Associations Between Major and Everyday Discrimination and Self-Rated Health Among US Asians and Asian Americans

COVID-19-Related Racism and Mental Health Among Asian Americans: Integrative Review

Background

Racism against Asian Americans escalated during the COVID-19 pandemic. About 31%-91% of Asian American adults and children reported experiencing various types of racism during the pandemic. According to the Federal Bureau of Investigation hate crime statistics, anti-Asian hate crime incidents increased from 158 in 2019 to 279 in 2020 and 746 in 2021. In 2022, the incidents decreased to 499, corresponding to the downward trend of the pandemic. The degree of impact racism has on mental health and wellness among Asian Americans requires investigation, specifically during the COVID-19 pandemic.

Objective

We aim to describe racism-related mental health problems experienced by Asian Americans living in the United States and propose implementation strategies for mitigating their consequences.

Methods

We conducted an integrative review of peer-reviewed publications in English reporting anti-Asian sentiments and racism's impacts on mental health among Asian Americans in the United States.

Results

The 29 eligible articles report on studies that utilized cross-sectional survey designs with various sample sizes. Racism is directly correlated with the prevalence of depression and anxiety experienced by victims of racist acts. The prevalence of in-person direct racism (racist expression aimed directly at the victim) is lower than in-person indirect racism (racist expression aimed at the ethnic group the victim belongs to). During the COVID-19 pandemic, the incidence of explicit online racism was lower than online indirect racism.

Conclusions

COVID-19-related racism exacerbated preexisting racism, contributing to worse depression and anxiety among Asian Americans. To address this issue, we propose 2 main approaches: increase public awareness and education about recognizable racist sentiments/acts and systematized reporting of racially motivated crimes to guide political action. At an individual level, culturally responsive, trauma-informed interventions promoting cultural support and cohesion for various Asian American groups will foster this empowerment. These proposed actions will help alleviate racism by reducing stereotypes, empowering victims, and chipping away at the systemic racism structure.

Perceived Racial/Ethnic Discrimination, Citizenship Status, and Self-Rated Health Among Immigrant Young Adults

Both racial/ethnic discrimination and citizenship status are manifestations of racism. Few empirical studies have examined the role of multiple stressors and how both stressors are interlinked to influence health among immigrant young adults. Informed by the theory of stress proliferation, the current study seeks to examine the interplay between perceived racial/ethnic discrimination and citizenship status on health. We used the third wave of the Children of Immigrants Longitudinal Study (CILS) to examine the influence of perceived racial/ethnic discrimination and citizenship status on self-rated health (SRH) among immigrant young adults (N = 3344). Perceived racial/ethnic discrimination was initially associated with SRH. After adjusting for both predictors, those experiencing perceived racial/ethnic discrimination and non-citizen youth were less likely to report better health than youth who did not report perceived racial/ethnic discrimination or citizen youth. In fully adjusted multivariate regression models, racial/ethnic discrimination remained significant, while citizenship status was no longer associated with SRH. To test stress proliferation, an interaction term was included to assess whether the relationship between perceived racial/ethnic discrimination and SRH varied by citizenship status. The interaction term was significant; non-citizen young adults who experienced racial/ethnic discrimination were less likely to report better health in comparison to citizen young adults and those who did not report perceived racial/ethnic discrimination. Results suggest that the interplay between perceived racial/ethnic discrimination and citizenship status may be influential for health among immigrant young adults. These findings underscore the need for further assessment of the role of stress proliferation on immigrant young adults' health.

Differential Risk: Gender and Racial Differences in the Relationship between Trauma, Discrimination, and Schizotypy

Traumatic experiences are associated with increased experiences of positive schizotypy. This may be especially important for People of Color, who experience higher rates of trauma and racial discrimination. No study to date has examined how racial disparities in traumatic experiences may impact schizotypy. Furthermore, of the studies that have examined the relationship between trauma and schizotypy, none have examined racial discrimination as a potential moderator. The present study examined if racial discrimination moderates the relationship between trauma and multidimensional (positive, negative, and disorganized) schizotypy. In a sample of 770 college students, we conducted chi-squared analyses, analyses of variance, and stepwise regressions. We found that Black students experienced significantly higher racial discrimination and trauma than Latinx and Asian students. Furthermore, Black and Latinx students experienced significantly more multidimensional schizotypy items than Asian students. Trauma and racial discrimination explained 8 to 23% of the variance in each dimension of schizotypy. Racial discrimination did not moderate the relationships between trauma and multidimensional schizotypy. Our findings suggest that we need to examine risk factors that may prevent recovery from psychotic disorders. Additionally, disorganized schizotypy showed the most robust associations and may be a critical site of intervention.

Asian Hate, religion, and perceived changes in physical health: exploring the flip side of minority stress during the COVID-19 pandemic

OBJECTIVES

Prior research suggests that racism is associated with adverse mental health outcomes for Asians in the United States. Relatively less research has been conducted to examine the effects of racism on physical health, particularly the changes in physical health among Asians and Asian Americans. This study aims to fill in this gap in prior research.

