discrimination, and suicidal ideation in NK refugee women living in South Korea. Participants (N = 273) were NK refugee women living in South Korea who were 19 years of age or older; 34.4% of the participants reported past-year suicidal ideation. The study results indicated that network diversity significantly moderated the association between postmigration discrimination and suicidal ideation, p = .031, whereas networks with church-based ties significantly moderated the association between premigration trauma and suicidal ideation, p = .026. The present findings support the hypothesis that social ties can buffer the appraisal of migration-related stressors on suicidality. These findings have implications for practitioners serving vulnerable populations that experience multiple traumatic events.

Racial discrimination and disability among Asian and Latinx populations in the United States

Purpose: This study examined the association between perceived racial discrimination and disability among Asian and Latinx residents of the United States, as the link between discrimination and disability has gone largely ignored in analyses of these populations.Materials and methods: Nationally representative samples included 2046 Asian Americans and 2515 Latinx Americans from the National Latino and Asian American Study (NLAAS). We used multivariable logistic regression and multivariable negative binomial regression to analyze the association between racial discrimination and five different disability domains as well as racial discrimination and a count of simultaneous functional limitations, respectively. The disability domains included: self-care, cognition, mobility, time out of role, and social interaction.Results and conclusions: Perceived racial discrimination positively and significantly predicted impairments across a variety of disability domains for both Asian and Latinx populations. The estimated associations between racial discrimination and disability were heterogeneous across Asian and Latinx ethnicities. Racial discrimination may contribute to stress for Asians and Latinxs in the United States, potentially increasing the possibility these populations develop disabilities. Rehabilitation efforts should consider the social contexts in which people of color live, recognizing that discrimination may differentially affect risk profiles for disabilities across racial and ethnic groups.IMPLICATIONS FOR REHABILITATIONAcross Asian and Latinx populations, racial discrimination is associated with impairments in self-care, cognition, mobility, time out of role, and social interaction.Future translational research can explore the utility of brief racial discrimination screens in clinical settings to assess risk for disability in various domains.Professionals should attend to the stress and overall impact of racial discrimination, as it is conceivable that racial discrimination may result in the exclusion or hindrance of people of color who are pursuing meaningful participation in places of work, public spaces, and civic life.Society bears the collective obligation to reduce discrimination against Asian and Latinx populations, particularly against those who experience disability.

Social Support, Activities of Daily Living, and Depression among Older Japanese and Koreans Immigrants in the U.S

This study investigates the relationship between social support, activities of daily living (ADL), and depression among older Japanese and Koreans living in the U.S. Data were collected from 207 older Japanese and 210 older Koreans in various long-term care settings in Honolulu and Los Angeles. A hierarchical regression analysis indicated that social support was a significant factor of depressive symptoms in both groups and ADL was significantly associated with depressive symptoms among older Japanese. Based on our findings, we recommend means for social workers to address depression among older Japanese and Korean immigrants by improving social support and ADL.

Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review

PURPOSE

This systematic review aims to synthesise the evidence on behavioural and attitudinal patterns as well as barriers and enablers in Filipino formal help-seeking.

METHODS

Using PRISMA framework, 15 studies conducted in 7 countries on Filipino help-seeking were appraised through narrative synthesis.

RESULTS

Filipinos across the world have general reluctance and unfavourable attitude towards formal help-seeking despite high rates of psychological distress. They prefer seeking help from close family and friends. Barriers cited by Filipinos living in the Philippines include financial constraints and inaccessibility of services, whereas overseas Filipinos were hampered by immigration status, lack of health insurance, language difficulty, experience of discrimination and lack of acculturation to host culture. Both groups were hindered by self and social stigma attached to mental disorder, and by concern for loss of face, sense of shame, and adherence to Asian values of conformity to norms where mental illness is considered unacceptable. Filipinos are also prevented from seeking help by their sense of resilience and self-reliance, but this is explored only in qualitative studies. They utilize special mental health care only as the last resort or when problems become severe. Other prominent facilitators include perception of distress, influence of social support, financial capacity and previous positive experience in formal help.

CONCLUSION

We confirmed the low utilization of mental health services among Filipinos regardless of their locations, with mental health stigma as primary barrier, while resilience and self-reliance as coping strategies were cited in qualitative studies. Social support and problem severity were cited as prominent facilitators.

Ethnic Discrimination and Smoking-Related Outcomes among Former and Current Arab Male Smokers in Israel: The Buffering Effects of Social Support

We examined the relationship between two forms of ethnic discrimination-interpersonal and institutional-and smoking outcomes among Arab men in Israel, and whether social support buffered these associations. We used cross-sectional data of adult Arab men, current or former smokers (n = 954). Mixed-effects regression models estimated the association between discrimination and smoking status, and nicotine dependence among current smokers. Interpersonal discrimination was associated with higher likelihood of being a current smoker compared to a former smoker, whereas institutional group discrimination was not. Social support moderated the ethnic discrimination-nicotine dependence link. Among men with low social support, greater interpersonal discrimination was associated with greater nicotine dependence. Similarly, among smokers with high institutional group discrimination, those with high social support reported lower nicotine dependence compared to those with low social support. Ethnic discrimination should be considered in efforts to improve smoking outcomes among Arab male smokers in Israel.

