%0 Journal Article %J J Consult Clin Psychol %D 2013 %T The immigrant paradox among Asian American women: are disparities in the burden of depression and anxiety paradoxical or explicable? %A Lau, Anna S %A Tsai, William %A Shih, Josephine %A Liu, Lisa L %A Hwang, Wei-Chin %A Takeuchi, David T %K Age Factors %K Anxiety Disorders %K Asian Americans %K Cost of Illness %K Depressive Disorder %K Emigrants and Immigrants %K Female %K Health Status Disparities %K Humans %K Middle Aged %K Risk Factors %K Social Class %K Stress, Psychological %K Young Adult %X

OBJECTIVE: We evaluated potential explanations for advantaged mental health status among immigrant Asian American women compared to U.S.-born Asian American women.

METHOD: In a nationally representative sample of 1,030 women (185 U.S.-born, 368 early-life immigrants [arrived before 25 years of age], 477 late-life immigrants), we examined the hypothesis that increased exposure to social risk factors mediate nativity-based differences in lifetime prevalence of depression and anxiety disorders. Indicators of social class were also examined as protective factors enjoyed by U.S.-born women that may suppress observed nativity-based disparities. We also examined whether there were group differences in reactivity to stress in predicting disorder.

RESULTS: U.S.-born women were twice as likely as late-life immigrants to report lifetime history of depression (odds ratio [OR] = 2.03, 95% CI [1.35, 4.54]) and anxiety (OR = 2.12, 95% CI [1.34, 5.19]). Nativity differences in perceived discrimination, family conflict, and cultural conflict explained disparities in rates of disorder. There was no support for the contention that immigrant women were more psychologically hardy or resilient to social stress.

CONCLUSION: Findings suggest that the gap in mental health status between U.S.- and foreign-born Asian American women would indeed be magnified if differences in social status were accounted for, but also that ready explanations for the so-called immigrant paradox are found in differential levels of reported stress exposure.

%B J Consult Clin Psychol %V 81 %P 901-11 %8 2013 Oct %G eng %N 5 %R 10.1037/a0032105 %0 Journal Article %J Med Care %D 2013 %T Prevalence, risk, and correlates of posttraumatic stress disorder across ethnic and racial minority groups in the United States. %A Alegría, Margarita %A Fortuna, Lisa R %A Lin, Julia Y %A Norris, Fran H %A Gao, Shan %A Takeuchi, David T %A Jackson, James S %A Shrout, Patrick E %A Valentine, Anne %K Adolescent %K Adult %K African Americans %K Aged %K Asian Americans %K Continental Population Groups %K Ethnic Groups %K Female %K Hispanic Americans %K Humans %K Male %K Mental Disorders %K Middle Aged %K Patient Acuity %K Prevalence %K Risk Factors %K Social Support %K Socioeconomic Factors %K Stress Disorders, Post-Traumatic %K United States %K Young Adult %X

OBJECTIVES: We assess whether posttraumatic stress disorder (PTSD) varies in prevalence, diagnostic criteria endorsement, and type and frequency of potentially traumatic events (PTEs) among a nationally representative US sample of 5071 non-Latino whites, 3264 Latinos, 2178 Asians, 4249 African Americans, and 1476 Afro-Caribbeans.

METHODS: PTSD and other psychiatric disorders were evaluated using the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) in a national household sample that oversampled ethnic/racial minorities (n=16,238) but was weighted to produce results representative of the general population.

RESULTS: Asians have lower prevalence rates of probable lifetime PTSD, whereas African Americans have higher rates as compared with non-Latino whites, even after adjusting for type and number of exposures to traumatic events, and for sociodemographic, clinical, and social support factors. Afro-Caribbeans and Latinos seem to demonstrate similar risk to non-Latino whites, adjusting for these same covariates. Higher rates of probable PTSD exhibited by African Americans and lower rates for Asians, as compared with non-Latino whites, do not appear related to differential symptom endorsement, differences in risk or protective factors, or differences in types and frequencies of PTEs across groups.

CONCLUSIONS: There appears to be marked differences in conditional risk of probable PTSD across ethnic/racial groups. Questions remain about what explains risk of probable PTSD. Several factors that might account for these differences are discussed, as well as the clinical implications of our findings. Uncertainty of the PTSD diagnostic assessment for Latinos and Asians requires further evaluation.

