Asian American Youth Research Articles

A Systematic Review of Barriers and Facilitators Impacting the Utilization of Mental Health Services Among Asian American Youth

ABSTRACT Background Asian American youth are the least likely racial/ethnic group to receive mental health services in the U.S. perpetuating mental health disparities within this population. In response, studies have begun to identify barriers and facilitators influenced by Asian cultural factors that impact access to mental health care in this population. Objective As no published studies have synthesized this literature, our preregistered systematic review sought to consolidate the existing literature on barriers and facilitators of mental health service use for Asian American youth across 1) knowledge, 2) structural, 3) attitudinal, and 4) relational domains, and to examine the role of cultural factors. Method All procedures were conducted in accordance with PRISMA guidelines. Searches were conducted in October 2023 using PsycINFO, PubMed, and Medline. Of the 605 articles identified, 6 met criteria for inclusion. We used a convergent integrated approach to synthesize the coded barriers and facilitators of mental health service use. All six studies examined barriers that included structural, attitudinal, relational, knowledge, cultural, and other factors. Two studies described facilitators that included structural, attitudinal, and relational factors. Results We found that: 1) Asian American youth faced barriers known to impact service use more generally in the literature (i.e. knowledge, relational, attitudinal, and structural barriers), and 2) Cultural factors were part of these themes and distinct barriers. Conclusions The findings highlight the pressing need to address barriers perpetuating Asian American youth mental health disparities and the potential for culturally relevant facilitators to improve access to care.

Disaggregated Suicide Mortality Rates Among Asian American Youths and Young Adults by Ethnic Subgroup

This cross-sectional study examines suicide mortality rates among Asian American youths and young adults overall and by ethnic subgroup from 2018 to 2021.

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.

Contributors to Underdiagnosis of ADHD among Asian Americans: A Narrative Review

Objective Rates of ADHD are lowest among Asian American children (1–6.1%) compared to all other major ethnic and racial groups in the US, but there is limited literature on reasons for the disparity in estimated prevalence rates. Method: We conducted a narrative review to integrate the literature on ADHD in children in Asian countries with that on ADHD among Asian American youth to highlight potential explanations for disparities in ADHD diagnosis and treatment among Asian American children relative to other racial and ethnic groups. Results: Factors possibly contributing to the low estimated prevalence rates of ADHD among Asian American children include: a higher proportion of Inattentive ADHD presentation among Chinese, Malaysian, and Indian children; racial bias and the influence of the Model Minority Myth; cultural differences in classroom identification; mental health stigma in Asian American communities; parent perception of ADHD as misbehavior rather than a neurodevelopmental disorder; and parent support for children’s academic activities that may mask impairment. Conclusion: We offer recommendations to inform individual and community-level psychoeducation, and new directions for research to address this health disparity.

Suicide Rates Among Asian American and Pacific Islander Youths—A Cause for Alarm

Suicide Rates Among Asian American and Pacific Islander Youths—A Cause for Alarm

National Trends in Suicide Among Asian American or Pacific Islander Youth

National Trends in Suicide Among Asian American or Pacific Islander Youth

Impact of Perceived Racial Discrimination on Depressive Symptoms and School Outcomes Among Asian American Youth

Using two survey datasets–the Korean American Families (KAF) Project and the Cross Cultural Families (CCF) Project, this study examined how perceived racial discrimination influences depressive symptoms and school outcomes among Asian American adolescents, and what factors mediate the association between perceived discrimination and youth outcomes. The KAF Project surveyed Korean American (KA) youth in Midwest (n = 220), and the CCF Project surveyed Cambodian American (CA) youth (n = 164), and Vietnamese American (VA) youth (n = 163) in a Pacific Northwest school district. Using Structural Equation Modeling, the results revealed perceived discrimination was positively associated with depressive symptoms for KA and VA youths, but school misbehavior only for CA youth. Among KA youth, perceived discrimination was positively associated with ethnic identity, in turn positively related to social support, thereby reducing depressive symptoms. Among CA and VA youths, perceived discrimination was not associated with ethnic identity, but ethnic identity was related to social support, which in turn was associated with lower depressive symptoms, less school misbehaviors and better grades. This study offers insights into the way in which perceived racial discrimination may exert an impact on children’s mental health and school outcomes and how the mechanisms that explain this relationship vary across AA subgroups. The findings of this study highlight the need for sustained research in the future to advance research and practice for AA groups.