Time-varying associations of racial discrimination and adjustment among Chinese-heritage adolescents in the United States and Canada

The aim of our study was twofold: to examine (a) whether the link between racial discrimination and adjustment showed age-related changes across early to late adolescence for Chinese-heritage youth and (b) whether the age-related associations of the discrimination–adjustment link differed by gender, nativity, and geographical region. We pooled two independently collected longitudinal data sets in the United States and Canada (N = 498, ages 12–19 at Wave 1) and used time-varying effect modeling to show that discrimination is consistently associated with poorer adjustment across all ages. These associations were stronger at certain ages, but for males and females, first- and second-generation adolescents, and US and Canadian adolescents they differed. There were stronger relations between discrimination and adjustment in early adolescence for males compared to females, in middle adolescence for first-generation compared to second-generation adolescents, and in early adolescence for US adolescents compared to Canadian adolescents. In general, negative implications for adjustment associated with discrimination diminished across the span of adolescence for females, second-generation, and US and Canadian adolescents, but not for males or first-generation adolescents. The results show that the discrimination–adjustment link must be considered with regard to age, gender, nativity, and region, and that attention to discrimination in early adolescence may be especially important.

Health of Philippine Emigrants Study (HoPES): study design and rationale

BACKGROUND

Immigrants to the United States are usually healthier than their U.S.-born counterparts, yet the health of immigrants declines with duration of stay in the U.S. This pattern is often seen for numerous health problems such as obesity, and is usually attributed to acculturation (the adoption of "American" behaviors and norms). However, an alternative explanation is secular trends, given that rates of obesity have been rising globally. Few studies of immigrants are designed to distinguish the effects of acculturation versus secular trends, in part because most studies of immigrants are cross-sectional, lack baseline data prior to migration, and do not have a comparison group of non-migrants in the country of origin. This paper describes the Health of Philippine Emigrants Study (HoPES), a study designed to address many of these limitations.

METHODS

HoPES is a dual-cohort, longitudinal, transnational study. The first cohort consisted of Filipinos migrating to the United States (n = 832). The second cohort consisted of non-migrant Filipinos who planned to remain in the Philippines (n = 805). Baseline data were collected from both cohorts in 2017 in the Philippines, with follow-up data collection planned over 3 years in either the U.S. for the migrant cohort or the Philippines for the non-migrant cohort. At baseline, interviewers administered semi-structured questionnaires that assessed demographic characteristics, diet, physical activity, stress, and immigration experiences. Interviewers also measured weight, height, waist and hip circumferences, blood pressure, and collected dried blood spot samples.

DISCUSSION

Migrants enrolled in the study appear to be representative of recent Filipino migrants to the U.S. Additionally, migrant and non-migrant study participants are comparable on several characteristics that we attempted to balance at baseline, including age, gender, and education. HoPES is a unique study that approximates a natural experiment from which to study the effects of immigration on obesity and other health problems. A number of innovative methodological strategies were pursued to expand the boundaries of current immigrant health research. Key to accomplishing this research was investment in building collaborative relationships with stakeholders across the U.S. and the Philippines with shared interest in the health of migrants.

Toward a New Understanding of Ethnic-Racial Settings for Ethnic-Racial Identity Development

The purpose of this conceptual article is to advance theory and research on one critical aspect of the context of ethnic-racial identity (ERI) development: ethnic-racial settings, or the objective and subjective nature of group representation within an individual's context. We present a new conceptual framework that consists of four dimensions: (1) perspective (that settings can be understood in both objective and subjective terms); (2) differentiation (how groups are defined in a setting); (3) heterogeneity (the range of groups in a setting); and (4) proximity (the distance between the individual and the setting). Clarifying this complexity is crucial for advancing a more coherent understanding of how ethnic-racial settings are related to ERI development.

Self-reported discrimination and mental health among Asian Indians: Cultural beliefs and coping style as moderators

The South Asian (SA) population has been underrepresented in research linking discrimination with health indicators; studies that focus on the unique cultural and psychosocial experiences of different SA subgroups are needed. The purpose of this study was to examine associations between self-reported discrimination and mental health among Asian Indians (AIs), and whether traditional cultural beliefs (believing that South Asian cultural traditions should be practiced in the US), coping style, and social support moderated these relationships. Asian Indians (N = 733) had been recruited from community-based sampling frames for the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study were included in this analysis. Multiple linear regression analyses were employed to evaluate relationships between discrimination and depressive symptoms, anger, and anxiety. Participants (men = 54%) were on average 55 years of age and had high levels of English proficiency, education, and income. Higher reports of discrimination were significantly associated with higher depressive symptoms, B = .27 (.05) p < .001, anger, B = .08 (.01), p < .001, and anxiety, B = .10 (.01), p < .001. Associations between discrimination and anger, B = -.005 (.002), p = .02, were weakest among those with stronger cultural beliefs. The link between discrimination and anxiety was attenuated by an active coping style, B = -.05 (.03), p = .04. In sum, self-reported discrimination appeared to adversely impact the mental health of AIs. Discrimination may be better coped with by having strong traditional cultural beliefs and actively managing experiences of discrimination.

