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Objective: Elucidate the representation of Asian and Asian Americans in academic otolaryngology and the influence of race on promotion and leadership opportunities., Study Design: Retrospective analysis of the Association of American Medical Colleges Faculty Administrative Management Online User System., Setting: Full-time otolaryngology faculty from all US medical schools from 2020 to 2023., Methods: Faculty demographics, tenure, and rank were collected. Descriptive statistics, Fischer's exact test, Rank Equity Index (REI), and multivariable logistic and ordinal regressions were used to characterize our cohort and assess the impact of race on academic advancement and leadership, defined as promotion to tenure or full professorship., Results: Asians comprised 20.53% of 9056 faculty over 4 years. Asians were most likely to hold tenure-eligible positions (n = 600, 30.74%) but were significantly less likely than non-Asians to be tenured (43.00% vs 48.65%, P = .015). Asians were slightly above parity in promotion from assistant to associate professor (REI = 1.09) but below parity in promotion from associate professor to professor (REI = 0.78). Relative to whites, Hispanics, and African Americans, Asians reported the lowest associate/professor and assistant/professor REIs. On multivariable regressions, Asian race was not associated with decreased odds of tenure-eligible positions but was associated with decreased odds of tenure (odds ratio [OR] = 0.77, 95% confidence interval [CI] = [0.64-0.93]) and rank promotion (OR = 0.82, 95% CI = [0.74-0.90])., Conclusion: Despite strong overall representation in otolaryngology, Asians are less likely to receive promotion, tenure, or full professorship relative to other racial groups. Future efforts should emphasize equitable advancement opportunities to ensure a diverse otolaryngology leadership., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: This study explores mental health stressors related to family dynamics of Korean American college students during the time of the COVID-19 pandemic. Participants: In January 2021, using purposive sampling, we recruited 15 Korean American student leaders at a west coast university. Methods: Self-identified leaders were interviewed via Zoom, and data were transcribed verbatim and analyzed using a thematic analytic approach based on grounded theory. Results: Students leaders' perceived sources of family stress for Korean American college students centered on three themes: (1) loss of independence, (2) family pressure, and (3) strained family relationships. Conclusion: Study findings offer insight for college mental health programming regarding family stressors, especially as related to moving back home with family.

Background: Loneliness is a significant issue among older Asian Americans, exacerbated by the COVID-19 pandemic. Older age, lower income, limited education, and immigrant status heighten loneliness risk. Information communication technologies (ICTs) have been associated with decreased loneliness among older adults. However, older Asian Americans are less likely to use ICTs, particularly if they are immigrants, have limited English proficiency, or are low income. The Technology Acceptance Model posits that perceived usefulness (PU), and perceived ease of use (PEOU) are key factors in predicting technology use., Objective: This study aimed to examine associations between PU, PEOU, ICT use, and loneliness among low-income, older Asian Americans., Methods: Cross-sectional survey data were gathered from predominately older Asian Americans in affordable senior housing (N=401). Using exploratory factor analysis and Horn parallel analysis, we examined 12 survey items to identify factors accounting for variance in ICT use. We deployed structural equation modeling to explore relationships among the latent factors and loneliness, adjusting for demographic and cognitive factors., Results: Exploratory factor analysis and Horn parallel analysis revealed 3 factors that accounted for 56.48% (6.78/12) total variance. PEOU combined items from validated subscales of tech anxiety and comfort, accounting for a 28.44% (3.41/12) variance. ICT use combined years of technological experience, computer, tablet, and smartphone use frequency, accounting for 15.59% (1.87/12) variance. PU combined 2 items assessing the usefulness of technology for social connection and learning and accounted for a 12.44% (1.49/12) variance. The 3-factor structural equation modeling revealed reasonable fit indexes (χ 2 =345.132; P<.001, chi-square minimum (CMIN)/df = 2595, comparative fit index (CFI)=0.93, Tucker-Lewis Index (TLI)=0.88). PEOU was positively associated with PU (β=.15; P=.01); PEOU and PU were positive predictors of ICT use (PEOU β=.26, P<.001; PU β=.18, P=.01); and ICT use was negatively associated with loneliness (β=-.28, P<.001). Demographic and health covariates also significantly influenced PU, PEOU, ICT use, and loneliness. English proficiency and education positively predicted PEOU (r=0.25, P<.001; r=0.26, P<.001) and ICT use (β=1.66, P=.03; β=.21, P<.001), while subjective cognitive decline and Asian ethnicity were positively associated with loneliness (β=.31, P<.001; β=.25, P<.001).133 =345.132; P<.001, chi-square minimum (CMIN)/df = 2595, comparative fit index (CFI)=0.93, Tucker-Lewis Index (TLI)=0.88). PEOU was positively associated with PU (β=.15; P=.01); PEOU and PU were positive predictors of ICT use (PEOU β=.26, P<.001; PU β=.18, P=.01); and ICT use was negatively associated with loneliness (β=-.28, P<.001). Demographic and health covariates also significantly influenced PU, PEOU, ICT use, and loneliness. English proficiency and education positively predicted PEOU (r=0.25, P<.001; r=0.26, P<.001) and ICT use (β=1.66, P=.03; β=.21, P<.001), while subjective cognitive decline and Asian ethnicity were positively associated with loneliness (β=.31, P<.001; β=.25, P<.001)., Conclusions: This study suggests that targeted interventions enhancing PU or PEOU could increase ICT acceptance and reduce loneliness among low-income Asian Americans. Findings also underscore the importance of considering limited English proficiency and subjective cognitive decline when designing interventions and in future research., (©Pauline DeLange Martinez, Daniel Tancredi, Misha Pavel, Lorena Garcia, Heather M Young. Originally published in JMIR Aging (https://aging.jmir.org), 08.01.2025.)

Background: Cardiovascular disease (CVD) prevalence varies widely among Asian American adults. The American Heart Association added healthy sleep to its metrics to define ideal cardiovascular health. Little is known about the association between sleep and CVD prevalence among Asian subgroups. We aim to examine the association between suboptimal sleep duration and CVD risk prevalence among Asian American subgroups., Methods and Results: We used 2012 to 2018 National Health Interview Survey data to examine the association between suboptimal sleep duration and CVD prevalence. We included 6868 self-identifying Asian adults age >40 years (Asian Indian [n=1053], Chinese [n=1415], Filipino [n=1734], and Other Asian [n=2666] adults). Suboptimal sleep was defined as <7 or >9 hours per night. CVD was defined as self-reported stroke, heart attack, coronary artery disease, or angina. Logistic regression was used to calculate odds ratios and 95% CI to estimate the association between suboptimal sleep duration and CVD prevalence. Filipino and Other Asian participants with suboptimal sleep had the highest prevalence of CVD. Aggregated Asian American participants with suboptimal sleep duration had a higher prevalence of CVD (odds ratio [95% CI, 1.35 [1.09-1.68]) compared with those with optimal sleep duration. After stratification by race or ethnicity or both, a significant association persisted for Other Asian participants (1.77 [95% CI, 1.27-2.46]) but not among all other Asian American subgroups., Conclusions: Our study highlights the heterogeneity of CVD prevalence associated with suboptimal sleep duration among Asian American adults. Future studies should consider how different measures of sleep duration and quality affect CVD outcomes among disaggregated Asian American subgroups.

