Thao N. Le

Health care access and preventive care among Vietnamese immigrants: Do traditional beliefs and practices pose barriers?

Some have speculated that underutilization of Western health services among non-Western populations can be explained by traditional health beliefs and practices rooted deep within cultures. These beliefs and practices may act as barriers to access to and utilization of services. Among Vietnamese, in particular, a number of traditional health beliefs and practices have been identified which are said to pose barriers to Western medical care. No studies to date, however, have examined this hypothesis empirically. To examine this hypothesis, we measured traditional health beliefs and practices among Vietnamese in the San Francisco Bay area and analyzed the relationships between these factors and access to health care and use of preventive health services. The results of this study show clearly that many Vietnamese possess traditional health beliefs and practices which differ from those of the general U.S. population. Yet, the data do not support the hypothesis that these traditional beliefs and practices act as barriers to access to Western medical care or to utilization of preventive services. Being married and poverty status were the most consistent predictors of health care access. Furthermore, the components of access to health care (having some form of health insurance or having a regular doctor, for example) were the strongest predictors of preventive health care services utilization. Importantly, the cultural attributes of individuals did not explain either lack of health care access or underutilization of preventive health care services.

Acculturative dissonance, ethnic identity, and youth violence.

Studies suggest that the process of acculturation for immigrant youth, particularly for second-generation youth, is significantly associated with delinquency and violence. This study explored the acculturation-violence link with respect to acculturative dissonance and ethnic identity. The results revealed in a sample of 329 Chinese, Cambodian, Mien/Laotian, and Vietnamese youth that acculturative dissonance was significantly predictive of serious violence, with full mediation through peer delinquency. Ethnic identity was not significantly associated with peer delinquency or serious violence. Although acculturative dissonance and ethnic identity accounted for a small percentage of variance in violence compared with peer delinquency, it cannot be discounted as trivial. Structural equation analyses provided support for both measurement and structural invariance across the four ethnic groups, lending support for cross-cultural comparisons. The results also lend support for the inclusion of cultural factors in youth violence prevention and intervention efforts.

Individualism, Collectivism, and Delinquency in Asian American Adolescents

Although the study of delinquency has previously focused on identifying individual, family, peer, and social risk and protective factors, little empirical research has studied cultural factors and their relations to delinquency. In a large community sample of 329 Chinese, Cambodian, Laotian/Mien, and Vietnamese youths, individualism was positively related to, and collectivism negatively related to, self-reported delinquency, with partial mediation through peer delinquency (PD). Although the percentage of variance in delinquency attributable to individualism–collectivism was small compared to PD, it cannot be discounted as trivial. The results also supported the measurement and structural invariance of these associations across the 4 ethnic groups.

The Relationship of School, Parent, and Peer Contextual Factors with Self-Reported Delinquency for Chinese, Cambodian, Laotian or Mien, and Vietnamese Youth

The study of delinquency has focused on examining the relative predictive value of school, parent, and peer contextual variables, but relatively little research has included Chinese and Southeast Asian youth. Using data from a larger, community-based research study with 329 Chinese, Cambodian, Laotian or Mien, and Vietnamese youth, the authors found that peer delinquency was the strongest predictor of self-reported delinquency. However, its predictive power for the Chinese group is about one half that of the other groups. School attachment negatively predicted delinquency for Chinese and Vietnamese and for males and females but not for Cambodian and Laotian or Mien. Parent Attachment and parent discipline were found to be nonsignificant predictors. LISREL analyses also indicated measurement and structural invariance across ethnic groups, providing support for cross-cultural comparisons. Implications for interventions are discussed.

Acculturation factors and substance use among Asian American youth.

In this study of 329 Cambodian, Chinese, Laotian/Mien, and Vietnamese youth in Oakland, California, acculturation factors of individualism-collectivism and acculturative dissonance were examined as risk and protective factors for substance use. Results of structural equation modeling and bootstrapping revealed that peer substance use was a robust mediator between individualism and youth’s self-reported substance use, particularly among Vietnamese and males. Peer substance use also significantly mediated the relation between collectivism and substance use for females. As such, there appears to be ethnic and gender group variations in the saliency of cultural/acculturation factors with respect to substance use. Implications for substance use prevention programs for ethnic and immigrant youth are discussed.