Are Immigrants Healthier? The Case of Depression among Filipino Americans

Immigration has fundamentally changed American society by increasing racial and ethnic diversity. Yet, our knowledge of the relationship between immigrant status and mental health remains limited. This study provides evidence that Filipino American immigrants have significantly lower levels of depressive symptoms than Filipinos born in the United States, net of gender, age, marital status, socioeconomic status, and place of residence. I also examine the mediating effects of individualism, collectivism, ethnic identification, and perceived racial/ethnic discrimination to understand why immigrants are healthier. Furthermore, my results suggest that age at immigration warrants more attention. Immigrating during childhood predicts significantly higher levels of depressive symptoms in adulthood than immigrating after childhood, independent of the duration of residence in the United States. Although this study is specific to Filipino Americans, it has implications for theories about selective migration and the social psychological ramifications of adapting to American culture as a racial/ethnic minority.

The association between discrimination and depressive symptoms among older African Americans: the role of psychological and social factors

BACKGROUND/STUDY CONTEXT: Several studies have demonstrated a link between perceived discrimination and depression in ethnic minority groups, yet most have focused on younger or middle-aged African Americans and little is known about factors that may moderate the relationship.

METHODS

Participants were 487 older African Americans (60-98 years old) enrolled in the Minority Aging Research Study. Discrimination, depressive symptoms, and psychological and social resources were assessed via interview using validated measures. Ordinal logistic regression models were used to assess (1) the main relationship between discrimination and depression and (2) resilience, purpose in life, social isolation, and social networks as potential moderators of this relationship.

RESULTS

In models adjusted for age, sex, education, and income, perceived discrimination was positively associated with depressive symptoms (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.10-1.31; p < .001). However, there was no evidence of effect modification by resilience, purpose in life, social isolation, or social networks (all ps ≤ .05).

CONCLUSION

Findings provide support for accumulating evidence on the adverse mental health effects of discrimination among older African Americans. Because the association was not modified by psychological or social factors, these findings do not support a role for a buffering effect of resources on discrimination and depressive symptoms. Further studies are needed to examine a wider range of coping resources among older adults.

Race-Ethnicity, Poverty, Urban Stressors, and Telomere Length in a Detroit Community-based Sample

Residents of distressed urban areas suffer early aging-related disease and excess mortality. Using a community-based participatory research approach in a collaboration between social researchers and cellular biologists, we collected a unique data set of 239 black, white, or Mexican adults from a stratified, multistage probability sample of three Detroit neighborhoods. We drew venous blood and measured telomere length (TL), an indicator of stress-mediated biological aging, linking respondents' TL to their community survey responses. We regressed TL on socioeconomic, psychosocial, neighborhood, and behavioral stressors, hypothesizing and finding an interaction between poverty and racial-ethnic group. Poor whites had shorter TL than nonpoor whites; poor and nonpoor blacks had equivalent TL; and poor Mexicans had longer TL than nonpoor Mexicans. Findings suggest unobserved heterogeneity bias is an important threat to the validity of estimates of TL differences by race-ethnicity. They point to health impacts of social identity as contingent, the products of structurally rooted biopsychosocial processes.

Emotional support, instrumental support, and gambling participation among Filipino Americans

Using representative survey data of Filipino Americans in Honolulu and San Francisco (SF) (N = 2,259), we examined the roles of emotional support and instrumental support on gambling participation. With considerable difference in gambling environments between two regions, we conducted two sets of hierarchical regression analyses for Honolulu sample, which has restricted gambling laws, and SF sample, which has legal gambling environment, and compared the effects of two types of social support on gambling participation. The results indicated that emotional support was positively and instrumental support was negatively associated with gambling participation among Filipino Americans in Honolulu. However, neither type of social support was significantly associated with gambling participation among Filipino Americans living in SF. This study highlights the differing roles and effects of instrumental and emotional support on gambling where gambling is restricted. It also suggests that gambling behaviors of Filipino Americans are subject to situation- and environment-specific factors.

Does Social Support Buffer the Stress of Discrimination and Reduce Psychological Distress Among Asian Americans?

