Self-rated Health Disparities Among Asian Americans: Mediating Roles of Education Level and Household Income

Determinants of self-rated health in socioeconomically disadvantaged women: a cross-sectional study in Iran

BACKGROUND

To reduce potential health disparities, it is critical to recognize health determinants among socioeconomically disadvantaged women. Therefore, we aimed to investigate the determinants of self-rated health in socioeconomically disadvantaged women supported by a Relief Foundation (RF).

METHOD

This cross-sectional study was conducted on women in Iran who were supported by a RF as an aided institute. We collected demographic and socioeconomic data, as well as information on physical, mental, and social health and self-rated health status. Data analysis was performed by random forest, classification and regression tree (CART) techniques, and gamma regression.

RESULTS

The mean age of the 556 included disadvantaged women was 42.8 ± 12.4 years, and the mean self-rated health status was 66.5. Physical health was the most important factor affecting self-rated health. In disadvantaged women with physical problem, nonacademic and academic educated had significantly greater health perceptions than illiterate individuals (1.267, 95% CI: 1.106, 1.451) and (1.666, 95% CI: 1.251, 2.217) respectively. Also, anxiety and stress were both significant predictors of self-rated health status in disadvantaged women with physical health problem (0.765, 95% CI: 0.653, 0.896), and (0.872, 95% CI: 0.762, 0.999) respectively.

CONCLUSION

The study of disadvantaged women revealed a significant influence of physical health on their overall sense of well-being. The findings suggest that education and anxiety have impacts on self-rated health of both diseased and healthy women. To improve the well-being of disadvantaged women, providing accessible physical and mental health support, along with expanding educational opportunities, would be beneficial.

Examining Health Insurance and Non-Medical Challenges Among Vietnamese Americans in Texas During the COVID-19 Pandemic

When COVID-19 data on Asian Americans are available, they are frequently aggregated, concealing community-specific concerns. Consequently, there is limited COVID-19 literature on Vietnamese Americans. In this study, we investigated the association between health insurance coverage and non-medical challenges during the COVID-19 pandemic, in Vietnamese Americans in Texas. The NIH Community Engagement Alliance (CEAL) Common Survey 2 was administered electronically in English and Vietnamese and contained 23 questions about non-medical drivers of health, COVID-19 vaccination, and research participation. Vietnamese American adults in Texas were recruited between September 2021 and March 2022 via partnerships with community organizations. Responses were compared and analyzed using logistic regression. Of 217 respondents, 23 (11%) were uninsured. Of the uninsured participants, 43% lost health insurance coverage during the COVID-19 pandemic. Uninsured individuals had significantly higher odds of experiencing non-medical challenges, including obtaining housing (OR = 6.10, p < 0.001), food (OR = 6.41, p < 0.001), and medications (OR = 3.45, p < 0.05) than insured individuals. Uninsured individuals had a significantly longer time-lapse since seeing a healthcare provider (ordinal OR = 0.20, p < 0.05) than insured individuals. Thus, lack of insurance is strongly associated with non-medical challenges during the COVID-19 pandemic among Vietnamese Americans in Texas. Disaggregating data can address non-medical drivers of health, advancing equity for marginalized communities.

Disparities in educational attainment and assault mortalities among Asian Americans in the USA, 2009-2021

BACKGROUND

In 2021, a spike in Asian American hate crimes resurged discussion on Asian health disparities. This study describes the association between education and assault among Asian Americans and their subgroups.

METHODS

This cross-sectional study used individual-level data from the mortality multiple cause-of-death data from the National Center for Health Statistics from 2009 to 2021. Non-Hispanic Asians or Pacific Islanders age>25 years who died from assault (X85-Y09) were disaggregated into Chinese, Japanese, Filipino, Indian, Korean and Vietnamese. The gross proportion of decedents who attained at least bachelor's degrees was calculated for Asians or Pacific Islanders and each subgroup and compared with data from the National Center for Education Statistics reported in 2016.

RESULTS

Based on US Census estimates in 2016, 55% Chinese, 52% Japanese, 50% Filipino, 56% Korean, 75% Indian and 29% Vietnamese>25 years held at least bachelor's degrees. Between 2009 and 2021, there were 3495 assault mortalities involving Asians or Pacific Islanders, 22.3% of whom had at least attained bachelor's degrees. On disaggregating the data, 35.6% Chinese, 27.7% Japanese, 33.2% Filipino, 43.0% Indian, 36.3% Korean and 15% Vietnamese decedents attained at least a bachelor's degree.

