Social Anxiety and Mental Health Service Use Among Asian American High School Students

Parenting Practices and Well-Being and Health Behaviors Among Young Asian American Children

Importance

Literature suggests that well-being and health status differ by generational status among Asian American individuals.

Objective

To compare young children's well-being and health behaviors and their parents' parenting practices among families of second-generation Asian American, third- or later-generation Asian American, and third- or later-generation non-Hispanic White children in the US.

Design, Setting, and Participants

For this survey study, secondary data analysis was conducted from September 2, 2023, to June 19, 2024, using data from the 2018 to 2022 National Survey of Children's Health participants aged 6 months to 5 years. Parents completed a survey about their positive parenting practices and their child's psychological well-being and health behaviors via mail or online. Multivariable logistic and linear regression analyses were conducted to compare psychological well-being and health behaviors by study groups and positive parenting practices, adjusting for sociodemographic variables.

Main Outcomes and Measures

Positive parenting practices (ie, reading, storytelling or singing, and family meals), psychological well-being (ie, flourishing, social-emotional development, and self-regulation), and health behaviors.

Results

The analysis included 42 846 participants (5456 in 2018, 5140 in 2019, 7494 in 2020, 12 817 in 2021, and 11 939 in 2022; 46.6% female and 53.4% male). Participants were categorized into 3 groups: 2881 (6.7%) were second-generation Asian American children aged 0 to 5 years, 570 (1.3%) third- or later-generation Asian American children aged 0 to 5 years, and 39 395 (92.0%) third- or later-generation non-Hispanic White children aged 0 to 5 years. Compared with White children, Asian American children were less likely to flourish (odds ratio [OR], 0.57 [95% CI, 0.52-0.63] for second-generation Asian American; OR, 0.82 [95% CI, 0.65-1.03] for third- or later-generation Asian American), have regular bedtimes (OR, 0.80 [95% CI, 0.69-0.92] for second-generation Asian American; OR, 0.66 [95% CI, 0.49-0.88] for third- or later-generation Asian American), and have moderate screen time (OR, 0.92 [95% CI, 0.84-1.00] for second-generation Asian American; OR, 0.82 [95% CI, 0.69-0.97] for third- or later-generation Asian American). Results for regular reading and storytelling or singing were the lowest among second-generation Asian American children (1430 [49.6%] for reading and 1629 [56.5%] for storytelling or singing), followed by the third- or later-generation Asian American children (376 [66.0%] for reading and 412 [72.3%] for storytelling or singing) and than White children (28 628 [72.7%] for reading and 30 375 [77.1%] for storytelling or singing) (P < .001). Results for family meals were similar between second-generation (2356 [81.8%]) and third- or later-generation (467 [81.9%]) Asian American children; however, both were significantly lower than for White children (33 928 [86.1%]) (P < .001). All 3 positive parenting practices were positively associated with children's psychological well-being and health behaviors.

Conclusions and Relevance

This survey study of young children found lower likelihoods of flourishing, regular bedtimes, and moderate screen time among Asian American children compared with non-Hispanic White children in the US. Reading and storytelling or singing parenting practices, which were associated with children's well-being and health behaviors, were particularly less frequent among parents of second-generation Asian American children than those of third- or later-generation Asian American children. Promotion of these practices among Asian immigrant parents may help improve the psychological well-being and health behaviors of their young Asian American children.

A Pathway to Positive Youth Development: Unpacking the Asian American Youth Paradox and Cultural Orientations among Filipino American and Korean American Youth

This study used longitudinal survey data of Filipino American and Korean American youth in the Chicago Metropolitan area (N = 786, MAGE = 15.00, SD = 1.91 at Wave 1 in 2014) to examine whether and how a set of organized predictors (i.e., universal predictors of youth outcomes and cultural orientations) independently and collectively explains internalizing and externalizing problems and academic performance. The results were that universal predictors such as youth antisocial beliefs, peer antisocial behaviors, and the quality of parent-child relations, were extensively predictive of youth outcomes in the expected directions. The magnitudes of universal predictors were largely unchanged when bilinear and multidimensional cultural orientation variables were accounted for together. The magnitudes of cultural orientation variables were slightly attenuated in full models but showed independent associations with youth outcomes. Specifically, English and heritage language proficiencies were protective of externalizing and internalizing problems. Behavioral practices in respective cultures increased youth problems. In addition, ethnic identity, although beneficial to mental health, can increase externalizing problems. The findings of this study provide insights into understanding the mixed outcomes among Asian Americans and important empirical evidence that can inform intervention programs to prevent youth problems, ultimately toward a pathway to positive youth development among Asian American youth.

Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review

The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.

Racial/Ethnic Disparities in Psychiatric Traits and Diagnoses within a Community-based Sample of Children and Youth: Disparités raciales/ethniques dans les traits et diagnostics psychiatriques au sein d'un échantillon communautaire d'enfants et de jeunes

OBJECTIVE

Racial/ethnic disparities in the prevalence of psychiatric disorders have been reported, but have not accounted for the prevalence of the traits that underlie these disorders. Examining rates of diagnoses in relation to traits may yield a clearer understanding of the degree to which racial/ethnic minority youth in Canada differ in their access to care. We sought to examine differences in self/parent-reported rates of diagnoses for obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders after adjusting for differences in trait levels between youth from three racial/ethnic groups: White, South Asian and East Asian.

METHOD

We collected parent or self-reported ratings of OCD, ADHD and anxiety traits and diagnoses for 6- to 17-year-olds from a Canadian general population sample (Spit for Science). We examined racial/ethnic differences in trait levels and the odds of reporting a diagnosis using mixed-effects linear models and logistic regression models.

RESULTS

East Asian (N = 1301) and South Asian (N = 730) youth reported significantly higher levels of OCD and anxiety traits than White youth (N = 6896). East Asian and South Asian youth had significantly lower odds of reporting a diagnosis for OCD (odds ratio [OR]East Asian = 0.08 [0.02, 0.41]; ORSouth Asian = 0.05 [0.00, 0.81]), ADHD (OREast Asian = 0.27 [0.16, 0.45]; ORSouth Asian = 0.09 [0.03, 0.30]) and anxiety (OREast Asian = 0.21 [0.11, 0.39]; ORSouth Asian = 0.12 [0.05, 0.32]) than White youth after accounting for psychiatric trait levels.

CONCLUSIONS

These results suggest a discrepancy between trait levels of OCD, ADHD and anxiety and rates of diagnoses for East Asian and South Asian youth. This discrepancy may be due to increased barriers for ethnically diverse youth to access mental health care. Efforts to understand and mitigate these barriers in Canada are needed.

Investigating Asian American Adolescents' Resiliency Factors and Young Adult Mental Health Outcomes at 14-year Follow-up: A Nationally Representative Prospective Cohort Study

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.

Help-seeking for mental health services in Asian American college students: an exploratory qualitative study

Objective: To understand how the college environment might influence mental health help-seeking in Asian American undergraduates. Participants: Participants were 19 Asian American undergraduates recruited through Facebook. Methods: Participants were interviewed about attitudes toward mental health and mental health help-seeking, and thematic analysis with both inductive and deductive codes was used to analyze interview transcripts. Results: Several factors specific to the college environment encourage students to seek help: social support provided by peers and by campuses, psychological distance from home, and physical distance from home. However, other Asian American-specific factors discourage students from seeking help, such as cultural factors and stigma surrounding mental health issues. Conclusions: The college environment may encourage help-seeking, while Asian American-specific factors may discourage it. Potential interventions based on these findings may increase help-seeking rates by focusing on these encouraging factors in a culturally-sensitive way.

Explaining the Asian American Youth Paradox: Universal Factors versus Asian American Family Process Among Filipino and Korean American Youth

This study used longitudinal survey data of Filipino American and Korean American youth to examine ways in which universal factors (e.g., peer antisocial behaviors and parent-child conflict) and Asian American (AA) family process variables (e.g., gendered norms) independently and collectively predict grade point average (GPA), externalizing, and internalizing problems. We aimed to explain the "Asian American youth paradox" in which low externalizing problems and high GPA coexist with high internalizing problems. We found that universal factors were extensively predictive of youth problems and remained robust when AA family process was accounted for. AA family process also independently explained youth development and, in part, the AA youth paradox. For example, gendered norms increased mental distress. Academic controls did the opposite of what it is intended, that is, had a negative impact on GPA as well as other developmental domains. Family obligation, assessed by family-centered activities and helping out, was beneficial to both externalizing and internalizing youth outcomes. Parental implicit affection, one of the distinct traits of AA parenting, was beneficial, particularly for GPA. This study provided important empirical evidence that can guide cross-cultural parenting and meaningfully inform intervention programs for AA youth.