Using the stress process paradigm and data from the first national epidemiological survey of Asian Americans, we investigate whether social support from family and friends buffers the stress of discrimination to protect psychological well-being. Results suggest that perceived emotional support from family for a serious problem buffers the stress of high levels of everyday discrimination, controlling for sociodemographics, acculturation, and community factors. Contrary to our expectations, perceived emotional support from family about worries and received social support from regularly talking on the phone and getting together with family are not statistically significant stress buffers. Moreover, perceived and received social support from friends do not buffer the stress of any level of discrimination. Overall, our study has broader implications for research on the influence of social relationships on mental health and advances our knowledge of the social psychological process of coping with discrimination in the United States.

The impact of acculturation and acculturative stress on alcohol use across Asian immigrant subgroups

Acculturation and acculturative stress are examined as predictors of alcohol use among Asian immigrants, using the 2004 National Latino and Asian Americans Survey (NLAAS). Separate regression analyses were conducted for Chinese (n = 600), Filipino (n = 508), and Vietnamese (n = 520) immigrants. Alcohol use varied for the three groups. English proficiency was associated with drinking for all groups. Family conflict was associated with drinking for Chinese immigrants. General acculturative stress and discrimination were associated with drinking for Vietnamese immigrants. Results underscore acculturation and acculturative stress as being contributors to alcohol consumption, and the importance of considering the heterogeneity of Asian immigrants in research on their alcohol use. The study's limitations are noted.

Predictors of hypertension among Filipino immigrants in the Northeast US

Hypertension remains disproportionately high among Filipinos compared to other racial and ethnic minority populations, and little research on cardiovascular disease risk factors has been conducted among Filipino immigrants in the Northeastern part of the United States. To determine hypertension prevalence and risk factors among Filipino Americans in the New York City area, blood pressure and other clinical measurements were taken from a sample of Filipino Americans during 119 community health screenings conducted between 2006 and 2010. Additional socio-demographic and health-related characteristics were also collected via a cross-sectional survey. A total of 1,028 Filipino immigrants completed the survey and had clinical readings collected. Bivariate analyses and logistic regression were performed in order to predict and assess risk factors for hypertension among our sample. Fifty-three percent of individuals were hypertensive, and half of hypertensive individuals were uninsured. Logistic regression indicated that older age, male gender, living in the United States for over 5 years, a BMI greater than 23.0 kg/m(2), an elevated glucose reading, a family history of hypertension, and fair or poor self-reported health status were predictors of hypertension. There is a great need to develop more effective community-based interventions in the Filipino community to address cardiovascular health disparities.

Perceptions of health equity and subjective social status among baccalaureate nursing students engaged in service-learning activities in Hawai'i

The purpose of this study was to measure undergraduate students' knowledge of social determinants of health, health equity, and subjective social status (SSS). A cross-sectional semi-structured survey was administered to 68 racially/ethnically diverse freshman students enrolled in a baccalaureate nursing program in O'ahu, Hawai'i. Students ranked the impact of 13 issues on Hawai'i residents' health and described how well the health care system addressed these issues. A 10-rung ladder was used to rank SSS; students marked an "X" on the ladder rung where they stand in society and explained what they would need to "move up or down" the ladder. The students identified three key issues that adversely impact health: substance abuse, diet/nutrition, and cancer. Sixty-nine percent of students stated that social determinants of health impact Hawai'i residents' health either "quite a bit" or "very much", while only 31% felt that the health care system adequately addressed these determinants. Students who ranked high on the ladder (rungs 6-10) cited family as the reason. The students who ranked low on the ladder (rungs 3-5) credited their position to lack of money. Students' perceptions of social determinants of health and health equity align with findings from public health studies in Hawai'i. These concepts were integrated into the 4-year nursing school curricula and findings inform future research and service-based learning activities conducted by the students. While findings presented here focus on nursing students in Hawai'i, this educational innovation could be replicated with students in other undergraduate health sciences programs.

Impact of social discrimination, job concerns, and social support on Filipino immigrant worker mental health and substance use

BACKGROUND

The personal and social impact of mental health problems and substance use on workforce participation is costly. Social determinants of health contribute significantly to health disparities beyond effects associated with work. Guided by a theory-driven model, we identified pathways by which social determinants shape immigrant worker health.

METHOD

Associations between known social determinants of mental health problems and substance use (social discrimination, job and employment concerns, and social support) were examined using structural equation modeling in a sample of 1,397 immigrants from the Filipino American Community Epidemiological Study.

RESULTS

Social discrimination and low social support were associated with mental health problems and substance use (P < 0.05). Job and employment concerns were associated with mental health problems, but not substance use.

CONCLUSIONS

The integration of social factors into occupational health research is needed, along with prevention efforts designed for foreign-born ethnic minority workers.