%B Med Care %V 51 %P 1114-23 %8 2013 Dec %G eng %N 12 %R 10.1097/MLR.0000000000000007 %0 Journal Article %J J Behav Med %D 2012 %T Beyond conventional socioeconomic status: examining subjective and objective social status with self-reported health among Asian immigrants. %A Gong, Fang %A Xu, Jun %A Takeuchi, David T %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Asia %K Data Collection %K Emigrants and Immigrants %K Female %K Health Status %K Health Status Disparities %K Humans %K Male %K Mental Health %K Middle Aged %K Self Report %K Social Class %K Stress, Psychological %K United States %K Young Adult %X

Despite mounting evidence for a strong and persistent association between socioeconomic status (SES) and health, this relationship is largely unknown among Asian immigrants, a fast growing minority group in the US population. Previous research has typically focused on objective SES (primarily education and income) and ignored self-perceived SES. Using data from the National Latino and Asian American Study (NLAAS) (N = 1,570), we examined the impact of subjective as well as objective SES upon multiple self-reported health outcomes among Asian immigrants. Results indicated that conventional SES indicators by and large were non-significantly related to self-rated physical health, physical discomfort, self-rated mental health, and psychological distress. In contrast, subjective SES relative to people in the United States and people in the community showed strong associations with health outcomes above and beyond conventional SES markers. This study suggested a promising avenue to incorporate subjective SES in health disparities research, especially among immigrants.

%B J Behav Med %V 35 %P 407-19 %8 2012 Aug %G eng %N 4 %R 10.1007/s10865-011-9367-z %0 Journal Article %J Soc Sci Med %D 2012 %T Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders. %A John, Dolly A %A de Castro, A B %A Martin, Diane P %A Duran, Bonnie %A Takeuchi, David T %K Adult %K Asian Americans %K Confidence Intervals %K Emigrants and Immigrants %K Employment %K Female %K Health Status %K Humans %K Logistic Models %K Male %K Mental Disorders %K Odds Ratio %K Population Surveillance %K Self Report %K Sex Distribution %K United States %X

A robust socioeconomic gradient in health is well-documented, with higher socioeconomic status (SES) associated with better health across the SES spectrum. However, recent studies of U.S. racial/ethnic minorities and immigrants show complex SES-health patterns (e.g., flat gradients), with individuals of low SES having similar or better health than their richer, U.S.-born and more acculturated counterparts, a so-called "epidemiological paradox" or "immigrant health paradox". To examine whether this exists among Asian Americans, we investigate how nativity and occupational class (white-collar, blue-collar, service, unemployed) are associated with subjective health (self-rated physical health, self-rated mental health) and 12-month DSM-IV mental disorders (any mental disorder, anxiety, depression). We analyzed data from 1530 Asian respondents to the 2002-2003 National Latino and Asian American Study in the labor force using hierarchical multivariate logistic regression models controlling for confounders, subjective social status (SSS), material and psychosocial factors theorized to explain health inequalities. Compared to U.S.-born Asians, immigrants had worse socioeconomic profiles, and controlling for age and gender, increased odds for reporting fair/poor mental health and decreased odds for any DSM-IV mental disorder and anxiety. No strong occupational class-health gradients were found. The foreign-born health-protective effect persisted after controlling for SSS but became nonsignificant after controlling for material and psychosocial factors. Speaking fair/poor English was strongly associated with all outcomes. Material and psychosocial factors were associated with some outcomes--perceived financial need with subjective health, uninsurance with self-rated mental health and depression, social support, discrimination and acculturative stress with all or most DSM-IV outcomes. Our findings caution against using terms like "immigrant health paradox" which oversimplify complex patterns and mask negative outcomes among underserved sub-groups (e.g., speaking fair/poor English, experiencing acculturative stress). We discuss implications for better measurement of SES and health given the absence of a gradient and seemingly contradictory finding of nativity-related differences in self-rated health and DSM-IV mental disorders.

