David H. Chae

Immigration-related factors and mental disorders among Asian Americans.

OBJECTIVES We examined lifetime and 12-month rates of any depressive, anxiety, and substance abuse disorders in a national sample of Asian Americans. We focused on factors related to nativity and immigration as possible correlates of mental disorders. METHODS Data were derived from the National Latino and Asian American Study, the first national epidemiological survey of Asian Americans in the United States. RESULTS The relationships between immigration-related factors and mental disorders were different for men and women. Among women, nativity was strongly associated with lifetime disorders, with immigrant women having lower rates of most disorders compared with US-born women. Conversely, English proficiency was associated with mental disorders for Asian men. Asian men who spoke English proficiently generally had lower rates of lifetime and 12-month disorders compared with nonproficient speakers. CONCLUSIONS For Asian Americans, immigration-related factors were associated with mental disorders, but in different ways for men and women. Future studies will need to examine gender as an important factor in specifying the association between immigration and mental health.

Racial Discrimination and Health Among Asian Americans: Evidence, Assessment, and Directions for Future Research

Research shows that racial discrimination is related to illness among diverse racial and ethnic populations. Studies of racial discrimination and health among Asian Americans, however, remain underdeveloped. In this paper, the authors review evidence on racial discrimination and health among Asian Americans, identify gaps in the literature, and provide suggestions for future research. They identified 62 empirical articles assessing the relation between discrimination and health among Asian Americans. The majority of articles focused on mental health problems, followed by physical and behavioral problems. Most studies find that discrimination was associated with poorer health, although the most consistent findings were for mental health problems. This review suggests that future studies should continue to investigate the following: 1) the measurement of discrimination among Asian Americans, whose experiences may be qualitatively different from those of other racial minority groups; 2) the heterogeneity among Asian Americans, including those factors that are particularly salient in this population, such as ethnic ancestry and immigration history; and 3) the health implications of discrimination at multiple ecologic levels, ranging from the individual level to the structural level.

Unfair Treatment, Racial/Ethnic Discrimination, Ethnic Identification, and Smoking Among Asian Americans in the National Latino and Asian American Study

OBJECTIVES We examined the relations of self-report of general unfair treatment and self-report of race/ethnicity-specific discrimination with current smoking among Asian Americans. We investigated whether ethnic identification moderated either association. METHODS Weighted logistic regressions were performed among 1977 Asian Americans recruited to the National Latino and Asian American Study (2002-2003). RESULTS In weighted multivariate logistic regression models including both general unfair treatment and racial/ethnic discrimination, odds of current smoking were higher among Asian Americans who reported high levels of unfair treatment (odds ratio [OR]=2.80; 95% confidence interval [CI]=1.13, 6.95) and high levels of racial/ethnic discrimination (OR=2.40; 95% CI=0.94, 6.12) compared with those who reported no unfair treatment and discrimination, respectively. High levels of ethnic identification moderated racial/ethnic discrimination (F(3) =3.25; P =.03). High levels of ethnic identification were associated with lower probability of current smoking among participants reporting high levels of racial/ethnic discrimination. CONCLUSIONS Our findings suggest that experiences of unfair treatment and racial/ethnic discrimination are risk factors for smoking among Asian Americans. Efforts to promote ethnic identification may be effective in mitigating the influence of racial/ethnic discrimination on smoking in this population.

Discrimination, Racial Bias, and Telomere Length in African-American Men

BACKGROUND Leukocyte telomere length (LTL) is an indicator of general systemic aging, with shorter LTL being associated with several chronic diseases of aging and earlier mortality. Identifying factors related to LTL among African Americans may yield insights into mechanisms underlying racial disparities in health. PURPOSE To test whether the combination of more frequent reports of racial discrimination and holding a greater implicit anti-black racial bias is associated with shorter LTL among African-American men. METHODS Cross-sectional study of a community sample of 92 African-American men aged between 30 and 50 years. Participants were recruited from February to May 2010. Ordinary least squares regressions were used to examine LTL in kilobase pairs in relation to racial discrimination and implicit racial bias. Data analysis was completed in July 2013. RESULTS After controlling for chronologic age and socioeconomic and health-related characteristics, the interaction between racial discrimination and implicit racial bias was significantly associated with LTL (b=-0.10, SE=0.04, p=0.02). Those demonstrating a stronger implicit anti-black bias and reporting higher levels of racial discrimination had the shortest LTL. Household income-to-poverty threshold ratio was also associated with LTL (b=0.05, SE=0.02, p<0.01). CONCLUSIONS Results suggest that multiple levels of racism, including interpersonal experiences of racial discrimination and the internalization of negative racial bias, operate jointly to accelerate biological aging among African-American men. Societal efforts to address racial discrimination in concert with efforts to promote positive in-group racial attitudes may protect against premature biological aging in this population.

The associations between socio-economic status and major depressive disorder among Blacks, Latinos, Asians and non-Hispanic Whites: findings from the Collaborative Psychiatric Epidemiology Studies

BACKGROUND This study examined whether there were associations between individual measures of socio-economic status (SES) and the 12-month prevalence of major depressive disorder (MDD) in representative samples of Blacks, Latinos, Asians and Whites in the USA. METHOD The data used were from the Collaborative Psychiatric Epidemiology Studies (CPES). RESULTS There was an association between household income and MDD among Whites. However, the association was not statistically significant. Statistically significant associations were present between educational attainment and MDD among Whites. Among both Whites and Latinos, being out of the labor force was significantly associated with MDD. In analyses by nativity, being out of the labor force was significantly associated with MDD among US-born and foreign-born Latinos. CONCLUSIONS Significant associations between various measures of SES and MDD were consistently observed among White and, in some cases, Latino populations. Future studies should continue to examine sociopsychological factors related to SES that increase the risk of MDD among people from racial-ethnic communities.