A systematic review of the relationships between social capital and socioeconomic inequalities in health: a contribution to understanding the psychosocial pathway of health inequalities

Introduction

Recent research on health inequalities moves beyond illustrating the importance of psychosocial factors for health to a more in-depth study of the specific psychosocial pathways involved. Social capital is a concept that captures both a buffer function of the social environment on health, as well as potential negative effects arising from social inequality and exclusion. This systematic review assesses the current evidence, and identifies gaps in knowledge, on the associations and interactions between social capital and socioeconomic inequalities in health.

Methods

Through this systematic review we identified studies on the interactions between social capital and socioeconomic inequalities in health published before July 2012.

Results

The literature search resulted in 618 studies after removal of duplicates, of which 60 studies were eligible for analysis. Self-reported measures of health were most frequently used, together with different bonding, bridging and linking components of social capital. A large majority, 56 studies, confirmed a correlation between social capital and socioeconomic inequalities in health. Twelve studies reported that social capital might buffer negative health effects of low socioeconomic status and five studies concluded that social capital has a stronger positive effect on health for people with a lower socioeconomic status.

Conclusions

There is evidence for both a buffer effect and a dependency effect of social capital on socioeconomic inequalities in health, although the studies that assess these interactions are limited in number. More evidence is needed, as identified hypotheses have implications for community action and for action on the structural causes of social inequalities.

Effects of acculturation and social network support on depression among elderly Korean immigrants

OBJECTIVE

Acculturation and social network support have been identified as predictors of mental health for immigrant and elderly populations. The present study examined both independent and interactive effects of acculturation and social network support on depressive symptomatology among elderly Korean immigrants.

METHOD

Self-reported measures included sociodemographic characteristics, acculturation, social network support, and depressive symptoms. This study used cross-sectional analysis of a community-based cohort.

RESULTS

After controlling for the effects of demographic variables, a robust hierarchical regression model indicated that social network support was negatively associated with depressive symptoms. Also, the interaction between acculturation and social network was significantly associated with lower levels of depressive symptoms (β = -0.29, p < 0.05). In other words, elderly Korean immigrants who had high social network support and were highly acculturated exhibited lower levels of depression compared to those who had low support and were highly acculturated.

CONCLUSION

Our findings call attention to the role of social network support in the mental health of elderly Korean immigrants. Service providers can develop strategies for decreasing depression by increasing social network support, especially with family members, among their elderly parents.

Discrimination, family relationships, and major depression among Asian Americans

Depression represents a growing concern among Asian Americans. This study examined whether discrimination and family dynamics are associated with depression in this population. Weighted logistic regressions using nationally representative data on Asian American adults (N = 2095) were used to examine associations between discrimination, negative interactions with relatives, family support, and 12-month major depressive disorder (MDD). Discrimination (odds ratio [OR] = 2.13, 95% confidence interval [CI] = 1.67, 2.71) and negative interactions with relatives (OR = 1.28, 95% CI = 1.03, 1.58) were positively associated with MDD. Family support was associated with lower MDD (OR = 0.73, 95% CI = 0.59, 0.89), and buffered lower levels of discrimination. Results suggest that discrimination may have negative mental health implications, and also point to the importance of family relationships for depression among Asian Americans. Findings suggest that providers may consider stress experienced at multiple ecological levels to address Asian American mental health needs.

Chronic conditions, behavioral health, and use of health services among Asian American men: the first nationally representative sample

Although the Asian American population is increasing, Asian American men's health remains underinvestigated. This study examined the overall pattern of their health and health care usage. Using a nationally representative sample (N = 998) from the National Latino and Asian American Study (2002-2003), the first comprehensive epidemiological survey, rates of chronic conditions, behavioral health, and mental health service utilization (e.g., general medical, specialty mental health, and any medical services) were computed. The ages ranged from 18 to 95 and the mean age was 41. Of the sample, there were no ethnic subgroup differences in most of the physical and chronic conditions, with the exception of allergies/hay fever, arthritis, asthma, and high blood pressure. Behavioral health problems and substance use varied among Asian American men with more Vietnamese American men reporting that they are current smokers and more Filipino American men reporting having ever used drugs and having higher rates of obesity. Levels of mental health status and health services-seeking behaviors also varied among Asian subgroups. Variations exist among the three subgroups of Asian American men with regard to chronic, behavioral, and mental health issues. The results provide greater understanding of the heterogeneity and relationships among the Asian American subgroups with respect to physical, behavioral, and mental health concerns. Similarities and differences in prevalence rates and use of health services must include examining the social context. Social factors such as immigration status, living environments, lifestyle, culture, and health insurance may help explain the variations among Asian American men.

Hispanic acculturation, psychosocial functioning, and routine support for diabetes self-management

PURPOSE

The purpose of this study was to describe the relationship between Spanish language-based acculturation, psychosocial coping with diabetes, and perceptions of social support obtainment for the daily management of diabetes.