DESIGN

Survey was conducted via Qualtrics in March 2023. A panel sample of 356 Asian and Asian American adults from across the US was collected. Ordinary Least Squares Regression was employed to examine the interrelationships among racism, religion, and perceived changes in physical health during the COVID-19 pandemic.

RESULTS

Contrary to conventional wisdom, more frequent experience with blatant racism was associated with a perceived improvement in physical health after controlling for subtle racism, anxiety, acculturation, and various sociodemographic variables. Interestingly, this robust relationship was more significant among Asians who attended religious services more frequently. Additional three-way interactions revealed that the interaction between blatant racism and religious service attendance on perceived changes in physical health was more significant for US-born Asians and Asians of Indian or Japanese ethnicity.

CONCLUSION

Racism exerts a significant influence on physical health outcomes among Asians and Asian Americans. However, this relationship was contingent upon the specific aspect of racism and intersected with religiosity, acculturation, and ethnic identity.

The impact of ethnic discrimination on chronic pain: the role of sex and depression

ABSTRACTPerceived ethnic discrimination (PED) is predictive of chronic pain-related outcomes. Less is known about pathways through which these constructs interact. The goal of this study was to test whether PED was predictive of chronic pain-related outcomes (pain interference, pain intensity, and symptoms related to central sensitization), whether depression mediated the relationship between PED and pain outcomes, and if these relationships were maintained across sex in a sample of racially and ethnically minoritized adults (n = 77). PED significantly predicted pain interference, pain intensity, and symptoms related to central sensitization. Sex accounted for a significant proportion of the variance in pain interference only. Depression explained the relationship between PED and pain interference and pain intensity. Sex moderated the indirect pathway, such that for men, the relationship between PED and pain interference and pain intensity was explained via depression. Depression partially explained the relationship between PED and symptoms related to central sensitization. Sex did not moderate this mediational effect. This study provided a unique contribution to the pain literature by providing a contextual analysis of PED and pain. Addressing and validating experiences of lifetime discrimination may be a clinically relevant tool in the management of chronic pain for of racially and ethnically minoritized adults.

Experiencing, anticipating, and witnessing discrimination during the COVID-19 pandemic: Implications for health and wellbeing among Asian Americans

The onset of the COVID-19 pandemic spurred increased racial animus toward Asians and Asian Americans (A/AA) who have since been contending with increased racism and violence. While some of the harm associated with this increased prejudice may derive from personally experienced discrimination, the COVID-19 pandemic has also been marked by an increase in vicarious exposure to discrimination as well as increased anticipation of discrimination, both of which may be taxing for the mental and physical health of A/AA. The goal of this study, accordingly, was to examine the effects of personal experiences of discrimination, vicarious exposure to discrimination, and anticipated discrimination on depressive symptoms, physical health symptoms, sleep quality, and sleep disturbances among A/AA. Results from our two-wave field survey demonstrated that experiencing and anticipating discrimination were associated with mental and physical health symptoms as well as sleep disturbances. Further, personal experiences of discrimination interacted with vicarious discrimination to determine physical health symptoms such that greater vicarious exposure weakened the relationship between experienced discrimination and physical health symptoms. These findings demonstrate the need to mobilize resources to combat the multipronged, negative implications of the recent rise in anti-Asian prejudice during the COVID-19 pandemic.

Racial Discrimination and Health-Related Quality of Life: An Examination Among Asian American Immigrants

OBJECTIVES

We aimed to examine the relationship between everyday and major racial discrimination with health-related quality of life (HRQOL), which consists of self-rated health, days of poor physical health, mental health, and activity limitation.

DESIGN

In a cross-sectional analytic sample of 524 foreign-born Asian adults, aged 18 years and older, we conducted multivariable logistic regression and multivariable negative binomial regression to examine associations between discrimination and HRQOL. Furthermore, potential effect modification was tested by gender, ethnicity, and social support.

RESULTS

Associations were found between everyday racial discrimination and days of poor physical health (incidence rate ratio, IRR = 1.05), mental health (IRR = 1.03), and activity limitation (IRR = 1.05). Stronger significant associations were observed between major racial discrimination and days of poor physical health (IRR = 1.21), mental health (IRR = 1.16), and activity limitation (IRR = 1.53), adjusting for all covariates. Racial discrimination was not associated with poor self-rated health. In addition, gender significantly modified the relationship between continuous racial discrimination and activity limitation days with associations of greater magnitude among men, while social support significantly modified the association between categorized major racial discrimination and physically unhealthy days. When stratified, the association was only significant among those with low social support (IRR = 3.04; 95% CI: 1.60, 5.79) as opposed to high social support.

CONCLUSIONS

This study supports the association between racial discrimination and worse HRQOL among Asian Americans, which can inform future interventions, especially among men and those with low social support, aimed at improving the quality of life in this population.