Introduction: Asian American, Native Hawaiian, and Pacific Islander (AANHPI) people represent one of the largest and most rapidly growing groups in the United States and are often aggregated as a homogeneous, rather than diverse, population in medical research and education. Currently, few educational interventions focus on the disaggregation of AANHPI patient populations and the improvement of knowledge about health disparities that affect AANHPI patients., Methods: We developed, implemented, and facilitated a workshop for medical students to address AANHPI health disparities, adaptable for in-person and online formats. The 1-hour session involved a preworkshop evaluation; a PowerPoint presentation outlining the history of the Asian monolith bias, health disparities within AANHPI subgroups, and strategies for health care professionals and trainees to engage effectively with these communities; and a postworkshop evaluation. Pre- and postworkshop evaluations assessed participants' confidence and understanding of AANHPI health disparities. Additionally, the postworkshop evaluation gathered feedback on the presentation., Results: Pre- and postworkshop evaluations revealed that this workshop, attended by 42 diverse participants over two sessions, significantly improved participants' understanding of the Asian monolith bias and AANHPI health care disparities ( p < .05). Whether attending virtually or in person, participants reported notable improvements in their self-evaluated confidence in treating AANHPI patients., Conclusion: The AANHPI patient population comprises a myriad of different cultures, historical contexts, and health needs. We present an educational module that is associated with significant improvement of knowledge about health disparities specific to this population, informing further efforts in cultural competence within medical education., (© 2025 Luthria et al.)

Purpose: To analyze drug overdose mortality trends among Asian American and Native Hawaiian/Pacific Islander (AANHPI) populations., Methods: We obtained data on drug overdose deaths and population totals from CDC WONDER and the American Community Survey (2018-2022). Crude mortality rates per 100,000 were calculated overall and by sex, U.S. Census Division, and drug type. Disaggregated analyses included six Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and three NHPI subgroups (Native Hawaiian, Guamanian, and Samoan)., Results: In 2022, Asian Americans had 1226 drug overdose deaths and NHPI individuals had 154. The mortality rate for NHPI individuals (17.52 [95 % CI: 14.76-20.29] per 100,000) tripled that of Asian Americans (5.85 [95 % CI: 5.52-6.18] per 100,000). Fentanyl was the leading drug-related death among Asian Americans (3.17 [95 % CI: 2.93-3.41] per 100,000), while methamphetamine led for NHPI individuals (11.38 [95 % CI: 9.15-13.61] per 100,000). Disaggregated mortality rates were highest for Korean Americans (9.06 [95 % CI: 8.88-9.24] per 100,000) and Guamanians (43.16 [95 % CI: 39.05-48.24] per 100,000) among the Asian American and NHPI subgroups, respectively., Conclusions: AANHPI populations experience distinct overdose mortality patterns, with NHPI individuals and specific ethnic subgroups disproportionately affected, warranting targeted public health interventions., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Prior research shows that perceived racism was associated with higher risks of suicidal ideation among US Asians. Nevertheless, the relationship between internalized racism and the suicidal risks of US Asians has not been adequately researched. In addition, as an important social institution, religion has been left out of the studies of racism and suicide for US Asians. This study is aimed at filling in these gaps and contributing to a better understanding of internalized racism, religion, and the mental health of US Asians., Design: This study surveyed 970 Asian or Asian American adults living in the United States. Survey participants were recruited using Qualtrics online panel samples between April and June 2024. Quotas were set for key demographic variables, such as sex and ethnicity, following the national census., Results: The main results suggest that even after controlling important mental health measures such as anxiety and loneliness, higher internalized racism was still tied to higher risks of suicidal ideation. The effect of internalized racism was not only robust but also stronger than other mental health measures as well as perceived external racism. Finally, the deleterious internalized racism effect on suicidal ideation was stronger among US Asians, who attend religious services more often., Conclusion: Internalized racism exerts a fairly strong and robust effect on suicidal ideation among US Asians. This deleterious effect is also interactive with the religious characteristics of US Asians. Healthcare providers, community workers, and religious leaders may want to take internalized racism into consideration in their future service to the US Asian community.

This qualitative study explored how Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) responded to anti-Asian racism during COVID-19. Participants (n = 459; M age  = 26.4 years; 77.8% female) completed a survey and responded to the open-ended question: "How have you responded to anti-Asian racism since the beginning of the COVID-19 pandemic?" Reflective thematic analysis was utilized to code responses. Three themes were identified, indicating that AANHPIs engaged in knowledge sharing and cultural exploration; experienced emotional reactions that galvanized efforts to take care of themselves, friends, family, and their community; and engaged in advocacy and activism to advance social justice. Subthemes were also identified to further characterize responses. Results reflect how AANHPI communities responded to anti-Asian racism by leveraging cultural strengths and taking the initiative to create social change. These findings have individual-, organizational-, and community-level implications to mitigate the impacts of anti-Asian racism and promote the well-being of AANHPI communities., (© 2024 The Author(s). Journal of Community Psychology published by Wiley Periodicals LLC.)

The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other's persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

Objective: This study examined how individual (satisfaction of basic psychological needs), relational (perceived achievement- and dependency-oriented parental psychological control), and cultural (ethnic identity) factors may contribute to Asian American college students' (18 - 25 years of age) disordered eating. Participants: Asian American college students ( N  = 118) participated in the study. Methods: Participants completed a cross-sectional survey study. Moderated mediation models were used to analyze the data. Results: Analyses showed that perceived achievement-oriented, but not dependency-oriented, parental psychological control was more strongly associated with psychological needs satisfaction at higher, compared to lower, levels of ethnic identity. Conclusions: Findings highlighted the importance of both parenting and ethnic identity among Asian American college students' psychological needs and risk for disordered eating. The complex relations among achievement expectations, ethnic identity and wellbeing in Asian Americans are discussed. The results can inform intervention and prevention programs attending to the needs of this population.

Background: Discrimination faced by Asian American trainees in medical school include those reported by female trainees. This study aims to characterize the microaggressions faced by Asian American woman medical students., Methods: We use a mixed methods approach to characterize the experiences of Asian Americans in United States (US) medical schools through an anonymous online survey and participation in focus groups., Results: Among our 305 participants, 65.9 ​% were women. More women experienced microaggressions than men (p ​< ​0.001). Compared to men, women reported significantly higher rates of supervisors having higher expectations of them, implying they were submissive, and describing them as too quiet. Women felt that their experiences with microaggressions were entangled with being Asian and a woman, but could not distinguish which identity was being targeted., Conclusion: The intersectionality of being Asian American and a woman in medical training has not been explored. We found that this duality intensified experiences of microaggressions., Competing Interests: Declaration of competing interest All authors have no financial interests related to this study to disclose., (Published by Elsevier Inc.)

Background: Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities by influencing patient-provider communication and utilization of healthcare services., Objective: This study aimed to investigate how Asian American subgroups differ in their perception of everyday racism, internalized racism, and perceived racism in healthcare settings and whether these perceptions predict their interactions with their health care providers and their utilization of healthcare services., Methods: An online survey study was conducted. ANOVA tests were employed to compare the differences in perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system among Filipino ( N  = 310), Japanese ( N  = 242), Chinese ( N  = 287), Asian Indian ( N  = 304), Korean ( N  = 199) and Vietnamese ( N  = 151) participants. Multiple regression analyses assessed whether perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system predicted healthcare service utilization and patient-provider communication among the Asian subgroups sampled., Results: There were significant group differences in perceived everyday racism ( F  = 8.56, p  < .001), internalized racism ( F  = 3.46, p  < .01), perceived racism in healthcare ( F  = 4.57, p  < .001). Perceptions of racism and socioeconomic variables were found to predict patient-provider communication and utilization of healthcare services disparately across various Asian subgroups. For instance, the perception of everyday racism was a significant predictor of patient-provider communication for each of the subgroups, excluding the Vietnamese participants. Internalized racism was a significant predictor only for Filipino and Chinese participants. Surprisingly, perceived racism in healthcare was not a predictor for any of the subgroups., Conclusion: Findings highlight the complex interplay of sociodemographic factors and perceived racism in shaping patient-provider communication and healthcare service utilization within the Asian American community. Implications are suggested for addressing the unique challenges faced by different Asian American subgroups and for promoting equitable healthcare access and fostering positive patient-provider relationships among the Asian American subgroups.