%B Soc Sci Med %V 75 %P 2085-98 %8 2012 Dec %G eng %N 12 %R 10.1016/j.socscimed.2012.01.035 %0 Journal Article %J Soc Sci Med %D 2012 %T Limited English proficiency and psychological distress among Latinos and Asian Americans. %A Zhang, Wei %A Hong, Seunghye %A Takeuchi, David T %A Mossakowski, Krysia N %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Asian Americans %K Communication Barriers %K Female %K Hispanic Americans %K Humans %K Male %K Middle Aged %K Minority Groups %K Multilingualism %K Prejudice %K Socioeconomic Factors %K Stress, Psychological %K United States %K Young Adult %X

English proficiency is increasingly recognized as an important factor that is related to the mental health of immigrants and ethnic minorities. However, few studies have examined how the association between English proficiency and mental health operates and whether the pattern of association is similar or different among various ethnic minority groups. This paper investigates how limited English proficiency directly and indirectly affects psychological distress through pathways of discrimination for both Latinos and Asian Americans in the United States. Findings suggest that, for Asian Americans, limited English proficiency has an independent relationship with psychological distress over and above demographic variables, socioeconomic and immigration-related factors and discrimination. For Latinos, however, socio-demographic variables and discrimination show a stronger association than limited English proficiency in affecting psychological distress. Different forms of discrimination - everyday discrimination and racial/ethnic discrimination - are equally important for both ethnic groups. Findings underscore the differential role of limited English proficiency for the mental health of Asian Americans and Latinos and suggest the distinctive racial experiences and backgrounds of these two ethnic groups.

%B Soc Sci Med %V 75 %P 1006-14 %8 2012 Sep %G eng %N 6 %R 10.1016/j.socscimed.2012.05.012 %0 Journal Article %J J Consult Clin Psychol %D 2012 %T Social capital, acculturation, mental health, and perceived access to services among Mexican American women. %A Valencia-Garcia, Dellanira %A Simoni, Jane M %A Alegría, Margarita %A Takeuchi, David T %K Acculturation %K Adolescent %K Adult %K Anxiety %K Cross-Sectional Studies %K Depression %K Female %K Health Services Accessibility %K Humans %K Mental Health %K Mexican Americans %K Middle Aged %K Social Class %K Stress, Psychological %K Women %X

OBJECTIVE: We examined whether individual-level social capital-the intangible resources in a community available through membership in social networks or other social structures and perceived trust in the community-was associated with acculturation, depression and anxiety symptoms, and perceived access to services among women of Mexican ancestry.

METHOD: Recruited through venue-based targeted sampling in King County, Washington, 205 women of Mexican descent ages 18 to 64 years who differed in socioeconomic status and nativity completed a cross-sectional survey. Half completed the survey in Spanish and half in English. Structural equation modeling was used for model testing.

RESULTS: Social capital increased with level of acculturation and was negatively related to depression and anxiety; it had no direct association with perceived access to services. Social capital mediated the relation between acculturation and both depression and anxiety symptoms. Acculturation had no direct association with psychological distress but was directly associated with perceived access to services. This community sample of women reported high levels of psychological distress, with 20% to 26% of women meeting diagnostic criteria for depression or anxiety.

CONCLUSIONS: Social capital can be assessed at the individual level, increases with acculturation, and may be a potential target for interventions to improve mental health among Mexican American women residing in the United States.

%B J Consult Clin Psychol %V 80 %P 177-85 %8 2012 Apr %G eng %N 2 %R 10.1037/a0027207 %0 Journal Article %J Soc Sci Med %D 2011 %T A life course perspective on migration and mental health among Asian immigrants: the role of human agency. %A Gong, Fang %A Xu, Jun %A Fujishiro, Kaori %A Takeuchi, David T %K Acculturation %K Adolescent %K Adult %K Age Factors %K Aged %K Aged, 80 and over %K Asian Americans %K Emigrants and Immigrants %K Female %K Humans %K Life Change Events %K Male %K Mental Health %K Middle Aged %K Motivation %K Stress, Psychological %K United States %K Young Adult %X