Do experiences of racial discrimination predict cardiovascular disease among African American men? The moderating role of internalized negative racial group attitudes

Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group attitudes in linking experiences of racial discrimination and history of cardiovascular disease among African American men. We predicted a significant interaction between reported discrimination and internalized negative racial group attitudes in predicting cardiovascular disease. Weighted logistic regression analyses were conducted among 1216 African American men from the National Survey of American Life (NSAL; 2001-2003). We found no main effect of racial discrimination in predicting history of cardiovascular disease. However, agreeing with negative beliefs about Blacks was positively associated with cardiovascular disease history, and also moderated the effect of racial discrimination. Reporting racial discrimination was associated with higher risk of cardiovascular disease among African American men who disagreed with negative beliefs about Blacks. However, among African American men who endorsed negative beliefs about Blacks, the risk of cardiovascular disease was greatest among those reporting no discrimination. Findings suggest that racial discrimination and the internalization of negative racial group attitudes are both risk factors for cardiovascular disease among African American men. Furthermore, the combination of internalizing negative beliefs about Blacks and the absence of reported racial discrimination appear to be associated with particularly poor cardiovascular health. Steps to address racial discrimination as well as programs aimed at developing a positive racial group identity may help to improve cardiovascular health among African American men.

Perceived Discrimination among African American Adolescents and Allostatic Load: A Longitudinal Analysis with Buffering Effects.

This study was designed to examine the prospective relations of perceived racial discrimination with allostatic load (AL), along with a possible buffer of the association. A sample of 331 African Americans in the rural South provided assessments of perceived discrimination from ages 16 to 18 years. When youth were 18 years, caregivers reported parental emotional support and youth assessed peer emotional support. AL and potential confounder variables were assessed when youth were 20. Latent growth mixture modeling identified two perceived discrimination classes: high and stable, and low and increasing. Adolescents in the high and stable class evinced heightened AL even with confounder variables controlled. The racial discrimination to AL link was not significant for young adults who received high emotional support.

Smoking prevalence among asian americans: findings from the National Latino and Asian American Study (NLAAS).

Objective. National studies suggest that the prevalence of current smoking among Asian Americans is lower than that for other racial/ethnic groups. However, these studies may have yielded inaccurate estimates because of the underrepresentation of non-English-speaking groups. Using data from the National Latino and Asian American Study (NLAAS), the authors estimated the prevalence of current and lifetime smoking among Asian Americans. Methods. Current and lifetime smoking status was assessed through a population-based survey administered to Asian American adults aged 18 and older. Results. An overall current smoking prevalence of 14.9% was found, with notable differences by gender, nativity, and other sociodemographic factors. The prevalence of current smoking was higher among foreign-born vs. U.S.-born men (24.9% vs. 15.6%), while U.S.-born women had a higher prevalence than foreign-born women (6.3% vs. 11.7%). Overall, 28.3% of Asian Americans were ever smokers (including current and former smokers), suggesting that approximately half of ever smokers cease smoking. Results indicated that some Asian American groups are more likely to initiate smoking and/or be more likely to continue smoking. Conclusion. Results revealed that the prevalence of current smoking exceeds that of the general U.S. population for some Asian American groups and suggest that excluding non-English-speaking Asian Americans may underestimate the prevalence of smoking among men. Findings indicate that some Asian American groups are at greater risk for initiating smoking and/or continuing smoking, and highlight the need for tailored interventions that address differential smoking patterns by gender, nativity, and other social characteristics.

Stress, Marital Satisfaction, and Psychological Distress Among African Americans:

This study examines relationships among financial strain, unfair treatment, and martial satisfaction among African Americans. Using data from the National Survey of American Life, findings indicated that social stressors that occur inside of the home (i.e., financial strain) as well as those experienced outside of the home (i.e., unfair treatment) have negative consequences for marital quality and psychological distress. Furthermore, the combination of experiencing unfair treatment and financial strain has particularly deleterious mental health consequences for married African Americans. Results also highlight the protective effect of marital satisfaction on psychological distress as well as its potential to buffer the negative effects of unfair treatment and financial strain on psychological distress. Implications for policy to improve marital quality and promote the mental health of African Americans are discussed.

Barriers to Health Care among Asian Immigrants in the United States: A Traditional Review

Asian immigrants in the U.S. are far less likely to have health insurance or use health care services than both U.S.-born Asians and non-Hispanic Whites. Furthermore, Asian immigrants who access the U.S. health care system are less likely than non-Hispanic Whites to receive high-quality services. This paper reviews four barriers faced by Asian immigrants to participating in the U.S. health care system fully: (1) linguistic discordance between providers and patients; (2) health-related beliefs and cultural incompetency of health systems; (3) issues related to accessing health services; and (4) discrimination in the health care system. Interventions to improve the health of Asian immigrants must address barriers experienced at multiple levels, including those that occur interpersonally and institutionally, as well as broader societal factors that affect health care access and quality.