Uptake of COVID-19 vaccine booster doses is an important public health topic of study to prevent morbidity and mortality in underserved U.S. populations. However, limited research exists on COVID-19 vaccine booster use and willingness - including its associated factors - among Asian Americans (AA): the fastest growing racial group in the U.S. This study collected survey data from 447 AA adults from three large AA subgroups: Chinese, Korean, and Filipino. Data were collected as part of a community-driven county-wide needs assessment conducted in collaboration with AA community organizations in Riverside County, California. Data indicated that nearly 24% of AA participants received at least four doses of the COVID-19 vaccine, with 36% expressing definite willingness to receive future booster doses. Participants reported experiencing an average of 1.6 instances of racial discrimination across their lifetime. Ordered logistic regression and marginal effects analysis revealed ethnicity, education, racial discrimination, preexisting health conditions, and the number of prior COVID-19 vaccine doses received significantly predicted willingness to receive future vaccine doses. The study suggests that key social factors such as racial discrimination may play an important role in influencing public health efforts to promote vaccine uptake in diverse Asian American populations.

Background: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non-US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults., Objective: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults., Methods: This cross-sectional survey included Asian American individuals aged ≥62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline., Results: Self-rated health was not significantly associated with ICT use (β=.087; P=.13), PU (β=.106; P=.10), or PEOU (β=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use (ΔR 2 =0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ≥85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant., Conclusions: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population., (©Pauline DeLange Martinez, Daniel Tancredi, Misha Pavel, Lorena Garcia, Heather M Young. Originally published in JMIR Formative Research (https://formative.jmir.org), 03.12.2024.)

There is a dearth of research understanding the sexual health of Asian American adolescents, and even more so for those who identify as sexual minorities (lesbian, gay, bisexual, queer, asexual, and other sexual orientations). This study is a secondary qualitative analysis focused on young adults' recollections of their formal and informal sex education experiences in childhood and adolescence using a sub-sample of in-depth interviews from students who self-identified as both Asian and sexual minorities living in the USA ( n  = 9). Results were organised into three sections: (1) latent cultural factors (e.g. stigma surrounding sex, self-sufficiency, filial piety); (2) the downstream effects of latent cultural factors (e.g. sex-related discussions, rules disallowing dating, role of lateral family members); and (3) the impact of deficient familial sex-related discussions (e.g. Internet, resentment). Study findings underscore the links between identity concealment and relationship concealment that are unique to Asian sexual minority individuals. We suggest that interventions involving Asian American US youth and their families should be culturally informed and promote cross-generational sex-related discussion. Future research should further explore the role of chosen family and non-parental family members as a point of intervention as they can be helpful sources of informal sex education.

Background: Studies show that the use of information and communications technologies (ICTs), including smartphones, tablets, computers, and the internet, varies by demographic factors such as age, gender, and educational attainment. However, the connections between ICT use and factors such as ethnicity and English proficiency, especially among Asian American older adults, remain less explored. The technology acceptance model (TAM) suggests that 2 key attitudinal factors, perceived usefulness (PU) and perceived ease of use (PEOU), influence technology acceptance. While the TAM has been adapted for older adults in China, Taiwan, Singapore, and Korea, it has not been tested among Asian American older adults, a population that is heterogeneous and experiences language barriers in the United States., Objective: This study aims to examine the relationships among demographics (age, gender, educational attainment, ethnicity, and English proficiency), PU, PEOU, and ICT use among low-income Asian American older adults. Two outcomes were examined: smartphone use and ICT use, each measured by years of experience and current frequency of use., Methods: This was a secondary data analysis from a cross-sectional baseline survey of the Lighthouse Project, which provided free broadband, ICT devices, and digital literacy training to residents living in 8 affordable senior housing communities across California. This analysis focused on Asian participants aged ≥62 years (N=392), specifically those of Korean, Chinese, Vietnamese, Filipino, and other Asian ethnicities (eg, Hmong and Japanese). Hypotheses were examined using descriptive statistics, correlation analysis, and hierarchical regression analysis., Results: Younger age, higher education, and greater English proficiency were positively associated with smartphone use (age: β=-.202; P<.001; education: β=.210; P<.001; and English proficiency: β=.124; P=.048) and ICT use (age: β=-.157; P=.002; education: β=.215; P<.001; and English proficiency: β=.152; P=.01). Male gender was positively associated with PEOU (β=.111; P=.047) but not with PU (β=-.031; P=.59), smartphone use (β=.023; P=.67), or ICT use (β=.078; P=.16). Ethnicity was a significant predictor of PU (F 4,333 =5.046; P<.001), PEOU (F 4,345 =4.299; P=.002), and ICT use (F 4,350 =3.177; P=.01), with Chinese participants reporting higher levels than Korean participants, who were the reference group (β=.143; P=.007). PU and PEOU were positively correlated with each other (r=0.139, 95% CI=0.037-0.237; P=.007), and both were significant predictors of smartphone use (PU: β=.158; P=.002 and PEOU: β=.166; P=.002) and ICT use (PU: β=.117; P=.02 and PEOU: β=0.22; P<.001), even when controlling for demographic variables., Conclusions: The findings support the use of the TAM among low-income Asian American older adults. In addition, ethnicity and English proficiency are significant predictors of smartphone and ICT use among this population. Future interventions should consider heterogeneity and language barriers of this population to increase technology acceptance and use., (©Pauline DeLange Martinez, Daniel Tancredi, Misha Pavel, Lorena Garcia, Heather M Young. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.11.2024.)

Objectives: Mental health remains an unmet need among Chinese Americans. This study aims to identify specific needs and strategies that may address the needs., Design: A total of 55 Chinese Americans consented and participated in online focus groups conducted in either Chinese or English using nominal group technique. Participants discussed the following questions, achieved themes, and provided ranking of themes in importance for each: (1) In general, what do people in the Chinese American community think about mental health or emotional well-being? (2) What have you found to be helpful for accessing mental health or emotional well-being services or care in the Chinese American population? And (3) What actions would you suggest to improve mental health and emotional well-being in the Chinese American population?, Results: Across the focus groups, we observed high consistency of top ranked themes including lack of knowledge and awareness, negative impression, lack of Chinese-speaking providers, and that the most helpful factor toward access to care was education and increased awareness. Seminars and trainings was the top actionable suggestion., Conclusion: The findings are consistent with previous findings and continue to show that Chinese Americans need more education and training and that providers who can speak the language and understand the culture would be very helpful to increase access to care. This study emphasizes addressing mental health disparities in the Chinese American community through awareness, tailored interventions, and barrier removal. Promoting equal access also underscores the need for ongoing assessment and responsive strategies.