METHODS

Adults (N = 209) were surveyed by telephone about Hispanic ethnicity, depressed mood (PHQ-8), anxiety and worry over diabetes, social burden due to diabetes, diabetes control, and physical function (Diabetes-39), and Spanish language-based acculturation (n = 101, Hispanic only).

RESULTS

Significant associations revealed a relationship between less language-based acculturation with other contextual factors (gender, family demands, disease severity), and depressed mood and social burden of disease. Acculturation alone explained little about psychosocial coping. Individuals with poor psychosocial coping were more likely to have routine daily help with diabetes self- management, with acculturation explaining little about who obtains help.

CONCLUSIONS

Hispanic values such as placing a priority on providing help to friends and family likely have more to do with psychosocial coping with diabetes than does language preference or proficiency. Individuals with poor psychosocial functioning may benefit from external social support when family support is not present to help with the routine management of diabetes.

An integrative review of relationships between discrimination and Asian American health

PURPOSE

Many ethnic minorities in the United States experience disproportionate rates of adverse health outcomes or health disparities. Factors such as socioeconomic status do not fully explain how these disparities are generated and maintained. Research has demonstrated that chronic experiences of discrimination are harmful to the health of African Americans and Latinos. However, there is a dearth of research examining Asian Americans' experiences with discrimination and health disparities. The purpose of this integrative review was to summarize the current literature examining discrimination and the mental and physical health of Asian Americans.

DESIGN AND METHODS

Combinations of search terms related to discrimination, health, and Asian Americans were used to search five electronic databases. Inclusion criteria were primary research studies, published in English between 1980 and 2011, Asian American adults, and discrimination examined in relationship to a physical or mental health outcome. The search initially yielded 489 results; 14 quantitative studies met inclusion criteria.

FINDINGS AND CONCLUSIONS

Quantitative studies in this review revealed several significant associations between discrimination and health outcomes in Asian Americans. Discrimination was significantly associated with depressive symptoms in seven studies. Three studies found associations between discrimination and physical health, including cardiovascular disease, respiratory conditions, obesity, and diabetes. Although the literature was limited by self-reported data, cross-sectional designs, and inconsistent definitions and measurement of discrimination, the findings suggest that discrimination is a significant contributor to poorer health and health disparities for Asian Americans. The findings clearly demonstrate the need for further nursing research in this area to inform evidence-based practice and social policy.

CLINICAL RELEVANCE

Patient care providers can recognize discrimination as a significant stressor or purveyor of illness and explore ways to facilitate coping and resilience with their Asian American patients. Community-based participatory research approaches can be implemented by clinicians, academicians, and Asian American community partners to address the issue of discrimination and Asian American health outcomes.

Racial/ethnic differences in responses to the everyday discrimination scale: a differential item functioning analysis

The authors examined the impact of race/ethnicity on responses to the Everyday Discrimination Scale, one of the most widely used discrimination scales in epidemiologic and public health research. Participants were 3,295 middle-aged US women (African-American, Caucasian, Chinese, Hispanic, and Japanese) from the Study of Women's Health Across the Nation (SWAN) baseline examination (1996-1997). Multiple-indicator, multiple-cause models were used to examine differential item functioning (DIF) on the Everyday Discrimination Scale by race/ethnicity. After adjustment for age, education, and language of interview, meaningful DIF was observed for 3 (out of 10) items: "receiving poorer service in restaurants or stores," "being treated as if you are dishonest," and "being treated with less courtesy than other people" (all P's < 0.001). Consequently, the "profile" of everyday discrimination differed slightly for women of different racial/ethnic groups, with certain "public" experiences appearing to have more salience for African-American and Chinese women and "dishonesty" having more salience for racial/ethnic minority women overall. "Courtesy" appeared to have more salience for Hispanic women only in comparison with African-American women. Findings suggest that the Everyday Discrimination Scale could potentially be used across racial/ethnic groups as originally intended. However, researchers should use caution with items that demonstrated DIF.

The DRUID study: exploring mediating pathways between racism and depressive symptoms among indigenous Australians

PURPOSE

Racism is an important determinant of mental and physical health for minority populations. However, to date little is known about the relationship between racism and ill-health outside of the U.S. or the causal pathways between racism and poor health. This paper focuses on the relationship between racism and depression in a non-U.S. indigenous population, including examination of novel mediators and moderators.

METHODS

One hundred and eighty-five adults in the Darwin Region Urban Indigenous Diabetes study responded to a validated instrument assessing multiple facets of racism. Depressive symptoms were assessed using the Centre for Epidemiologic Studies Depression Scale. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were considered as possible mediators and moderators in linear regression models.

RESULTS

Interpersonal racism was significantly associated with depression after adjusting for socio-demographic factors (β = 0.08, p < 0.001). Lack of control, stress, negative social connections and feeling ashamed, amused or powerless as reactions to racism were each identified as significant mediators of the relationship between racism and depressive symptoms. All examined mediators together accounted for 66% of the association between interpersonal racism and depressive symptoms.