CONCLUSIONS

Higher educational attainment is correlated with fewer assault deaths across all Asians. Variation in the proportion of Indian and Vietnamese victims with at least bachelor's degrees may be explained by significantly different rates of bachelor's degrees. However, the variation in proportion of Chinese, Japanese, Filipino and Korean victims with at least bachelor's degrees requires further investigation into underlying factors that contribute to assault disparities.

Perceived Community Belonging as a Moderator: Effects of Childhood Abuse on Health and Well-Being Among Middle-Aged and Older Canadians

This study examined the moderating role of perceived community belonging in the relationship between childhood abuse and health and well-being outcomes among Canadian individuals aged 55 and older. Using data from the 2014 Canadian General Social Survey (n = 14,416), multiple linear regression models revealed that women who experienced either childhood physical or sexual abuse reported poorer self-rated general and mental health, as well as lower life satisfaction, compared to those without such histories. The most pronounced effects were observed among women who experienced both types of abuse. For men, a similar pattern was evident only for those who experienced childhood physical abuse. Notably, among women, a strong sense of community belonging lessened the negative effects of both types of childhood abuse on all examined outcomes. These findings underscore the protective role of perceived community belonging against the consequences of childhood abuse for older women. They illuminate the crucial role of gerontological social workers and scholars in promoting community integration and support. Focusing on these areas, especially for those with traumatic histories, can potentially improve their overall health and well-being.

Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions

BACKGROUND

Self-rated health (SRH) is widely recognized as a clinically significant predictor of subsequent mortality risk. Although COVID-19 may impair SRH, this relationship has not been extensively examined. The present study aimed to examine the correlation between habitual sleep duration, changes in sleep duration after infection, and SRH in subjects who have experienced SARS-CoV-2 infection.

METHODS

Participants from 16 countries participated in the International COVID Sleep Study-II (ICOSS-II) online survey in 2021. A total of 10,794 of these participants were included in the analysis, including 1,509 COVID-19 individuals (who reported that they had tested positive for COVID-19). SRH was evaluated using a 0-100 linear visual analog scale. Habitual sleep durations of < 6 h and > 9 h were defined as short and long habitual sleep duration, respectively. Changes in habitual sleep duration after infection of ≤ -2 h and ≥ 1 h were defined as decreased or increased, respectively.

RESULTS

Participants with COVID-19 had lower SRH scores than non-infected participants, and those with more severe COVID-19 had a tendency towards even lower SRH scores. In a multivariate regression analysis of participants who had experienced COVID-19, both decreased and increased habitual sleep duration after infection were significantly associated with lower SRH after controlling for sleep quality (β = -0.056 and -0.058, respectively, both p < 0.05); however, associations between current short or long habitual sleep duration and SRH were negligible. Multinomial logistic regression analysis showed that decreased habitual sleep duration was significantly related to increased fatigue (odds ratio [OR] = 1.824, p < 0.01), shortness of breath (OR = 1.725, p < 0.05), diarrhea/nausea/vomiting (OR = 2.636, p < 0.01), and hallucinations (OR = 5.091, p < 0.05), while increased habitual sleep duration was significantly related to increased fatigue (OR = 1.900, p < 0.01).

CONCLUSIONS

Changes in habitual sleep duration following SARS-CoV-2 infection were associated with lower SRH. Decreased or increased habitual sleep duration might have a bidirectional relation with post-COVID-19 symptoms. Further research is needed to better understand the mechanisms underlying these relationships for in order to improve SRH in individuals with COVID-19.

Racism, self-rated general health status, and health-related quality of life among Black and Asian Americans

Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities. Extant research shows significant health inequities between white and Black people. However, little is known about health gaps between or among other racial groups. This study investigated how Blacks and Asian Americans perceive and experience racism in healthcare settings and in general daily life situations, and how these factors relate to their self-rated general health status and health-related quality of life. Findings from an online survey suggest strong similarities and subtle differences between the two racial groups and within the Asian subgroups.

Operationalizing racialized exposures in historical research on anti-Asian racism and health: a comparison of two methods

Background

Addressing contemporary anti-Asian racism and its impacts on health requires understanding its historical roots, including discriminatory restrictions on immigration, citizenship, and land ownership. Archival secondary data such as historical census records provide opportunities to quantitatively analyze structural dynamics that affect the health of Asian immigrants and Asian Americans. Census data overcome weaknesses of other data sources, such as small sample size and aggregation of Asian subgroups. This article explores the strengths and limitations of early twentieth-century census data for understanding Asian Americans and structural racism.