Tobacco product use rates among Native Hawaiian/Pacific Islander (NHPI), Asian American, and Filipino American young adults in Hawai'i have risen rapidly in recent years following the introduction of electronic nicotine delivery systems. Though some research has examined tobacco use correlates for these demographics of young adults, research examining protective factors, such as cultural connectedness, is lacking. Additionally, research that disaggregates Asian Americans from Pacific Islanders is scarce, despite the differing risk and protective factors that have been determined for each group. This study separately examined cultural connectedness among NHPIs, Asian Americans, and Filipino Americans to help fill the gaps in the current tobacco product literature. The findings indicated that Asian Americans and Filipino Americans who identify more with their own cultures are less likely to use e-cigarettes; however, this relationship was not supported for NHPIs. No significant evidence was found to indicate a relationship between cultural connectedness and combustible cigarette use among any of the sampled groups. The lack of relationship between cultural connectedness and e-cigarette use among Native Hawaiians may be explained by measurement limitations in the study, and suggest the need for more culturally competent scales (e.g., an enculturation scale) that account for Indigenous status.

Background: Despite decades of advocacy for disaggregated data collection and reporting for Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) people, significant gaps remain in our ability to understand AA and NHPI individuals' access to care. We assess inequities in access to care measures between non-Hispanic White and AA and NHPI adult Medicaid enrollees., Methods: We used the 2014-15 Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems, the first-and-only nationally representative sample of Medicaid enrollees. Our main outcomes were access to needed care, access to a personal doctor, timely access to a checkup, and timely access to specialty care. Using multivariable linear probability models, we assessed the relationship between racial/ethnic group and our outcomes, both in the aggregate and disaggregated into ten racial/ethnic groups, and adjusted for enrollee-level sociodemographic characteristics, health status, and state-level Medicaid expansion status., Results: In aggregate, AA and NHPI enrollees reported worse access to care than White enrollees on all four metrics (p < 0.001). The magnitude of disparities varied across the ten AA and NHPI ethnic groups. Disparities relative to White enrollees were particularly large in magnitude, roughly 1.5 to 2 times greater, for Chinese, Korean, and Vietnamese enrollees than for the aggregated AA and NHPI group., Conclusions: Despite comparable insurance coverage, there were inequities in multiple access to care metrics between non-Hispanic White and AA and NHPI Medicaid enrollees. Collection of disaggregated health data on AA and NHPI patients reveals important variation in access to care by ethnic group., (© 2023. W. Montague Cobb-NMA Health Institute.)

Data from Asian Americans (AsA) are commonly aggregated in research studies and reporting, obscuring the significant differences across AsA subgroups. We investigated the differential experience of AsA subgroups in COVID-19 testing, vaccination, engagement in risky and protective behaviors and mental health status against this infectious disease. We surveyed a representative sample of the Los Angeles County population (N = 5500) in April 2021 as part of the Los Angeles Pandemic Surveillance Cohort Study and focused on participants who self-identified as AsA (N = 756). There were significant differences across the AsA subgroups, with Koreans, Asian Indians, and Other Asians living in areas with higher COVID-19 mortality rates, and Asian Indians demonstrating the lowest proportion of COVID-19 vaccination. Vietnamese and Koreans had a higher proportion of becoming unemployed during the pandemic. Although the AsA sample on average demonstrated better outcomes than other racial and ethnic groups, the apparent advantages were heterogenous and due to specific subgroups of AsAs rather than AsAs as a whole. The observed differences in COVID-19 measures across AsA subgroups underscore the need to disaggregate AsA data to identify and reduce existing disparities., (© 2023. The Author(s).)

Friendship racial homophily, the tendency to form friendships with individuals who share the same racial background, is a normative developmental phenomenon that holds particular significance for youth of color in a racialized society. Yet, there exists a paucity of longitudinal research elucidating the stability and change of friendship racial composition across developmental span. This study aimed to examine the friendship racial homophily trajectories over a six-year period encompassing four time points. The sample comprised 437 Asian American youth (M Age  = 16.52, SD Age  = 1.36, 53% female), with 197 Filipino and 240 Korean participants. Using logistic multilevel modeling analyses, it was found that both Filipino and Korean American youth demonstrated an increase in friendship racial homophily from high school to college, but that Filipino youth overall reported lower levels of racial homophily compared to their Korean counterparts. The study findings also pinpointed several influential factors impacting these trajectories, including proficiency in heritage languages, ethnic identity, and encounters with racial discrimination from both White Americans and other People of Color. These results highlight the continuous evolution of friendship racial composition from high school to college and emphasize the crucial role of ethnic identity and experiences of discrimination in influencing these dynamics, with ethnic identity exerting more enduring effects and experiences of discrimination showing more situational impacts on the levels of racial homophily., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objectives: Studies on ovarian cancer (OC) diagnosis, treatment and survival across disaggregated Asian sub-ethnic groups are sparse. Few studies have also conducted trend analyses of these outcomes within and across Asian groups., Methods: Using logistic, Cox, and Joinpoint regression analyses of the 2000-2018 Surveillance, Epidemiology, and End Results (SEER) data, we examined disparities and trends in OC advanced stage diagnosis, receipt of treatments and the 5-year cause-specific survival across seven Asian sub-ethnic groups., Results: There were 6491 OC patients across seven Asian sub-ethnic groups (mean [SD] age, 57.29 [13.90] years). There were 1583(24.39%) Filipino, 1183(18.23%) Chinese, and 761(11.72%) Asian Indian or Pakistani (AIP) patients. The majority (52.49%) were diagnosed with OC with at an advanced stage. AIP were more likely to have advanced stage diagnosis than other subgroups (ORs, 95%CIs: 0.77, 0.62-0.96 [Filipino]; 0.76, 0.60-0.95 [Chinese]; 0.71, 0.54-0.94 [Japanese]; 0.74, 0.56-0.98 [Vietnamese] and 0.66, 0.53-0.83 [Other Asians]). The Filipinos were least likely to receive surgery but most likely to undergo chemotherapy. Japanese patients had the worst 5-year OC cause-specific survival (50.29%, 95%CI: 46.20%-54.74%). Based on the aggregated analyses, there was a significantly decreased trend in advanced-stage diagnosis and an increased trend in receipt of chemotherapy. Trends in OC outcomes for several subethnicities differed from those observed in aggregated analyses., Conclusion: In this cohort study of 6491 patients, OC diagnosis, treatment, survival, and trends differed across Asian American ethnic subgroups. Such differences must be considered in future research and interventions to ensure all Asian American subethnicities equally benefit from the advancements in OC care and control.

While Asian Americans experience disparate access to health services, little is known about the extent to which providers discriminate against Asian American patients. Further, research on Asian American health disparities tends to group Asian American ethnicities together, overlooking potential within-group differences. We deployed a field experiment to assess whether Asian American ethnic sub-groups experience discrimination in appointment scheduling. We further explored the impact of racial concordance between Asian patients and physicians. Overall, we did not detect significant differences in appointment offer rates between White and Asian American patients. However, we found that Asian Americans experienced longer wait times driven primarily by the treatment of patients of Chinese and Korean descent. Physician offices, surprisingly, offered concordant Asian patients appointments at significantly lower rates. The disparities Asian Americans experience relative to White Americans through longer waits for primary care appointments are not consistent across sub-groups. Increased attention to the unique experiences of people of Asian descent in accessing health services is warranted., (© 2023. W. Montague Cobb-NMA Health Institute.)

Using data from Vietnamese-origin older immigrants/refugees in the Houston, Texas area, we assessed their overall health, chronic conditions, disability, depressive symptoms, and cognitive impairment, and examined the association between their chronic conditions and disability by comorbidity clusters. The mean age of the sample was 76 years old. The majority were married in fair/poor health with several chronic conditions and disabilities and lived with families in low-income households. Hypertension and arthritis were the most common health conditions, but cognitive impairment had the most significant impact on their disability. They experienced similar health conditions to other older Americans but had higher rates of depressive symptoms and cognitive impairment possibly due to cultural factors that may have delayed mental health treatment. Culturally and linguistically tailored services created by policymakers, healthcare professionals, and local social service agencies are recommended for the well-being of immigrants/refugees who migrated to the U.S. for a better life., (© 2023. W. Montague Cobb-NMA Health Institute.)

