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Zhu DT, Zhong A, Ho WJ, Tamang S. Disaggregating Asian-American Mortality in Drug-Related Overdoses and Behavioral Disorders: A Cross-Sectional Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01983-5. [PMID: 38530623 DOI: 10.1007/s40615-024-01983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/25/2024] [Accepted: 03/17/2024] [Indexed: 03/28/2024]
Abstract
Asian Americans have been historically underrepresented in the national drug overdose discourse due to their lower substance use and overdose rates compared to other racial/ethnic groups. However, aggregated analyses fail to capture the vast diversity among Asian-American subgroups, obscuring critical disparities. We conducted a cross-sectional study between 2018 and 2021 examining Asian-American individuals within the CDC WONDER database with drug overdoses as the underlying cause of death (n = 3195; ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14) or psychoactive substance-related mental and behavioral disorders as one of multiple causes of death (n = 15,513; ICD-10 codes F10-F19). Proportional mortality ratios were calculated, comparing disaggregated Asian-American subgroups to the reference group (Asian Americans as a single aggregate group). Z-tests identified significant differences between subgroups. Compared to the reference group (0.99%), drug overdose deaths were less prevalent among Japanese (0.46%; p < 0.001), Chinese (0.47%; p < 0.001), and Filipino (0.82%; p < 0.001) subgroups, contrasting with a higher prevalence among Asian Indian (1.20%; p < 0.001), Vietnamese (1.35%; p < 0.001), Korean (1.36%; p < 0.001), and other Asian (1.79%; p < 0.001) subgroups. Similarly, compared to the reference group (4.80%), deaths from mental and behavioral disorders were less prevalent among Chinese (3.18%; p < 0.001), Filipino (4.52%; p < 0.001), and Asian Indian (4.56%; p < 0.001) subgroups, while more prevalent among Korean (5.60%; p < 0.001), Vietnamese (5.64%; p < 0.001), Japanese (5.81%; p < 0.001), and other Asian (6.14%; p < 0.001) subgroups. Disaggregated data also revealed substantial geographical variations in these deaths obscured by aggregated analyses. Our findings revealed pronounced intra-racial disparities, underscoring the importance of data disaggregation to inform targeted clinical and public health interventions.
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Affiliation(s)
- David T Zhu
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, 1201 E Marshall St, Richmond, VA, 23298, USA.
| | | | - Winnie J Ho
- Yale School of Public Health, New Haven, CT, USA
| | - Suzanne Tamang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Veterans Affairs, Program Evaluation Resource Center, Office of Mental Health and Suicide Prevention, Menlo Park, CA, USA
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Subica AM, Soakai L, Tukumoeatu A, Johnson T, Aitaoto N. Trauma and mental health in Pacific Islanders. Int J Soc Psychiatry 2024:207640241236109. [PMID: 38491441 DOI: 10.1177/00207640241236109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Little is known about trauma and its mental health impact on Native Hawaiians/Pacific Islanders (NH/PI), an understudied Indigenous-colonized population that endures severe mental health disparities. AIMS This novel investigation assessed trauma prevalence and its mental health and substance use correlates in NH/PIs in the U.S. METHOD Using community-based participatory research methods, survey data on NH/PI trauma, depression, anxiety, substance use, and treatment need were collected from 306 NH/PI adults using online, telephone, and in-person methods. Descriptive statistics and adjusted regression models were employed. RESULTS Sixty-nine percent of participants experienced lifetime trauma, reporting mean exposure to 2.5 different trauma types. Childhood physical and sexual abuse, and lifetime forced sexual assault rates were 34%, 25%, and 27%, respectively, exceeding general population rates. Women and men reported equivalent total mean exposure to different trauma types, as well as equal prevalence for every trauma type examined (e.g. sexual abuse/assault). Confirming hypotheses, after controlling for key demographic and mental health risk factors, increased exposure to multiple trauma types uniquely associated with greater depression, anxiety, alcohol symptomology, and greater likelihood for needing treatment and using illicit substances. CONCLUSIONS Trauma is prevalent in NH/PI populations and significantly impacts NH/PI mental health; serving as an important but overlooked contributor to NH/PI mental health disparities. Current findings fill critical gaps in our knowledge of NH/PI trauma and mental health while revealing the importance of screening and treating NH/PIs for trauma exposure to alleviate existing mental health disparities.