Methods

We used California census data from three decennial census spanning 1920-1940 to compare two criteria for identifying Asian Americans: census racial categories and Asian surname lists (Chinese, Indian, Japanese, Korean, and Filipino) that have been validated in contemporary population data. This paper examines the sensitivity and specificity of surname classification compared to census-designated "color or race" at the population level.

Results

Surname criteria were found to be highly specific, with each of the five surname lists having a specificity of over 99% for all three census years. The Chinese surname list had the highest sensitivity (ranging from 0.60-0.67 across census years), followed by the Indian (0.54-0.61) and Japanese (0.51-0.62) surname lists. Sensitivity was much lower for Korean (0.40-0.45) and Filipino (0.10-0.21) surnames. With the exception of Indian surnames, the sensitivity values of surname criteria were lower for the 1920-1940 census data than those reported for the 1990 census. The extent of the difference in sensitivity and trends across census years vary by subgroup.

Discussion

Surname criteria may have lower sensitivity in detecting Asian subgroups in historical data as opposed to contemporary data as enumeration procedures for Asians have changed across time. We examine how the conflation of race, ethnicity, and nationality in the census could contribute to low sensitivity of surname classification compared to census-designated "color or race." These results can guide decisions when operationalizing race in the context of specific research questions, thus promoting historical quantitative study of Asian American experiences. Furthermore, these results stress the need to situate measures of race and racism in their specific historical context.

Unpacking the Association Between Length of Residence and Health Among Immigrants in Canada: A Moderated Mediation Approach

The present study examines (1) whether perceived life stress mediates the associations between length of residence in Canada and self-rated mental health and general health and (2) how these processes differ across levels of perceived local community belonging. Data are from the 2017-2018 Canadian Community Health Survey (N = 14,570)-a nationally representative survey collected by Statistics Canada. Simple mediation and moderated mediation models are employed. The simple mediated associations are evaluated first and found to be statistically significant for both self-rated mental health (b = 0.046, 95% PBCI = 0.035, 0.058) and general health (b = 0.045, 95% PBCI = 0.034, 0.056). Moderated mediation analysis then reveals that while perceived local community belonging does not moderate the effects of length of residence on perceived life stress, it does moderate the effects of perceived life stress on self-rated mental health (b = - 0.042, 95% PBCI = - 0.057, - 0.028) and general health (b = - 0.026, 95% PBCI = - 0.042, - 0.011), suggesting that the adverse associations between perceived life stress and self-rated mental health and general health are weaker among immigrants with greater perceived local community belonging. Consistent with the predictions, the indirect effects are significant at all levels of local community belonging. Findings from this study highlight the need to focus more research and policy interventions on community-based coping resources.

The role of community and culture in abortion perceptions, decisions, and experiences among Asian Americans

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.

Social Capital and Self-Rated Health: A Cross-Sectional Study among Rural Japanese Working Residents

Social capital is positively associated with self-rated health; however, this association among workers is still unclear. Thus, this study examined the relationship between social capital and self-rated health with special attention to the employment type. A cross-sectional survey was conducted with 6160 workers aged 20-64 years from two towns in Mie Prefecture in January-March 2013. Social capital was assessed using five items in 4816 income-earning workers. The social capital scores were summed and then divided into three groups. The self-rated health responses were dichotomised into 'poor' and 'good'. The association was examined using a stepwise binomial logistic regression stratified by employment type and adjusted for potential confounders. Regular employees with low social capital had a higher significant odds ratio of poor self-rated health than medium (OR 0.58 95% CIs 0.39-0.87) and high (OR 0.39; 95% CIs 0.26-0.59) social capital levels after controlling for all potential confounders. Similar patterns were observed for non-regular employees with medium and high social capital. There was a significant relationship between some indicators of social capital and poor self-rated health among self-employees. These results highlight that social capital acts as an unequal health resource for different types of workers.

East Asian Population

This article explores the ways East Asian American (EAA) children and adolescents have experienced disparities in the United States throughout the COVID-19 pandemic. The history of racism toward Asian American and Pacific Islanders (AAPI) and the complexities of acculturation are reflected through this contemporary lens. Traditional East Asian (EA) values were disrupted during this period. Implications for children and families are discussed. Persistent underlying xenophobia and racism, such as the model minority myth or perpetual foreigner stereotype, rose to new prominence, furthering emotional distress in EA and EAA youths beyond those already experienced universally by AAPI families during the pandemic.