To supply proper and sufficient information and coaching through cancer education, it is important to decide who are risk groups among a target population. A decision tree analysis could help decide the characteristics of the risk groups. This study aimed to identify the combined characteristics of Asian American breast cancer survivors that were closely linked to high needs for help during their breast cancer survivorship process. The data on the needs for help among 185 Asian American breast cancer survivors from a parent clinical trial were included in this analysis. The instruments included the Supportive Care Needs Survey-Short Form 34 (SCNS-SF34) and multiple scales to measure the factors influencing the women's needs for help. The data were analyzed using latent profile analyses and decision tree analyses. The characteristics of the group with the highest needs for help were different depending on the types of needs. For instance, the group with the highest patient care/support needs for help score had high global symptom distress scores (cut point = 2.25) and high physical symptom distress (cut point = 1.57) and did not have regular access to health care (mean = 95.00; node 10). The findings suggest several risk groups to target in future interventions for cancer education to reduce the needs for help among this specific population. Multiple factors that could influence the needs for help among Asian American breast cancer survivors need to be considered in future intervention development for cancer education., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

The health of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) is uniquely impacted by structural and social determinants of health (SSDH) shaped by immigration policies and colonization practices, patterns of settlement, and racism. These SSDH also create vast heterogeneity in disease risks across the AANHPI population, with some ethnic groups having high disease burden, often masked with aggregated data. Longitudinal cohort studies are an invaluable tool to identify risk factors of disease, and epidemiologic cohort studies among AANHPI populations have led to seminal discoveries of disease risk factors. This review summarizes the limited but growing literature, with a focus on SSDH factors, from seven longitudinal cohort studies with substantial AANHPI samples. We also discuss key information gaps and recommendations for the next generation of AANHPI cohorts, including oversampling AANHPI ethnic groups; measuring and innovating on measurements of SSDH; emphasizing the involvement of scholars from diverse disciplines; and, most critically, engaging community members to ensure relevancy for public health, policy, and clinical impact.

The monolithic misrepresentation of Asian American (AsAm) populations has maintained assumptions that AsAm people are not burdened by health disparities and social and economic inequities. However, the story is more nuanced. We critically review AsAm health research to present knowledge of AsAm health profiles from the past two decades and present findings and opportunities across three topical domains: ( a ) general descriptive knowledge, ( b ) factors affecting health care uptake, and ( c ) effective interventions. Much of the literature emphasized underutilization of health care services; low knowledge and awareness among AsAms about health-related risk factors, prevention, diagnosis, and treatment; inadequate efforts by health systems to improve language access, provider-patient communication, and trust; and the critical roles of community- and faith-based organizations and leaders in health promotion initiatives. Future opportunities for AsAm health research will require adoption of and significant investment in community-engaged research infrastructure to increase representation, funding, and research innovation for AsAm communities.

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., (©Jacqueline H J Kim, Marjorie Kagawa Singer, Lisa Bang, Amy Ko, Becky Nguyen, Sandy Chen Stokes, Qian Lu, Annette L Stanton. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 22.04.2024.)

Objective: Language brokering (LB) is an act of interpreting and translating that immigrants often engage in to help their family members who may not be fluent in the English language. The study examined whether adhering to Asian American values (ie, values enculturation) could moderate the association between LB and internalizing symptoms (eg, depression, anxiety) among Asian American college students. Participants & Methods: An online survey was administered to a sample of 159 Asian American college students who had engaged in LB. Results: Results from the moderation analysis indicated that Asian American values enculturation significantly buffered against the adverse effects of high LB frequency on internalizing symptoms after controlling for gender and generation status. Conclusions: The current study offered insights into the toll that LB could take on Asian American college students' mental health as well as the potential protective roles of values enculturation.

Background: Stomach cancer incidence presents significant racial/ethnic disparities among racial/ethnic minority groups in the United States, particularly among Asian and Hispanic immigrant populations. However, population-based evaluation of disparities by nativity has been scarce because of the lack of nativity-specific population denominators, especially for disaggregated Asian subgroups. Population-based stomach cancer incidence and tumor characteristics by detailed race/ethnicity and nativity were examined., Methods: Annual age-adjusted incidence rates were calculated by race/ethnicity, sex, and nativity and tumor characteristics, such as stage and anatomic subsite, were evaluated using the 2011-2015 California Cancer Registry data. For Hispanic and Asian populations, nativity-specific population counts were estimated using the US Census and the American Community Survey Public Use Microdata Sample data., Results: During 2011-2015 in California, 14,198 patients were diagnosed with stomach cancer. Annual age-adjusted incidence rates were higher among foreign-born individuals than their US-born counterparts. The difference was modest among Hispanics (∼1.3-fold) but larger (∼2- to 3-fold) among Chinese, Japanese, and Korean Americans. The highest incidence was observed for foreign-born Korean and Japanese Americans (33 and 33 per 100,000 for men; 15 and 12 per 100,000 for women, respectively). The proportion of localized stage disease was highest among foreign-born Korean Americans (44%); a similar proportion was observed among US-born Korean Americans, although numbers were limited. For other Asians and Hispanics, the localized stage proportion was generally lower among foreign-born than US-born individuals and lowest among foreign-born Japanese Americans (23%)., Conclusions: Nativity-specific investigation with disaggregated racial/ethnic groups identified substantial stomach cancer disparities among foreign-born immigrant populations., (© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

The literature unequivocally demonstrates that lesbian, gay, and bisexual (LGB) individuals experience disproportionate mental health and social wellbeing impacts. Here, we respond to recent calls for research in the field of sexual minority health to better understand why various overlapping and intersecting identities can further drive health disparities. In this paper, we focus on the specific intersections of ethnicity and sexuality for Asian LGB individuals and the role of internalized stigma in driving poorer mental health outcomes for this group. We recruited 148 LGB Asian participants residing in the United States ( M age = 22.82 years, SD = 4.88) to participate in our online cross-sectional survey in which we collected data on their internalized stigma, levels of guilt and shame about their sexuality, and measures of depression, anxiety, and distress. Contrary to our predictions, there were no bivariate relationships between internalized sexual stigma and any of the mental health outcomes. However, a parallel mediation analysis revealed that guilt, but not shame, mediates the relationship between internalized sexual stigma and all mental health outcomes (depression, anxiety, and stress) for LGB Asian American individuals. This research highlights the important of exploring additional variables that may exacerbate of protect against poor mental health for individuals with multiple intersecting identities.