Comparing the Effectiveness of Solution-Focused Brief Therapy for Adolescent Outcomes in Schools Between the U.S. and East Asian Studies: A Systematic Review and Meta-Analysis

Solution-focused brief therapy (SFBT) can be a culturally adaptive school-based intervention for youth. Despite the evidence that supports the practical use of SFBT with various populations, its effectiveness particularly among East Asian American (EAA) youth outcomes in school settings requires further study. For this systematic review and meta-analysis, we searched U.S. and East Asian studies (e.g., Chinese, Korean, and Japanese) published from 1995 to 2022 and compared the treatment effects of SFBT on youth outcomes. This study looked at results from 110 studies from the U.S., Chinese, and Korean literatures and revealed stronger treatment effects of SFBT in Chinese and Korean studies compared with U.S. studies. The moderation effects of country showed that the overall treatment effect size was greater among Korean studies compared with U.S. studies. Implications for the use of SFBT among EAA youth are discussed.

Ethnic‐racial socialization in Chinese American immigrant families: Associations with middle childhood ethnic identity

AbstractCompared to studies of ethnic identity development in adolescence, fewer investigations have examined the development of ethnic identity during middle childhood, a developmental period of dynamic social and cognitive changes that have direct implications for social identity and group membership. Moreover, research on the developmental processes of Asian American youth has also primarily utilized cross‐group comparisons, while neglecting consideration of variations in acculturation, socioeconomic status, and other sociodemographic characteristics within Asian American ethnic groups. Using a socioeconomically‐ and acculturatively‐diverse sample of Chinese immigrant families in the United States (N = 169; 49.1% girls; M = 9.16 years; SD = 1.05), the present study examined how parents’ ERS practices varied by parents’ socioeconomic status, education, and cultural orientations, then tested associations between parents’ ERS and children's self‐reported ethnic centrality and ethnic regard. More highly‐educated Chinese American immigrant parents reported more frequent cultural socialization and more acculturated parents reported more preparation of their children for racial and ethnic bias. Consistent with hypotheses, parents’ cultural socialization was positively associated with children's self‐reported ethnic centrality and positive regard. Results highlight the roles of social status and acculturation in Chinese immigrant parents’ ERS, and point to middle childhood as a key developmental window for ethnic identity socialization and development in immigrant families.

Friendship Homophily Trajectories among Asian American Youth from High School to College.

Friendship racial homophily, the tendency to form friendships with individuals who share the same racial background, is a normative developmental phenomenon that holds particular significance for youth of color in a racialized society. Yet, there exists a paucity of longitudinal research elucidating the stability and change of friendship racial composition across developmental span. This study aimed to examine the friendship racial homophily trajectories over a six-year period encompassing four time points. The sample comprised 437 Asian American youth (MAge = 16.52, SDAge = 1.36, 53% female), with 197 Filipino and 240 Korean participants. Using logistic multilevel modeling analyses, it was found that both Filipino and Korean American youth demonstrated an increase in friendship racial homophily from high school to college, but that Filipino youth overall reported lower levels of racial homophily compared to their Korean counterparts. The study findings also pinpointed several influential factors impacting these trajectories, including proficiency in heritage languages, ethnic identity, and encounters with racial discrimination from both White Americans and other People of Color. These results highlight the continuous evolution of friendship racial composition from high school to college and emphasize the crucial role of ethnic identity and experiences of discrimination in influencing these dynamics, with ethnic identity exerting more enduring effects and experiences of discrimination showing more situational impacts on the levels of racial homophily.

Alcohol and Substance Use Among Different Subgroups/Ethnicities of East Asian American Youth in the United States

This reading challenges the prevailing Model Minority Myth perspective which influences the examination of substance use patterns among different subgroups of East Asian American (EAA) youth. A disaggregated analysis of existing literature reveals significant variations in substance use across EAA subgroups. This article explores influencing factors such as acculturation, cultural norms, and peer dynamics, emphasizing distinctions between Chinese Americans, Taiwanese Americans, Korean Americans, and Japanese Americans. Several EAA subgroups show a higher prevalence of cigarette or alcohol use than their white counterparts, a finding normally hidden by the aggregation of Asian American data. These unrealized differences prompt a call for tailored and culturally appropriate treatment approaches. Data shows EAA youth are more likely to not seek treatment or to drop out after beginning treatment (Wang & Kim, 2010 as cited in Ong, 2023). Understanding the typical family dynamics as well as the discrimination faced by EAA communities, including cultural stigma and culture-specific syndromes, plays a crucial role in improving treatment adherence. Additionally, studies of treatment preferences show that implementing family-based programs, outreach efforts, and involving culturally attuned treatment providers is crucial to actively address the unique needs of youth of different EAA subgroups (Lee et al., 2004). Keywords: substance use, treatment approach, culturally appropriate care, East Asian American, model minority