Racial and Treatment Center Differences on Time to Treatment Initiation for Nonsmall Cell Lung Cancer Patients Receiving Radiation Therapy As an Initial Treatment

Objective:

Because time to treatment has been shown to be associated with increase in the risk of death for Non Small Cell Lung Cancer (NSCLC) patients, we examined the prevalence and magnitude of racial disparities in mean time to radiation therapy (TTRT) for Stage I-III non-small cell lung cancer patients across a variety of treatment facilities.

Methods:

Utilizing the United States National Cancer Database (NCDB), we determined differences in TTRT between different races and different treatment facilities.

Results:

Concordant with past research, we found that non-White patients and patients treated at academic facilities, regardless of race, have longer mean TTRT, and that racial disparities in TTRT extend across all treatment facilities (all p<0.05).

Conclusions:

These findings shed light on the potential presence of and impact of structural racism on patients seeking cancer treatment, and the need for further investigation behind the reasonings behind longer TTI for non-White patients. To elucidate the real-world applicability of these results, further investigation into the societal determinants that perpetuate disparity in time to radiation therapy, and potential interventions in the clinical setting to improve cultural and racial sensitivity among healthcare professionals is recommended.

Food Insecurity, Financial Hardship, and Mental Health Among Multiple Asian American Ethnic Groups: Findings from the 2020 COVID-19 Household Impact Survey

Background

The COVID-19 pandemic has adversely impacted the financial and mental well-being of U.S. adults, however, Asian American (AA)-specific data are lacking, particularly disaggregated by AA ethnicity. Our objective was to evaluate food insecurity (FI), financial hardship, and mental health among disaggregated AA ethnic groups during the COVID-19 pandemic.

Methods

We used data from the COVID-19 Household Impact Survey, a sample of 10,760 U.S. adults weighted to reflect the U.S. population (weighted n: 418,209,893). AA ethnic categories were based on self-report (n=312, 5.1%; weighted n: 21,143,079) and provided as follows: Chinese American, South Asian, Filipino+Vietnamese, and Japanese+Korean. We estimated the prevalence of FI and financial hardship across AA ethnic categories. We estimated the demographic determinants of FI, including financial hardship, among AA adults using multivariable Poisson regression. We calculated the prevalence of mental health symptoms among food-insecure AA adults, as well as among AA adults experiencing both FI and financial hardship.

Results

Overall, the prevalence of FI and financial hardship among AA adults was highest among Filipino+Vietnamese adults (52.9-24.5%) and lowest among Japanese+Korean adults (13.9-8.6%). Determinants of FI among AA adults included Filipino+Vietnamese ethnicity (adjusted prevalence ratios [aPR]: 2.81, 95% confidence interval [CI]: 1.49-5.29), being widowed/divorced/separated (aPR: 3.14, 95% CI: 1.37-7.23), high school graduate only (aPR: 3.46, 95% CI: 1.96-6.11), having low income <$30,000 (aPR: 2.54, 95% CI: 1.27-5.06), and living in rural areas (aPR: 7.65, 95% CI: 1.17-50.14). Eighty-one percent and 63% of AA adults with anxiety and hopelessness at least 3-7 days/week, respectively, were food insecure and experiencing financial hardship.

Conclusion

Disparities exist in FI and financial hardship among AA adults, particularly Filipino+Vietnamese adults, and are associated with increased self-reporting of feelings of anxiety and hopelessness.

Assessing the Validity of Self-rated Health Across Ethnic Groups: Implications for Health Disparities Research

OBJECTIVES

This study examines the association between morbidity (i.e., chronic health conditions) and self-rated health (SRH) with the aim of testing the within-group and across-group validity of SRH across nine ethnic groups: non-Latinx White, Mexican, Puerto Rican, Cuban, African American, Afro-Caribbean, Chinese, Filipino, and Vietnamese Americans. In addition, we assess whether acculturation (i.e., nativity, years of US residency, language of interview) and health-related factors (e.g., mental disorder) account for ethnic distinctions in SRH.