Objectives: The objectives of this study were to examine the associations between acculturation and dental floss, regular dental visits and unmet dental care needs among Asian Americans, as well as the moderating effects of these associations., Methods: This study analysed national representative samples from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. A total of 2763 Asian Americans aged 20 and older were included in this analysis. The primary predictor, acculturation score, was determined by three questions: (i) language spoken at home (higher score for English), (ii) country of birth (higher score for United States) and (iii) length of time in the United States. Dental floss use, dental visits and unmet dental care needs were included as outcomes in this study. Descriptive statistics and logistic regressions were used to analyse the samples., Results: Acculturation was significantly associated with dental health behaviours: Individuals with higher levels of acculturation were more likely than less acculturated individuals to use dental floss (81.0% vs. 63.9%, respectively) and visit the dentist regularly (76.7% vs. 66.9% respectively). Insurance status moderated the association between acculturation and dental visits: Acculturation was significantly associated with dental visits in the past year among insured individuals (OR = 1.70, 95% CI: 1.29-2.23), but not among uninsured individuals. Unmet dental care needs were present in 11.1% of participants. While costs and insurance were the top two determinants of access to care, individuals with and without insurance differed with regard to their third major reason for unmet dental care needs: Being 'too busy' and not wanting to spend money on dental care., Conclusions: Among the Asian population in the United States, those with high acculturation scores were more likely to engage in dental flossing and visit the dentist regularly compared to those Asians with lower acculturation scores. To encourage dental flossing and regular dental visits among Asians with lower acculturation scores, cultural adaptation and language accessibility suggests being considered. Future research is necessary to confirm the moderating effect of insurance status on the association between acculturation and regular dental visits. Additionally, our findings emphasize the impact of costs and insurance on access to dental care among Asians in the United States, highlighting the importance of future public health programmes in addressing these barriers., (© 2023 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Objectives: This study characterized variation in e-cigarette use patterns and related protective factors by ethnicity among Asian American adolescents., Methods: Multivariable logistic regressions modelled associations between ethnic group, 6 protective factors (college aspirations, internal developmental assets, positive teacher engagement, family caring, and peer and parent anti-smoking norms), and past 30-day e-cigarette use, adjusting for covariates among 10,482 8th, 9th, and 11th grade Asian American respondents to the 2019 Minnesota Student Survey. Interaction terms (protective factor × ethnic group) were used in 6 subsequent regression models to examine whether the association between each protective factor and e-cigarette use differed as a function of ethnic group., Results: Respondents included 9.0% Indian, 0.3% Burmese, 7.9% Chinese, 2.5% Filipino, 25.0% Hmong, 3.2% Karen, 4.6% Korean, 2.7% Laotian, 8.2% Vietnamese, 7.5% other, 7.5% multi-ethnic, and 21.6% multi-racial adolescents. E-cigarettes were the predominant form of tobacco use. Laotian and multi-racial groups reported the highest e-cigarette use (16.6% and 16.3%), whereas Chinese and Asian Indians reported the lowest (4.7% and 5.0%). Strong peer anti-smoking norms, higher internal developmental assets scores, and positive teacher engagement were associated with lower odds of e-cigarette use across groups, with significant interactions for internal developmental assets by ethnicity., Conclusions: E-cigarettes are the most prevalent tobacco product used by Asian adolescents in Minnesota, with notable heterogeneity by ethnicity. While most established protective factors appeared to function similarly for Asian adolescents, others differed, underscoring the importance of disaggregating data by ethnicity to inform the tailoring of prevention and control strategies for these ethnic groups., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Throughout U.S. history, Asian Americans engaged in various forms of collective action to challenge systems of oppression. Despite this, few studies challenge the stereotype that Asian Americans are apolitical and uninterested in collective action and focus on psychological correlates of Asian Americans' collective action. Collective action may be motivated by critical reflection on racism and inequality, which may induce shifts in racial identity ideological values that lead Asian Americans to align with minoritized groups. The current study examines whether Asian American racial identity ideological values-specifically, Asian American Unity, Interracial Solidarity, and Transnational Critical Consciousness-help explain why critical reflection is linked to collective action among Asian Americans. Multiple mediation analyses suggested that, among Asian American college students in the Southwest United States (N = 272), beliefs about Interracial Solidarity and Asian American Unity mediated the relationship between critical reflection (i.e., Critical Reflection on Racism and Perceived Inequality) and collective action (i.e., Support for Black Lives Matter and Sociopolitical Participation). Transnational Critical Consciousness did not mediate the relationship between critical reflection and collective action. This study highlights how Asian American unity and interracial solidarity beliefs underlie Asian Americans' critical reflection and collective action., (© 2023 Society for Community Research and Action.)

Anti-Asian discrimination incidents in the USA have resurged during the COVID-19 pandemic. It is unclear how concern about being discriminatorily treated due to the COVID-19 pandemic varies between Asian and Asian American (A&AsA) and White adults. We examined A&AsA vs. White differences in concern about COVID-19 discrimination and associations of this concern with changes in cigarette smoking behaviors before and during the pandemic. Data were from a US representative sample of A&AsA and White adults (≥ 21 years) who currently and formerly used commercial tobacco (n = 1052), collected through an online panel oversampling A&AsA adults in January-February 2021. Participants reported their concern, worry, and stress about COVID-19 discrimination and past-30-day cigarette consumption before and during the pandemic. We examined the association between race and overall concern about COVID-19 discrimination, and this concern's associations with changes in past-30-day cigarette smoking consumption, smoking continuation, and return to smoking using weighted multivariable logistic and linear regression models. Overall concern about COVID-19 discrimination was higher (adjusted mean = 1.7, standard error = 0.16) among A&AsA adults who currently and formerly used commercial tobacco than their White counterparts (adjusted mean = 0.60, standard error = 0.04; p < 0.01). Overall concern about COVID-19 discrimination was associated with increased past-30-day cigarette consumption by 26.5 cigarettes (95% confidence interval [CI] = 1.2-51.9) and 4.4 times (95% CI = 2.3-8.5) greater odds of return to smoking among adults who smoke cigarettes. A&AsA adults who currently and formerly used commercial tobacco disproportionately bore higher concern about COVID-19 discrimination, and in turn could lead to increased smoking behavior and related morbidity and mortality among A&AsA adults., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Asian immigrants' children, even those from lower-backgrounds, tend to acquire higher levels of education than other ethnoracial groups, including White natives. Asian culture is often cited as a conventional explanation. The hyper-selectivity hypothesis challenges conventional wisdom by arguing that Asian American culture is an outcome of the community resources associated with hyper-selectivity. In this study, we assess the validity of the hyper-selectivity theory by examining the association between the magnitude of hyper-selectivity measured by the proportion of the BA + degree holders among the 1st generation Asian immigrants across communities and the likelihood of school enrollment for 1.5 and 2nd + generation Asian American children. Our results cast doubt on the hyper-selectivity theory. Asian American children's school enrollment is associated with the magnitude of educational selectivity among Asian immigrants for neither high school nor college. The benefits of hyper-selectivity do not seem to be cross-class or cross Asian ethnic groups. The higher the hyper-selectivity in a community is, the larger the education gap between upper- and lower-background Asian American children. The implications of these findings are discussed., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Objectives: Asian Americans report higher rates of insufficient sleep than non-Hispanic Whites (NHWs). It is unclear how sleep outcomes differ among disaggregated Asian subgroups., Methods: The National Health Interview Survey (2006-2018) was used to analyze self-reported sleep duration and quality measures for Asian American subgroups (Chinese [n = 11,056], Asian Indian [n = 11,249], Filipino [n = 13,211], and other Asians [n = 21,767]). Outcomes included hours of sleep per day, the number of days reporting trouble falling asleep, staying asleep, waking up rested, and taking sleep medication in the past week. Subsetted multivariate logistic regression was used to assess factors impacting sleep outcomes by ethnicity., Results: 29.2% of NHWs, 26.4% of Chinese, 24.5% of Asian Indians, and 38.4% of Filipinos reported insufficient sleep duration. Filipinos were less likely to report sufficient sleep duration (odds ratio 0.55, [confidence interval 95% 0.50-0.59]) and more likely to report trouble falling asleep (1.16 [1.01-1.33]) than NHWs. Chinese and Asian Indians had less trouble staying asleep (0.67 [0.58-0.77], 0.51 [0.44-0.59]) and falling asleep (0.77 [0.66-0.89], 0.72, [0.62-0.82]) than NHWs, and Asian Indians were more likely to wake feeling well rested (1.66 [1.48-1.87]). All Asian subgroups were less likely to report using sleep medications than NHWs. Foreign-born status had a negative association with sufficient sleep duration in Filipinos but a positive association in Asian Indians and Chinese., Conclusions: Filipinos report the highest burden of poor sleep outcomes, and Asian Indians report significantly better sleep outcomes. These findings highlight the importance of disaggregating Asian ethnic subgroups to address their health needs., Citation: Wang RZ, Jamal A, Wang Z, et al. Toward precision sleep medicine: variations in sleep outcomes among disaggregated Asian Americans in the National Health Interview Survey (2006-2018). J Clin Sleep Med . 2023;19(7):1259-1270., (© 2023 American Academy of Sleep Medicine.)