Disempowering Parenting and Mental Health among Asian American Youth: Immigration and Ethnicity

Guided by the concept of ABCDG (Abusive, Burdening, Culturally Disjointed, Disengaged, and Gender Prescriptive) parenting, this study investigated how subdomains of disempowering parenting adversely influence young people's mental health, independently and collectively, using a large-scale longitudinal survey data of community samples among Filipino American (FA) and Korean American (KA) youth (M _AGE =15.01, N=1,580; 391 FA and 417 KA families). Regression results showed that the subdomains of disempowering parenting, while individually harmful, were differentially associated with mental health. For example, abusive and disengaged parenting and culturally disjointed parenting (a.k.a. intergenerational cultural conflict) were the most notably adverse subdomains and remained significant when all subdomains were accounted together. This study pinpoints specific aspects of disempowering parenting that may lead to mental distress among FA and KA youth and underscores a need for culturally tailored intervention programs that address the harms of disempowering parenting approaches.

Patient-reported outcome measures among breast cancer survivors: A cross-sectional comparison between Malaysia and high-income countries

OBJECTIVES

Patient-reported outcomes (PROs) in high-income countries (HICs) suggest that physical, emotional, and psychological needs are important in cancer care. To date, there have been few inconsistent descriptions of PROs in low-income and middle-income Asian countries. Using a standard questionnaire developed by the International Consortium for Health Outcomes Measurement (ICHOM), we compared the perceived importance of PROs between patients in Malaysia and those in HICs and between clusters of Malaysian women.

METHODS

Breast cancer patients were recruited from three Malaysian hospitals between June and November 2017. We compared the proportion of patients who rated PROs as very important (scored 7-9 on a 9-point Likert scale) between Malaysian patients and data collected from patients in HICs via the ICHOM questionnaire development process, using logistic regression. A two-step cluster analysis explored differences in PROs among Malaysian patients.

RESULTS

The most important PROs for both cohorts were survival, overall well-being, and physical functioning. Compared with HIC patients (n = 1177), Malaysian patients (n = 969) were less likely to rate emotional (78% vs 90%), cognitive (76% vs 84%), social (72% vs 81%), and sexual (30% vs 56%) functioning as very important outcomes (P < 0.001). Cluster analysis suggests that older, parous, Malaysian women, who were less likely to have received breast reconstructive surgery, were more likely to rate body image and satisfaction with the breast as very important outcomes.

CONCLUSION

Taking into account the differences in PROs by cultural and socioeconomic settings could improve patient expectation of services and refine the assessment of cancer care outcomes.

Commentary: Charting Future Directions for Research on Asian American Child Development

Asian Americans are now the fastest growing ethnic minority group in the United States, but developmental research on them lags behind that of African Americans and Latinos. It is advocated that developmental scientists working with Asian American families focus on early developmental processes, on the cultural aspects of family socialization and dynamics that may contribute to child outcomes, and on capturing the complexity of factors that promote cultural adaptation and strengths in particular contexts. The theoretical frameworks, methodological recommendations, and timely themes highlighted in this special issue will motivate scholars, interventionists, and policymakers to find ways to better understand and meet the needs of the growing number of Asian American children and their families.

Annual Review of Asian American Psychology, 2014

This 2014 review of Asian American psychology is the sixth review in the series. It includes 316 articles that met the inclusion criteria established by the past five annual reviews. Featured articles were derived from three sources: 137 were generated via the search term "Asian American" in PyscINFO, 111 were generated via a search for specific Asian American ethnic groups, and 32 were generated via author searches of articles that met the inclusion criteria. The top primary topic was health and health-related behaviors, the most frequently employed study design was cross-sectional, and the most studied Asian American ethnic group was Chinese. This year's review includes information on the target population of the primary topic, the age range and developmental period of participants, and whether the study design was cross-sectional or longitudinal. It also identifies top authors and journals contributing to the 2014 annual review. These new features reveal that the most common target population of the primary topic was youths; studies most commonly included emerging adults ages 18-25; cross-sectional study design was employed more often than longitudinal design; the top contributor to the 2014 review was Stephen Chen, who authored the highest number of papers included; and the Asian American Journal of Psychology generated the highest number of publications for this review.