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Affiliation(s)
- Andrew M Subica
- School of Medicine, University of California, Riverside, USA
| | - Lolofi Soakai
- Motivating Action Leadership Opportunity, Pomona, CA, USA
| | - Amen Tukumoeatu
- Empowering Pacific Islander Communities, Inc., Portland, OR, USA
| | - Taffy Johnson
- United Territories of Pacific Islanders Alliance, Kent, WA, USA
| | - Nia Aitaoto
- United Territories of Pacific Islanders Alliance, Kent, WA, USA
- Pacific Islander Center of Primary Care Excellence, San Leandro, CA, USA
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Choi S, Hong S, Gatanaga OS, Yum AJ, Lim S, Neighbors CJ, Yi SS. Substance use and treatment disparities among Asian Americans, Native Hawaiians, and Pacific Islanders: A systematic review. Drug Alcohol Depend 2024; 256:111088. [PMID: 38262197 PMCID: PMC10922506 DOI: 10.1016/j.drugalcdep.2024.111088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/30/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND The increasing relevance of substance use disorder (SUD) within the Asian American, Native Hawaiian, and Pacific Islander (AA&NH/PI) communities, particularly amidst rising anti-Asian hate incidents and the disproportionate health and economic challenges faced by the NH/PI community during the COVID-19 pandemic, underscores the urgency of understanding substance use patterns, treatment disparities, and outcomes. METHODS Following PRISMA guidelines, 37 out of 231 studies met the search criteria. Study characteristics, study datasets, substance use rates, SUD rates, treatment disparities, treatment quality, completion rates, and analyses disaggregated by the most specific AA&NH/PI ethnic group reported were examined. RESULTS Despite increased treatment admissions over the past two decades, AA&NH/PI remain underrepresented in treatment facilities and underutilize SUD care services. Treatment quality and completion rates are also lower among AA&NH/PI. Analyses that did not disaggregate AA and NHPI as distinct groups from each other or that presented aggregate data only within AA or NHPI as a whole were common, but available disaggregated analyses reveal variations in substance use and treatment disparities among ethnic groups. There is also a lack of research in exploring within-group disparities, including specific case of older adults and substance use. CONCLUSION To address disparities in access to substance use treatment and improve outcomes for AA&NH/PI populations, targeted interventions and strategic data collection methods that capture diverse ethnic groups and languages are crucial. Acknowledging data bias and expanding data collection to encompass multiple languages are essential for fostering a more inclusive approach to addressing SUD among AA&NH/PI populations.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America.
| | - Sueun Hong
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America; New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Ohshue S Gatanaga
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Alexander J Yum
- University of Pennsylvania College of Arts and Sciences, Philadelphia, PA, United States of America
| | - Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Charles J Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
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Cha L, Thai J, True M, Le T, Ve'e T, Soon NA, Bautista R, Tseng W. A Community Assessment of Psychological Distress in Pacific Islanders Across San Francisco Bay Area Churches During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2024; 11:339-347. [PMID: 36745263 PMCID: PMC9901373 DOI: 10.1007/s40615-023-01522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated health and social disparities among US Pacific Islanders (PI). Historically, PIs have experienced a high burden of mental illness yet have underutilized mental health services. These already large treatment gaps in mental health care among PIs may worsen during the COVID-19 pandemic. In the face of pre-existing challenges, little is known about the impacts of the COVID-19 pandemic on mental health outcomes among PIs. METHODS A community-based, cross-sectional survey was administered to members of 13 PI churches across the San Francisco Bay Area. We assessed the burden of psychological distress among PIs and its associations with demographic, sociocultural, and health factors. KEY RESULTS Among 439 PI respondents, nearly half reported moderate or severe psychological distress. Only about one-tenth took prescription medication for mental health and less than half utilized a mental health provider in the past year. Most trusted PI churches to provide health and social services. Respondents reporting moderate or severe psychological distress were less likely to utilize a mental health provider in the past year and more likely to feel marginalized, excluded, isolated, or alienated from society "most of the time" or "always." Psychological distress was also associated with "fair" or "poor" health status, female gender, older adults, low trust in PI churches to provide health and social services, and concern over household finances. CONCLUSION Partnerships with faith-based and community-based organizations are essential to address unmet mental health needs and promote support-seeking behaviors among PIs during this ongoing pandemic and beyond.
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Affiliation(s)
- Leah Cha
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jessica Thai
- Berkeley School of Public Health, University of California, 2199 Addison St, Room 50, Berkeley, CA, 94720-7358, USA
| | - Makayla True
- Berkeley School of Public Health, University of California, 2199 Addison St, Room 50, Berkeley, CA, 94720-7358, USA
| | - Thomas Le
- Berkeley School of Public Health, University of California, 2199 Addison St, Room 50, Berkeley, CA, 94720-7358, USA
| | - Taunuu Ve'e
- Regional Pacific Islander Taskforce, Hayward, CA, USA
| | | | | | - Winston Tseng
- Berkeley School of Public Health, University of California, 2199 Addison St, Room 50, Berkeley, CA, 94720-7358, USA.
- Regional Pacific Islander Taskforce, Hayward, CA, USA.
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