Background: Evidence suggests that acculturation can increase risks of poor diet, obesity, and chronic diseases. Yet questions remain regarding acculturation proxy measures and associations with diet quality in Asian Americans., Objectives: Primary objectives included estimating percentages of Asian Americans with low, moderate, and high acculturation using 2 proxy measures of acculturation based on different language variables and determining if diet quality differences existed among acculturation levels using the 2 proxy acculturation measures., Methods: Study sample included 1275 Asian participants aged ≥16 y from National Health and Nutrition Examination Survey 2015-2018. Nativity/length of United States residence, immigration age, language spoken at home (home), and language of dietary recall (recall) were used as proxy measures for 2 acculturation scales. Replicate 24-h dietary recalls were conducted and diet quality was assessed using 2015 Healthy Eating Index. Statistical methods for complex survey designs were used for analysis., Results: Using home and recall language, 26% compared with 9% of participants were classified with low, 50% compared with 63% with moderate, and 24% compared with 28% with high acculturation. On the home language scale, participants with low and/or moderate acculturation had higher scores (0.5-5.5 points) for vegetables, fruits, whole grains, seafood and plant protein, saturated fats, added sugars, and total 2015 Healthy Eating Index than participants with high acculturation; participants with low acculturation had lower refined grain score (1.2 points) than participants with high acculturation. Results were similar for the recall language scale, except differences between participants with moderate and high acculturation were also observed for fatty acids., Conclusions: Although percentages of Asian Americans classified with low, moderate, and high acculturation differed between the 2 proxy measures for acculturation, diet quality differences among acculturation groups were remarkably similar between the 2 proxy measures. Hence, use of either language variables may yield comparable results regarding the relationships between acculturation and diet in Asian Americans., (Copyright © 2023 American Society for Nutrition. All rights reserved.)

Purpose: This study examined the epidemiology of self-harm emergency department (ED) visits among Asian American and Pacific Islander (AAPI) youth, and associated factors., Methods: We used California ED visit records in 2010 and 2011 to calculate incidence rates of self-harm ED visits for AAPI versus non-Hispanic White (NHW) patients aged 10-29 years. Demographic and clinical characteristics were compared for AAPI versus NHW patients presenting with self-harm. We used modified Poisson regression models to estimate the relative risk of recurrent ED self-harm visits for AAPI versus NHW patients and examined the association of insurance type and gender with recurrent self-harm among AAPIs., Results: Rates of self-harm ED visits for young AAPI patients were 38 and 26 per 100,000 among females and males, respectively. Although AAPI patients presenting with self-harm were equally or less likely than NHW patients to have comorbid psychological and substance use diagnoses at their index visit, they were 25% more likely to be admitted to hospital. However, they were 40% less likely to have a recurrent ED self-harm visit. Among AAPI patients, those who used Medicaid were significantly more likely than those with other insurance to be admitted as inpatients., Discussion: Young AAPI patients presenting to EDs with deliberate self-harm have different sociodemographic and clinical profiles compared to NHW patients. Our study also demonstrates significant heterogeneity in risk of recurrent self-harm by gender and insurance type among AAPI patients. This information may be useful for future intervention programs among self-harming AAPI youth., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Parental mental health socialization is a process by which parents shape how youth develop and maintain beliefs, attitudes, and behaviors regarding mental health and help-seeking behaviors. Although culture shapes parental mental health socialization, few studies have examined specific parental socialization practices regarding mental health and help-seeking, especially as a culturally anchored process. Using a qualitative approach, this study explores youth-reported parental socialization of mental health within Chinese American families by examining focus group data from 69 Chinese American high school and college students. Findings revealed that youth received parental messages that conveyed culturally anchored conceptualizations of mental health that included stigmatized views of mental illness and perceptions of mental distress as not a legitimate problem. Parents responded to youth distress in culturally consonant ways: by encouraging culturally specific coping methods, dismissing or minimizing distress, or responding with silence. Youth engaged in the active interpretation of parental messages through cultural brokering, bridging the gap between their parents' messages and mainstream notions of mental health and help-seeking. Overall, our findings point to the significant role of culture in parental mental health socialization in Chinese American families and the need to integrate culturally specific understandings of mental health into future interventions for Asian American youth., (© 2022 Family Process Institute.)

There is scant research on how Asian American adolescents' resiliency relates to mental well-being in adulthood. The objective of this study was to determine the prospective associations between resiliency factors (individual, family, and school community) in adolescence and mental health outcomes in adulthood, among a national sample of Asian Americans. We analyzed data from 1020 Asian American adolescents who were followed for 14 years in the National Longitudinal Study of Adolescent to Adult Health. Of the resiliency factors, individual self-esteem (Adjusted Odds Ratio [AOR] 0.54, 95% Confidence Interval [CI] 0.37-0.79) and family connectedness (AOR 0.78, 95% CI 0.65-0.93) in adolescence were found to be protective against adult mental health outcomes in logistic regression models adjusting for sociodemographic factors and baseline mental health. Our study identified individual and family resiliency factors which can be leveraged to help Asian American adolescents and families in cultivating better mental health., (© 2022. The Author(s).)

Background: Self-reported racial or ethnic discrimination in a healthcare setting has been linked to worse health outcomes and not having a usual source of care, but has been rarely examined among Asian ethnic subgroups., Objective: We examined the association between Asian ethnic subgroup and self-reported discrimination in a healthcare setting, and whether both factors were associated with not having a usual source of care., Design: Using the California Health Interview Survey (CHIS) 2015-2017, we used logistic regression models to assess associations among Asian ethnic subgroup, self-reported discrimination, and not having a usual source of care. Interactions between race and self-reported discrimination, foreign-born status, poverty level, and limited English proficiency were also analyzed., Participants: Respondents represented adults age 18 + residing in California who identified as White, Black, Hispanic, American Indian/Alaska Native, Asian (including Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian), and Other., Main Measures: We examined two main outcomes: self-reported discrimination in a healthcare setting and having a usual source of care., Key Results: There were 62,965 respondents. After survey weighting, Asians (OR 1.78, 95% CI 1.19-2.66) as an aggregate group were more likely to report discrimination than non-Hispanic Whites. When Asians were disaggregated, Japanese (3.12, 1.36-7.13) and Koreans (2.42, 1.11-5.29) were more likely to report discrimination than non-Hispanic Whites. Self-reported discrimination was marginally associated with not having a usual source of care (1.25, 0.99-1.57). Koreans were the only group associated with not having a usual source of care (2.10, 1.23-3.60). Foreign-born Chinese (ROR 7.42, 95% CI 1.7-32.32) and foreign-born Japanese (ROR 4.15, 95% CI 0.82-20.95) were more associated with self-reported discrimination than being independently foreign-born and Chinese or Japanese., Conclusions: Differences in self-reported discrimination in a healthcare setting and not having a usual source of care were observed among Asian ethnic subgroups. Better understanding of these differences in their sociocultural contexts will guide interventions to ensure equitable access to healthcare., (© 2022. W. Montague Cobb-NMA Health Institute.)