Examining the Relationship between Discrimination and Prescription Drug Misuse: Findings from a National Survey of Black Americans

Background: Research shows that substance use may be a way individuals cope with psychosocial stressors. Less is known about whether discrimination contributes to prescription drug misuse. Methods: Using a national sample of Black Americans, we examined whether two psychosocial stressors (i.e., everyday and lifetime major discrimination) were associated with lifetime prescription drug misuse (i.e., opioids, tranquilizers, sedatives, or stimulants). Results: Our logistic regression models separately examining the influence of everyday and major discrimination controlling for relevant demographic, health, and other drug use variables showed that only everyday discrimination was associated with higher odds of prescription drug misuse. In the model simultaneously considering both types of discrimination, only unit increases in everyday discrimination were associated with higher odds of prescription drug misuse. Conclusions: Encounters with everyday discrimination may be an important psychosocial stressor linked to prescription drug misuse in Black adults and possibly other racial-ethnic minorities. Intervention strategies aiming to reduce prescription drug misuse should consider developing ways to curb the negative health-related consequences of discriminatory experiences. Strategies to combat discrimination-related prescription drug misuse and limitations of this study are discussed.

The effect of stress and acculturation on the self-rated health of Arab Americans

BACKGROUND:

The self-rated health of Arab Americans has been found to be worse than non-Hispanic whites. Psychosocial factors such as stress and acculturation may explain this disparity. As a result, we designed this survey to better understand the effects of stress and acculturation on the self-rated health of the Arab-American community.

MATERIALS AND METHODS:

Using a convenience sample, we surveyed 142 self-identified Arab Americans regarding demographics, stress, acculturation, and self-rated health. Stress was measured using instruments assessing perceived stress, everyday discrimination, and acculturative stress. Acculturation was measured using a modified Vancouver Index of Acculturation. To measure self-rated health, participants were asked to rate their current health on a scale of 1 (very poor) to 5 (very good).

RESULTS:

A logistic regression model adjusted for age, sex, body mass index, and education did not find that stress significantly affected the odds of having poor self-rated health in Arab Americans. Heritage identity was associated with lower odds of having poor self-rated health (odds ratio = 0.37, 95% confidence interval [CI] 0.15, 0.94, P < 0.05). No association was found between acculturation and poor self-rated health.

CONCLUSION:

Greater levels of stress were not significantly associated with greater odds of poor self-rated health in Arab Americans. We also found that greater heritage identity significantly decreased the odds of poor self-rated health in Arab Americans. The effects of everyday discrimination, perceived stress, and acculturation on self-rated health in Arab Americans remain unclear and need to be examined further.

Unequal Returns of Employment on Self-Rated Health: Asian-White Differences

BACKGROUND

Previous research has shown that employment status is one of the most powerful socioeconomic resources utilized to promote health and well-being. However, racial and ethnic minorities often experience diminished returns of socioeconomic resources compared to non-Hispanic Whites. This analysis explores the association between employment status and self-rated health among Asians and non-Hispanic Whites, and whether race or ethnicity moderates this association.

METHODS

We used data from the 2016 National Asian American Survey, a nationally representative survey of Asians from ten ethnic backgrounds. We measured the association between employment status and self-rated health, using race and ethnicity as the primary moderators. Age, gender, income, education, nativity status, and English proficiency were used as controls. Pooled (by race) and stratified (by ethnicity) logistic regressions were estimated.

RESULTS

The pooled logistic regressions showed that employment was associated with lower odds of poorer self-rated health among Asians and Whites. Race, however, moderated this relationship, indicating a stronger protective effect of employment for Whites. In the stratified logistic regressions, employment was not associated with lower odds of poorer self-rated health across all of the assessed Asian ethnic subgroups. Ethnicity moderated the association between employment and self-rated health, suggesting a stronger protective effect of employment for Whites than for Chinese, Hmong, Koreans, Japanese, and Filipinos.

CONCLUSION

The protective health benefits of employment do not operate the same for Whites and Asians. Discrimination and unequal labor market and working conditions may weaken the positive health returns of employment for Asians compared to their White counterparts.

Associations between everyday and major discrimination and health status among a diverse national sample of ten Asian ethnic subgroups

PURPOSE

We examined the associations between major and everyday discrimination and self-rated health among a national sample of ten Asian ethnic subgroups, including Vietnamese, Chinese, Hmong, Cambodians, Pakistanis, Indians, Bangladeshis, Japanese, Filipinos, and Koreans.

METHODS

We used data from the 2016 National Asian American Survey (n = 4427). Logistic regression analyses were conducted to explore the associations between major and everyday discrimination and self-rated health among ten Asian ethnic subgroups, controlling for relevant sociodemographic factors.

RESULTS

Findings showed that major discrimination was associated with higher odds of poorer self-rated health among Asians as a group. Subgroup analyses revealed that encounters with major discrimination were associated with poorer self-rated health among Vietnamese, Filipinos, Cambodians, and Hmong. Everyday discrimination was associated with poorer self-rated health only among Hmong.

CONCLUSION

Overall, the negative health consequences of everyday and major discrimination vary by Asian ethnic subgroup. Targeting certain forms of discrimination facing specific Asian ethnic groups is needed to reduce their risk of adverse health outcomes.