CONCLUSIONS

This study demonstrates that racism is associated with depressive symptoms in an indigenous population. The mediating factors between racism and depressive symptoms identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health.

Depression and anxiety among Asian Americans: the effects of social support and strain

It is almost taken for granted that social relationships benefit mental health, yet these relationships may not always be protective. This study examines how the support and strains individuals derive from family and friends may be related to depression and anxiety among Asian Americans. Data come from the 2002-2003 National Latino and Asian American Study, the first nationally representative study of mental health outcomes among Asian Americans (n = 2,066). Results indicate that family support was associated with decreased odds of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria for both major depressive disorder (MDD) and generalized anxiety disorder (GAD) among men and women. In addition, family strain was associated with increased odds of GAD equally among men and women. However, friend strain was associated with increased odds of GAD among women but not men, and family strain was marginally associated with increased odds of MDD for women but was unrelated for men. The findings affirm the need to consider social strain along with social support, as well as their sources, with attention to the potentially stronger effects of strain for women. Implications for social work practice are discussed.

Predictors of gambling behaviors in Filipino Americans living in Honolulu or San Francisco

This study compared the prevalence and predictors of gambling behaviors between Filipino Americans who live in San Francisco (S.F.) or Honolulu. Data from the 1998-1999 Filipino American Community Epidemiological Survey were used to answer two research questions: (1) What are the prevalence and types of gambling behaviors among Filipino Americans and (2) What are the protective/risk factors of heavy gambling for Filipino Americans in S.F. and Honolulu? Overall, S.F. Filipino Americans had a higher level of participation in gambling, and the odds of gambling increased among older age groups, males, those who were US-born, and those with more health problems. Multinomial logistic regression analyses revealed that factors associated with infrequent and regular gambling participation were different between the S.F. group (older, male, higher education) and Honolulu group (male, US-born, more health concerns). Differential gambling environments, i.e., wide open gambling in S.F. and the restrictive gambling in Honolulu, may contribute to gambling participation and predictors of risk gambling Filipino Americans living in Honolulu and S.F. Policy makers and health professionals need to be aware of these differences to serve this population more effectively.

Foot self-care practices among Filipino American women with type 2 diabetes mellitus

INTRODUCTION

To determine the foot self-care practices performed by Filipino American (FA) women with type 2 diabetes mellitus (DM).

METHOD

The Summary of Diabetes Self Care Activities - Revised and Expanded measure was administered to 118 FA adult female immigrants with type 2 DM.

RESULTS

Younger FA women (<65 years), participants with higher education, those who immigrated to the United States (US) at younger ages, and participants diagnosed with type 2 DM at younger ages reported they washed their feet every day during the past week. Moreover, FA women who immigrated to the US at younger ages and participants who were diagnosed with the disease at younger ages reported that they dried their feet (in between toes) daily during the previous week. Further, FA women who were diagnosed with type 2 DM at younger ages were more likely to report that they checked their feet every day during the past week, when compared with participants who were diagnosed with the disease at older ages. Finally, most FA women did not inspect the inside of their shoes.

CONCLUSION

Foot self-care practices were less frequently performed by older FA women with type 2 DM (≥65 years), making them more prone to the development of foot problems such as ulcers, infections, and disfigurations. Optimum foot self-care practices must be encouraged in older FA women to prevent such foot problems, and subsequent amputations.

Social determinants and health service use among racial and ethnic minorities: findings from a community sample

Multiple models conceptualizing the relationship between social determinants and health exist, but little research has examined the relationship between social determinants and health service use. Using previously collected survey data from racial and linguistic minorities from high-crime communities in a Midwestern urban area, this study uses the Commission on Social Determinants of Health framework to test the structural and intermediary determinants of health service use. The results indicate that perceived discrimination and neighborhood cohesion increase the likelihood of a person using health services. Implications for social work practice, advocacy, and research to address intermediary social determinants are discussed.

Race/ethnicity, socioeconomic characteristics, coethnic social ties, and health: evidence from the national Jewish population survey

OBJECTIVES

We explored whether a White ethnic group with a history of structural disadvantage, Jewish Americans, shows evidence of continuing health impact independent of socioeconomic position (SEP), whether coethnic social ties appear health protective, and whether the strength of any protection varies by SEP.

METHODS

In a series of ordered logistic regressions, we analyzed data from the National Jewish Population Survey, 2000-2001, regressing self-rated health on race/ethnicity, education, and income for US Blacks, Jews, and other Whites and, for Jews alone, indicators of coethnic social ties.

RESULTS

controlling for SEP indicators, the self-rated health of Jews converged with that of Blacks and was significantly worse than that of other Whites. Access to coethnic social ties was associated with better self-rated health among Jews, with the strongest estimated association among those of lower SEP.