DESIGN

Data are from the National Survey of American Life (NSAL) and the National Latino and Asian American Study (NLAAS) (N = 8338). Weighted proportions and means for SRH and chronic conditions are reported. Ordered logistic regression analysis is used to determine ethnic group patterns in SRH.

RESULTS

Despite evidence of within-group validity of SRH for each ethnic group, our results seriously challenge the across-group validity of SRH. For example, Chinese and Vietnamese respondents report lower SRH despite having fewer chronic conditions relative to non-Latinx Whites. Moreover, Mexican Americans report fewer chronic health problems but lower SRH compared to non-Latinx Whites. Acculturation factors (e.g., language of interview) partially explain the Mexican-White difference in SRH. Among Chinese Americans, completing an interview in English is associated with higher SRH relative to those who completed an interview in Chinese.

CONCLUSION

These findings have implications for health disparities research that uses SRH as the dependent measure. Studies that compare the health profiles of diverse ethnic groups should use the SRH measure with caution, as SRH does not align with ethnic patterns of morbidity.

Asian Ethnic Subgroup Disparities in Delays of Surgical Treatment for Breast Cancer

Background

As Asian American breast cancer incidence rises, it is necessary to investigate the origins of differential breast cancer outcomes among Asian ethnic subgroups. This study aimed to examine disparities in delays of breast cancer surgery among Asian ethnic subgroups.

Methods

We obtained California Cancer Registry data on female breast cancer diagnoses and treatment from 2012 to 2017. Our main independent variable was patient race and ethnicity, including 6 Asian ethnic subgroups. Dependent variables included time to surgical treatment for breast cancer and receipt of surgical treatment within 30 and 90 days of diagnosis. We conducted multivariable logistic regression to determine the odds of receiving surgery within 30 and 90 days of diagnosis and multivariable Cox proportional hazards regression to determine the risk of prolonged time to surgery.

Results

In our cohort of 93 168 breast cancer patients, Hispanic (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.82 to 0.89) and non-Hispanic Black (OR = 0.83, 95% CI = 0.78 to 0.88) patients were statistically significantly less likely than non-Hispanic White patients to receive surgery within 30 days of breast cancer diagnosis, whereas Asian Indian or Pakistani (OR = 1.23, 95% CI = 1.09 to 1.40) and Chinese (OR = 1.30, 95% CI = 1.20 to 1.40) patients were statistically significantly more likely to receive surgery within 30 days of diagnosis.

Conclusions

This large, population-based retrospective cohort study of female breast cancer patients is the first, to our knowledge, to demonstrate that time to surgical treatment is not equal for all Asians. Distinct differences among Asian ethnic subgroups suggest the necessity of further investigating breast cancer treatment patterns to fully understand and target disparities in breast cancer treatment.

Racial Disparities in Surgery for Malignant Bowel Obstruction

BACKGROUND

Operative management of patients with malignant bowel obstruction (MBO) may provide effective palliation, but is associated with substantial risks. This study aimed to analyze racial and ethnic differences in surgical outcomes for patients with MBO.

METHODS

This retrospective study, using National Surgical Quality Improvement Program (NSQIP) registry data from 2010 to 2019, compared differences in outcomes by race and ethnicity for 2762 patients undergoing surgery for MBO. Multivariable logistic regression controlled for relevant covariates.

RESULTS

Black patients (n = 407) had higher rates of preoperative comorbidity and were more likely than White patients (n = 2081) to have major complications (28.5% vs 21.8%; p = 0.0031), overall complications (47.4% vs 40.4%; p = 0.0087), a longer median hospital stay (12 days; interquartile range [IQR, 8-19 days] vs 10 days [IQR, 7-17 days]; p = 0.0007), and unplanned readmission (17.1% vs 12.9%; p = 0.0266). Black patients had a similar mortality rate to that of White patients and were less frequently discharged to home (67.6% vs 73.0%; p = 0.0315). Differences in morbidity between Black patients and White patients persisted after controlling for potentially confounding variables. Hispanic patients had lower mortality than White patients (6.3% vs 13.1%; p = 0.0130) and a longer hospital stay (12 days [IQR, 8-18 days] vs 10 days [IQR, 7-17 days]; p = 0.0313). Outcomes did not differ between Asian patients and White patients.

CONCLUSIONS

This study demonstrated significant disparities for Black patients undergoing surgery for MBO. Understanding and addressing what drives these differences, including systemic inequalities such as access to care and racial biases, is essential to the achievement of more equitable, higher-quality patient care.