Study Objectives: This review summarizes race-based sleep health disparities between Asian Americans and other American racial groups and compares sleep outcomes between Asian American subgroups disaggregated by ethnicity and ancestral national origin. The study identifies gaps in the existing literature, analyzes barriers to studying Asian American sleep, and recommends topics for future research., Methods: A PubMed review of research on adult Asian American sleep was conducted. The articles included utilized actigraphy, polysomnography, and questionnaires to gather sleep health metrics. Information from these articles included data on sleep duration, sleep quality, sleep disturbances, and sleep disorders., Results: Most aggregated studies find Asian American adults experiencing lower sleep duration and poorer sleep quality compared to non-Hispanic White Americans and comparable or slightly higher sleep duration compared to Black Americans. Within Asian Americans, first-generation immigrants report better sleep quality than subsequent generations. East Asian Americans may experience better sleep outcomes compared to Southeast Asian Americans. Obstructive sleep apnea is critically underreported in South Asian Americans., Conclusions: Significantly more research is required in Asian American sleep disparities, specifically in South and Southeast Asian Americans. Sleep disparities between Asian Americans and other racial groups are impacted by perceived discrimination, poor mental health, and cultural attitudes toward sleep. The observed within-group disparities of Asian American sleep may be attributed to socioeconomic status and generational status/acculturation. Existing barriers to research include the model minority myth and lack of disaggregated racial sleep data., Citation: Nandagiri V, Vannemreddy S, Spector A. Sleep disparities in Asian Americans: a comprehensive review. J Clin Sleep Med . 2023;19(2):393-402., (© 2023 American Academy of Sleep Medicine.)

Introduction: Culture and community can play a role in views, stigma, and access related to abortion. No research to date has documented the influence of culture and community attitudes on Asian American (AA) experiences accessing abortion care in the United States (US). This paper aims to fill gaps in research and understand how cultural and community views influence medication abortion access and experiences among AAs., Methods: We used a community-based participatory research approach, which included collaboration among experts in public health, advocates, practitioners, and community partners to understand abortion knowledge, attitudes, and experiences among AAs. Using a semi-structured interview guide, we interviewed twenty-nine eligible people of reproductive age over 18 that self-identified as Asian American or mixed race including Asian American, Native Hawaiian, and/or Pacific Islander (AANHPI), and had a medication abortion in the US between January 2016 and March 2021. Interviews were analyzed and coded in NVivo 12 using a modified grounded theory approach., Results: Participants described various influences of religion negatively impacting acceptability of abortion among their family and community. Lack of openness around sexual and reproductive health (SRH) topics contributed to stigma and influenced most participants' decision not to disclose their abortion to family members, which resulted in participants feeling isolated throughout their abortion experience. When seeking abortion care, participants preferred to seek care with providers of color, especially if they were AANHPI due to past experiences involving stigma and judgment from White providers. Based on their experiences, respondents recommended ways to improve the abortion experience for AAs in the US including, (1) more culturally aware abortion providers from one's community who better understand their needs; (2) clinics providing abortion services located in or near AA communities with signage in local languages; and (3) tailored mental health resources with culturally aware therapists., Conclusion: This study demonstrates ways in which culture and community opinions toward SRH can influence both the acceptability of abortion and experiences seeking abortion care among AAs. It is important to consider family and community dynamics among AAs to better tailor services and meet the needs of AAs seeking abortion care in the US., Competing Interests: SrC, KK, and AO were employed by Ibis Reproductive Health, Cambridge, MA, United States. AL and SuC were employed by National Asian Pacific American Women's Forum. BG was employed by Ibis Reproductive Health, Oakland, CA, United States. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chandrasekaran, Key, Ow, Lindsey, Chin, Goode, Dinh, Choi and Choimorrow.)

This study describes barriers to using the MyPlate visual as a resource for communicating dietary recommendations to Asian American participants of a federally funded nutrition education program. To identify potential barriers to using MyPlate, an interdisciplinary team collected quantitative (n = 349) and qualitative (n = 40) data via a cross-sectional survey and a series of focus group interviews with convenience samples of Cambodian, Filipino, Japanese, Chinese, Vietnamese, and Korean adult participants of a nutrition education class in downtown Los Angeles. Findings showed that 13.2% of the participants ate meals only on a plate, 30.7% were accustomed to eating only refined grains like white rice, and 22.4% did not customarily make half their meals to consist of fruits and vegetables. Food customs, preference, and taste vary across these subgroups. The heterogeneity and complexity of dietary practices among Asian subgroups suggest a need to better tailor nutrition education resources for use in these populations., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Despite recognition that the health outcomes of Asian American subgroups are heterogeneous, research has mainly focused on the six largest subgroups. There is limited knowledge of smaller subgroups and their health outcomes. This scoping review identifies trends in the health outcomes, reveals those which are under-researched, and provide recommendations on data collection with 24 Asian American subgroups., Methods: Our literature search of peer-reviewed English language primary source articles published between 1991 and 2018 was conducted across six databases (Embase, PubMed, Web of Sciences, CINAHL, PsychINFO, Academic Search Complete) and Google Scholar, yielding 3844 articles. After duplicate removal, we independently screened 3413 studies to determine whether they met inclusion criteria. Seventy-six studies were identified for inclusion in this review. Data were extracted on study characteristics, content, and findings., Findings: Seventy-six studies met the inclusion criteria. The most represented subgroups were Chinese (n = 74), Japanese (n = 60), and Filipino (n = 60), while Indonesian (n = 1), Malaysian (n = 1), and Burmese (n = 1) were included in only one or two studies. Several Asian American subgroups listed in the 2010 U.S. Census were not represented in any of the studies. Overall, the most studied health conditions were cancer (n = 29), diabetes (n = 13), maternal and infant health (n = 10), and cardiovascular disease (n = 9). Studies showed that health outcomes varied greatly across subgroups., Conclusions: More research is required to focus on smaller-sized subgroup populations to obtain accurate results and address health disparities for all groups., (© 2021. W. Montague Cobb-NMA Health Institute.)

Family is uniquely influential in the health of young Asian Americans (AAs), yet little is known on the impact of specific shared family activities. This study explores different types and frequencies of AA young adult shared family activities on perceived familial influence on the ability to maintain a healthy lifestyle (diet, physical activity, sleep, social relationships, stress, and risky substances). A nationwide sample of 18-35-year-old AAs was surveyed in March 2021 on a list of 30 shared family activities with mothers, fathers, siblings, or extended family. Overall, 984 unique family relationships reported by 616 young AAs were analyzed. Confirmatory factor analysis synthesized a reliable two-factor (routine, leisure activities) 10-item Shared Activities with Family (SAF) scale. Mothers were most influential (mean 3.25, SD = 1.14), although shared activities among South Asians or with extended family were most associated with changes in perceived influence. Routine shared activities were more strongly associated with perceived influence on sleep, diet, and risky substances, while leisure shared activities were more associated with influence on developing healthy social relationships. Family-based, dyadic interventions for young AAs may incorporate shared activities (both routine and leisure) to promote healthy behaviors, although further research to explore mechanisms and directionality of influence is needed to inform action., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)