The relationship between human agency and health is an important yet under-researched topic. This study uses a life course perspective to examine how human agency (measured by voluntariness, migratory reasons, and planning) and timing (measured by age at immigration) affect mental health outcomes among Asian immigrants in the United States. Data from the National Latino and Asian American Study showed that Asian immigrants (n=1491) with multiple strong reasons to migrate were less likely to suffer from mental health problems (i.e., psychological distress and psychiatric disorders in the past 12 months) than those without clear goals. Moreover, Asian immigrants with adequate migratory planning had lower levels of distress and lower rates of 12-month psychiatric disorders than those with poorly planned migration. Compared with migrants of the youngest age category (six or younger), those who migrated during preteen and adolescent years without clear goals had higher levels of psychological distress, and those who migrated during adulthood (25 years or older) were less likely to suffer from recent depressive disorders (with the exception of those migrating for life-improving goals). Furthermore, we found that well-planned migration lowered acculturative stress, and multiple strong reasons for migration buffered the negative effect of acculturative stress upon mental health. Findings from this study advance research on immigrant health from the life course perspective by highlighting the effects of exercising human agency during the pre-migration stage upon post-migration mental health.

%B Soc Sci Med %V 73 %P 1618-26 %8 2011 Dec %G eng %N 11 %R 10.1016/j.socscimed.2011.09.014 %0 Journal Article %J Public Health Nurs %D 2010 %T Associations of employment frustration with self-rated physical and mental health among Asian American immigrants in the U.S. Labor force. %A de Castro, A B %A Rue, Tessa %A Takeuchi, David T %K Adaptation, Psychological %K Adult %K Asian Americans %K Cross-Sectional Studies %K Diagnostic Self Evaluation %K Emigrants and Immigrants %K Employment %K Female %K Health Status %K Health Status Indicators %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Mental Health %K Multivariate Analysis %K Occupational Health %K Psychometrics %K Sex Factors %K Socioeconomic Factors %K Stress, Psychological %K United States %X

OBJECTIVE: This study examined the associations between employment frustration and both self-rated physical health (SRPH) and self-rated mental health (SRMH) among Asian American immigrants.

DESIGN AND SAMPLE: A cross-sectional quantitative analysis was conducted utilizing data from 1,181 Asian immigrants participating in the National Latino and Asian American Study.

MEASURES: Employment frustration was measured by self-report of having difficulty finding the work one wants because of being of Asian descent. SRPH and SRMH were each assessed using a global one-item measure, with responses ranging from poor to excellent. Control variables included gender, age, ethnicity, education, occupation, income, whether immigrated for employment, years in the United States, English proficiency, and a general measure for everyday discrimination.

RESULTS: Ordered logistic regression showed that employment frustration was negatively associated with SRPH. This relationship, however, was no longer significant in multivariate models including English proficiency. The negative association between employment frustration and SRMH persisted even when including all control variables.

CONCLUSIONS: The findings suggest that Asian immigrants in the United States who experience employment frustration report lower levels of both physical and mental health. However, English proficiency may attenuate the relationship of employment frustration with physical health.

%B Public Health Nurs %V 27 %P 492-503 %8 2010 Nov-Dec %G eng %N 6 %R 10.1111/j.1525-1446.2010.00891.x %0 Journal Article %J Am J Public Health %D 2010 %T Discrimination and mental health-related service use in a national study of Asian Americans. %A Spencer, Michael S %A Chen, Juan %A Gee, Gilbert C %A Fabian, Cathryn G %A Takeuchi, David T %K Adult %K Asia %K Asian Americans %K Communication Barriers %K Female %K Health Care Surveys %K Humans %K Male %K Mental Health Services %K Middle Aged %K Patient Acceptance of Health Care %K Perception %K Prejudice %K United States %X

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

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

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

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

%B Am J Public Health %V 100 %P 2410-7 %8 2010 Dec %G eng %N 12 %R 10.2105/AJPH.2009.176321 %0 Journal Article %J Am J Public Health %D 2010 %T English proficiency and language preference: testing the equivalence of two measures. %A Gee, Gilbert C %A Walsemann, Katrina M %A Takeuchi, David T %K Acculturation %K Adult %K Asian Americans %K Attitude to Health %K Choice Behavior %K Data Interpretation, Statistical %K Educational Status %K Emigrants and Immigrants %K Female %K Health Status %K Humans %K Language %K Logistic Models %K Male %K Morbidity %K Multilingualism %K Surveys and Questionnaires %K Thinking %K United States %X

OBJECTIVES: We examined the association of language proficiency vs language preference with self-rated health among Asian American immigrants. We also examined whether modeling preference or proficiency as continuous or categorical variables changed our inferences.