Gender Differences in Cambodian Delinquency: The Role of Ethnic Identity, Parental Discipline, and Peer Delinquency

Contrary to the model minority stereotype, Asian youth are increasingly becoming more involved in crime and delinquency. For instance, in the California Youth Authority, Southeast Asian adolescents are disproportionately represented, including Cambodian, Hmong, and Lao and Mien youth. However, few studies have focused on factors that are associated with Southeast Asian adolescent delinquency. Using a Cambodian adolescent sample, this study found significant gender similarities as well as differences. In both groups, peer delinquency was significantly associated with juvenile delinquency. However, for males, ethnic identity search was also a significant factor whereas for females, parental discipline was significant. These findings argue for the need to consider gender differences in conducting research and intervention programs for Cambodians and generally, for Southeast Asian adolescents. These results also suggest a need for more research, not only with respect to gender differences, but also on how they are similar to their Southeast Asian, Asian, and U.S. counterparts.

The Influence of Parents, Peer Delinquency, and School Attitudes on Academic Achievement in Chinese, Cambodian, Laotian or Mien, and Vietnamese Youth

Past research on academic achievement has tended to overlook the diversity among Asian American groups and the educational and socioeconomic difficulties that many Asians, particularly Southeast Asians, face. The present study addressed several shortcomings of past research by contrasting parent attachment and discipline, peer delinquency, and school attitudes as predictors of self-reported grade point average in 329 Chinese, Cambodian, Laotian or Mien, and Vietnamese youth. Results revealed that parental factors generally did not contribute much explanatory power and that school attitudes may mediate the relationship between peer delinquency and academic achievement. Interventions aimed at promoting positive adjustment and school outcomes should focus on the role of delinquent peer affiliations and youth’s attitudes toward school.

Stressful Life Events, Culture, and Violence

This study explored the contributions of stressful life events and their interactions with social support and cultural factors in predicting serious violence among American adolescent immigrants of Chinese and Southeast Asian origins. Youth differed in their exposure to stressors and how they responded to them. Cambodian and Laotian youth reported the highest levels of stressors, except for emotional abuse. Only physical abuse was an independent predictor of serious violence for all groups, except Chinese. Perceived social support buffered the effects of some stressors, whereas increased levels of acculturation, intergenerational/intercultural conflict, and individualism placed youth at increased risk for serious violence. The results suggest that the moderating effects of culture and social support need to be considered when examining the association between life stressors and serious violence for Chinese and Southeast Asian youth.

Religiousness and Depressive Symptoms in Five Ethnic Adolescent Groups

This study examined the relation between religiousness and depressive symptoms in African American, Asian American, European American, Hispanic American, and Native American adolescents (N = 13,317) in the United States with self-esteem and school attachment as potential mediators in this link. The data were taken from a nationally represented sample of adolescents in Grades 7 through 12, from the National Longitudinal Study of Adolescent Health (Add Health). Structural equation analyses with measurement and structural invariance across the five ethnic groups and gender supported the model that religiousness, as a composite of internal and external religiousness items, negatively predicted depressive symptoms 1 year later controlling for baseline depressive symptoms. Self-esteem and school attachment partially mediated this link but only for European American and African American adolescents.

Parent Refugee Status, Immigration Stressors, and Southeast Asian Youth Violence

Purpose: To assess the effects of parents’ experience of traumatic events on violence among Southeast Asian and Chinese youth. The study examines independent effects of parents’ refugee camp experiences and immigration stress on serious or family/partner violence among youth. Findings contribute evidence on the intergenerational effects of community-level trauma that can help policy makers better integrate family and community strategies to reduce youth violence. Methods: Obtained cross-sectional, face-to-face interview data including peer delinquency, parental engagement, parental discipline, serious violence, and family/partner violence from a sample of 329 Chinese and Southeast Asian adolescents. Measures of socioeconomic status, refugee status, and immigration stressors were collected from their respective parents. Data were analyzed using LISREL 8.54 for structural equation modeling. Results: Findings show that parents’ refugee status facilitated serious violence, and was fully mediated by peer delinquency and parental engagement, but for Vietnamese only. Parents’ refugee status was also significantly related to family/partner violence, and mediated by peer delinquency. This relationship was not observed among the other Asian ethnic groups. The immigration stress variable had no significant effects on either serious violence or family/partner violence. Conclusions: Refugee communities may not transform easily into stereotypical immigrant Asian communities characterized by little youth violence. Results suggest that the refugee process, as experienced second-hand through the children of refugees, has a strong effect on externally oriented violence (serious violence) and on family/partner violence for particular subgroups. Therefore, community-oriented policy makers should join social workers in developing programs to address youth violence in Southeast Asian families and communities. Findings have implications for other forms of community trauma such as natural disasters.