CONCLUSIONS

The finding that a White ethnic group with a favorable socioeconomic profile reported significantly worse health than did other Whites, after controlling for SEP, calls for better understanding of the complex interplay of cultural, psychosocial, and socioeconomic resources in shaping population health.

Self-reported racial discrimination and substance use among Asian Americans in Arizona

We examined associations between different forms of self-reported racial discrimination and current substance use (i.e., smoking, alcohol use, and controlled substance use) among Asian Americans living in Arizona. The data are from 271 Asian American adults participating in the 2008 Asian Pacific Arizona Inititative (APAZI) Survey, which is part of a larger collaboration between community members, organizational leaders, and researchers. Asian Americans treated like they were not American because of their race were at increased risk of tobacco use, after controlling for covariates, including age, gender, education, family income, health insurance, nativity status, and language, and other types of racial discrimination. Also, individuals treated differently because of their race were at increased risk of alcohol use and controlled substance use, after controlling for covariates and other types of racial discrimination. The results indicate that Asian Americans experience a wide range of racial discrimination types and some forms of racial discrimination may have greater associations with tobacco, alcohol, and controlled substance use than others.

Racism, mental illness and social support in the UK

PURPOSE

The difference in risk of mental illness in UK ethnic minorities may be related to a balance between specific risk factors such as racial discrimination and mediating factors such as social support. We investigated whether social support from friends or relatives reduces the cross-sectional association between perceived racism and the risk of mental illness in an ethnic minority group.

METHODS

We conducted secondary analyses of nationally representative community samples of five UK ethnic minority groups (EMPIRIC dataset; n = 4,281) using multiple regression techniques.

RESULTS

We found that the associations between perceived racism, common mental disorder and potentially psychotic symptoms were mainly independent of social support as measured by the number of close persons and their proximity to the individual.

CONCLUSION

Social support when measured in this way does not mediate the associations between perceived racism and mental ill health in this population-based sample.

Discrimination and mental health-related service use in a national study of Asian Americans

OBJECTIVES

We examined the association between perceived discrimination and use of mental health services among a national sample of Asian Americans.

METHODS

Our data came from the National Latino and Asian American Study, the first national survey of Asian Americans. Our sample included 600 Chinese, 508 Filipinos, 520 Vietnamese, and 467 other Asians (n=2095). We used logistic regression to examine the association between discrimination and formal and informal service use and the interactive effect of discrimination and English language proficiency.

RESULTS

Perceived discrimination was associated with more use of informal services, but not with less use of formal services. Additionally, higher levels of perceived discrimination combined with lower English proficiency were associated with more use of informal services.

CONCLUSIONS

The effect of perceived discrimination and language proficiency on service use indicates a need for more bilingual services and more collaborations between formal service systems and community resources.

Perceived everyday discrimination and psychological distress: does social support matter?

OBJECTIVES

We investigate the association between perceived everyday discrimination and psychological distress among urban African-American women with young children (under 6 years) living in low-income neighborhoods. Specifically, we examine whether instrumental and emotional social support moderates the association between perceived everyday discrimination and psychological distress.

DESIGN

The data come from the Detroit Dental Health Project, a two-stage area probability sample representative of low-income African-American children in the city of Detroit. The analysis focuses on 969 female caregivers of young children. A series of hierarchical regression analyses were performed to examine the role of social support in the link between perceived everyday discrimination and psychological distress, with appropriate adjustments for the complex sample design.

RESULTS

Both moderate and high frequency levels of discrimination were associated with higher levels of psychological distress after controlling for age, education, income, and self-rated health. There was a main effect of emotional support so that availability of emotional support was associated with less psychological distress. Instrumental support exerted a buffering effect to mitigate the negative influence of moderate levels of perceived discrimination on psychological distress.

CONCLUSION

Findings suggest that instrumental social support provides some protection from everyday stress. Social support, however, does not offset the impact of acute stress caused by frequent perceptions of everyday discrimination.

Quality of life associated with perceived stigma and discrimination among the floating population in Shanghai, China: a qualitative study

The floating population refers to the large and increasing number of migrants without local household registration status and has become a new demographic phenomenon in China. Most of these migrants move from the rural areas of the central and western parts of China to the eastern and coastal metropolitan areas in pursuit of a better life. The floating population of China was composed of 121 million people in 2000, and this number was expected to increase to 300 million by 2010. Quality of life (QOL) studies of the floating population could provide a critical starting point for recognizing the potential of regions, cities and local communities to improve QOL. This study explored the construct of QOL of the floating population in Shanghai, China. We conducted eight focus groups with 58 members of the floating population (24 males and 34 females) and then performed a qualitative thematic analysis of the interviews. The following five QOL domains were identified from the analysis: personal development, jobs and career, family life, social relationships and social security. The results indicated that stigma and discrimination permeate these life domains and influence the framing of life expectations. Proposals were made for reducing stigma and discrimination against the floating population to improve the QOL of this population.