Weight, Weight Perceptions, and Health and Well-Being Among Canadian Adolescents: Evidence From the 2017-2018 Canadian Community Health Survey

PURPOSE

The present study examines the extent to which (mis)matched weight and weight perceptions predict adolescents' self-rated health, mental health, and life satisfaction.

DESIGN

Quantitative, cross-sectional study.

SETTING

Data from the 2017-2018 Canadian Community Health Survey (CCHS)-a nationally representative sample collected by Statistics Canada.

PARTICIPANTS

Canadian adolescents aged between 12 and 17 (n = 8,081).

MEASURES

The dependent variables are self-rated health, mental health, and life satisfaction. The independent variable is (mis)matched weight and weight perceptions.

ANALYSIS

We perform a series of ordinary least squares (OLS) regression models.

RESULTS

Overweight adolescents with overweight perceptions are associated with poorer self-rated health (b = -.546, p < .001 for boys; b = -.476, p < .001 for girls), mental health (b = -.278, p < .001 for boys; b = -.433, p < .001 for girls), and life satisfaction (b = -.544, p < .001 for boys; b = -.617, p < .001 for girls) compared to their counterparts with normal weight and normal weight perceptions. Similar patterns have also been observed among normal weight adolescents with overweight perceptions (e.g., normal weight adolescents with overweight perceptions are associated with poorer self-rated health (b = -.541, p < .01 for boys; b = -.447, p < .001 for girls)).

CONCLUSION

Normal weight adolescents are not immune to adverse self-rated health, mental health, and life satisfaction because their weight perceptions are also a contributing factor to health and well-being consequences.

Contrasting the experiences for high- and low-income Asian Americans during COVID-19

There is a lack of quantitative research examining how the pandemic has affected individuals at different income levels. The Asian American population has the highest level of income inequality and serves as an excellent case study for examining differences in experience between income groups. A non-probability sample of 3084 Asian American adults living in the US was surveyed in June 2020, examining health-related behaviors and outcomes. Descriptive analyses and chi-squared statistics were conducted to identify differences in income groups (low, medium, high) among Asian Americans across regional subgroups (East, South, Southeast, Multiethnic) and disaggregated ethnicities (Chinese, Asian Indian, Japanese, and Filipino). In bivariable analyses, a significantly (p < 0.05) greater percentage of high-income individuals during the pandemic reported having enough money to buy the food they needed, a away to get to the store for food, and reported stores where they get food had everything they needed. High-income Chinese, Japanese, and Filipino individual also noted that, since the COVID-19 crisis, they are now working partially or fully from home. In the total sample, multivariable adjusted logistic regressions revealed medium- and low-income individuals to have low odds of working partially or fully from home (AOR:0.55, 95%CI:0.42-0.72), higher odds of not having enough money to buy the food they needed (AOR:3.54, 95%CI:1.43-11.81), and higher odds of eating less (AOR:1.58, 95%CI:1.14-2.22). These results highlight the importance of considering income distribution when characterizing disparities in health behaviors within racial/ethnic minority groups and underscore the need to bolster the infrastructure supporting low-income Asian Americans.

Relationship between Employment Type and Self-Rated Health among Korean Immigrants in the US: Focusing on Gender and Number of Years in the US

Although Korean immigrants report worse self-rated health and a higher self-employment rate than other Asian immigrant groups, the relationship between their employment type and self-rated health is understudied. This study examines the relationship between employment type and self-rated health among Korean immigrants in the US. Survey data of 421 first-generation working-age (18-64 years old) Korean immigrants in the New York-New Jersey area were analyzed. The self-administrated survey questionnaire included 39 items (e.g., sociodemographic characteristics, self-rated health, and health insurance status). A logistic regression analysis was conducted to examine the relationship between the dependent variable-self-rated health (e.g., bad/not bad vs. good/very good)-and independent variable-employment type (e.g., work at non-ethnic firms, work at co-ethnic firms, self-employed, and unemployed)-by focusing on differences regarding gender and number of years living in the US. Self-employed and unemployed Korean immigrants were less likely to report good health compared to those working in non-ethnic firms. After controlling for sociodemographic characteristics (age, gender, marital status, education, health insurance status, membership in any Koran association, religion, and English proficiency), the relationship between employment type and self-rated health remained significant among female and recent Korean immigrants. More worksite interventions by occupational health nurses that target self-employed Korean immigrants, especially women and recent immigrants, are necessary.