METHODS: Data came from the 2002-2003 National Latino and Asian American Study (n = 1639). We focused on participants' proficiency in speaking, reading, and writing English and on their language preference when thinking or speaking with family or friends. We examined the relation between language measures and self-rated health with ordered and binary logistic regression.

RESULTS: All English proficiency measures were associated with self-rated health across all models. By contrast, associations between language preference and self-rated health varied by the model considered.

CONCLUSIONS: Although many studies create composite scores aggregated across measures of English proficiency and language preference, this practice may not always be conceptually or empirically warranted.

%B Am J Public Health %V 100 %P 563-9 %8 2010 Mar %G eng %N 3 %R 10.2105/AJPH.2008.156976 %0 Journal Article %J J Immigr Minor Health %D 2010 %T Examining alternative measures of social disadvantage among Asian Americans: the relevance of economic opportunity, subjective social status, and financial strain for health. %A de Castro, A B %A Gee, Gilbert C %A Takeuchi, David T %K Adolescent %K Adult %K Aged %K Asian Americans %K Body Mass Index %K Data Collection %K Educational Status %K Employment %K Female %K Health Status %K Humans %K Income %K Male %K Middle Aged %K Obesity %K Smoking %K Social Class %K United States %K Young Adult %X

Socioeconomic position is often operationalized as education, occupation, and income. However, these measures may not fully capture the process of socioeconomic disadvantage that may be related to morbidity. Economic opportunity, subjective social status, and financial strain may also place individuals at risk for poor health outcomes. Data come from the Asian subsample of the 2003 National Latino and Asian American Study (n = 2095). Regression models were used to examine the associations between economic opportunity, subjective social status, and financial strain and the outcomes of self-rated health, body mass index, and smoking status. Education, occupation, and income were also investigated as correlates of these outcomes. Low correlations were observed between all measures of socioeconomic status. Economic opportunity was robustly negatively associated with poor self-rated health, higher body mass index, and smoking, followed by financial strain, then subjective social status. Findings show that markers of socioeconomic position beyond education, occupation, and income are related to morbidity among Asian Americans. This suggests that potential contributions of social disadvantage to poor health may be understated if only conventional measures are considered among immigrant and minority populations.

%B J Immigr Minor Health %V 12 %P 659-71 %8 2010 Oct %G eng %N 5 %R 10.1007/s10903-009-9258-3 %0 Journal Article %J Am J Ind Med %D 2010 %T Smoking and the Asian American workforce in the National Latino and Asian American Study. %A de Castro, A B %A Garcia, Gabriel %A Gee, Gilbert C %A Tsai, Jenny Hsin-Chun %A Rue, Tessa %A Takeuchi, David T %K Adolescent %K Adult %K Aged %K Asian Americans %K Cross-Sectional Studies %K Employment %K Female %K Hispanic Americans %K Humans %K Interviews as Topic %K Male %K Middle Aged %K Occupations %K Prevalence %K Smoking %K United States %K Young Adult %X

BACKGROUND: Smoking among the Asian American workforce has not been extensively researched. This study examines smoking prevalence among a nationally representative sample of Asian Americans with an emphasis on occupational classification.

METHODS: Cross-sectional data come from the National Latino and Asian American Study. Multivariate logistic regression analyses were used to determine smoking prevalence by occupation, gender, and nativity, among 1,528 participants self-identifying as in the labor force.

RESULTS: Blue collar workers reported the highest smoking prevalence (32%) followed by unemployed (19%), other (17%), service (14%), and white collar (10%). Among both employed males and females, blue collar workers had the highest prevalence (45% and 18%, respectively). By nativity, smoking was highest among blue collar workers for immigrants (25%) and highest among the unemployed for U.S. born (16%). Blue collar employment was significantly associated with being a current smoker (OR = 2.52; 95% CI: 1.23-5.16; P < 0.05) controlling for demographics (e.g., age, gender, ethnic group, nativity, etc.).

CONCLUSIONS: Findings reveal that smoking differs by occupation among Asian Americans. Future research should examine factors explaining differences while considering gender and nativity.

%B Am J Ind Med %V 53 %P 171-8 %8 2010 Feb %G eng %N 2 %R 10.1002/ajim.20697