Pubertal Timing Across Asian American, Native Hawaiian, and Pacific Islander Subgroups

Earlier puberty is associated with adverse health outcomes, such as mental health issues in adolescence and cardiometabolic diseases in adulthood. Despite rapid growth of the Asian American, Native Hawaiian, and Pacific Islander populations in the US, limited research exists on their pubertal timing, potentially masking health disparities. To examine pubertal timing among Asian American, Native Hawaiian, and Pacific Islander children and adolescents by disaggregating ethnic subgroups. This retrospective cohort study included Asian American, Native Hawaiian, and Pacific Islander youths aged 5 to 18 years assessed for pubertal development at Kaiser Permanente Northern California, a large, integrated health care delivery system. Follow-up occurred from March 2005, through December 31, 2019. Data were analyzed in October 2023. Race and ethnicity, categorized into 11 ethnic subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Native Hawaiian and Pacific Islander, Other South Asian, Other Southeast Asian, Vietnamese, multiethnic, and multiracial. Pubertal timing was determined using physician-assessed sexual maturity ratings (SMRs). Outcomes included the median age at transition from SMR 1 (prepubertal) to SMR 2 or higher (pubertal) for onset of genital development (gonadarche) in boys, breast development (thelarche) in girls, and pubic hair development (pubarche) in both boys and girls. In this cohort of 107 325 Asian American, Native Hawaiian, and Pacific Islander children and adolescents (54.61% boys; 12.96% Asian Indian, 22.24% Chinese, 26.46% Filipino, 1.80% Japanese, 1.66% Korean, 1.96% Native Hawaiian and Pacific Islander, 0.86% Other South Asian, 3.26% Other Southeast Asian, 5.99% Vietnamese, 0.74% multiethnic, and 22.05% multiracial), the overall median ages for girls' pubarche and thelarche were 10.98 years (95% CI, 10.96-11.01 years) and 10.13 years (95% CI, 10.11-10.15 years), respectively. For boys' pubarche and gonadarche, median ages were 12.08 years (95% CI, 12.06-12.10 years) and 11.54 years (95% CI, 11.52-11.56 years), respectively. Differences between subgroups with earliest and latest median age at onset were 14 months for girls' pubarche, 8 months for thelarche, 8 months for boys' pubarche, and 4 months for gonadarche. In general, Asian Indian, Native Hawaiian and Pacific Islander, and Other South Asian subgroups had the earliest ages at onset across pubertal markers, while East Asian youths exhibited the latest onset. Restricting to those with healthy body mass index did not substantially change the findings. In this cohort study of Asian American, Native Hawaiian, and Pacific Islander children and adolescents, pubertal timing varied considerably across ethnic subgroups. Further investigation is warranted to assess whether these differences contribute to observed health disparities in adulthood, such as type 2 diabetes and cardiovascular diseases.

Hate Speech Against Asian American Youth: Pre-Pandemic Trends and The Role of School Factors

Although hate speech against Asian American youth has intensified in recent years—fueled, in part, by anti-Asian rhetoric associated with the COVID-19 pandemic—the phenomenon remains largely understudied at scale and in relation to the role of schools prior to the pandemic. This study describes the prevalence of hate speech against Asian American adolescents in the US between 2015 and 2019 and investigates how school-related factors are associated with whether Asian American youth are victims of hate speech at school. Analyses are based on a sample of 938 Asian American adolescents (Mage = 14.8; 48% female) from the three most recently available waves (2015, 2017, and 2019) of the School Crime Supplement to the National Crime Victimization Survey. On average, approximately 7% of Asian Americans were targets of hate speech at school between 2015 and 2019, with rates remaining stable over time. Findings also indicate that students had lower odds of experiencing hate speech if they attended schools with a stronger authoritative school climate, which is characterized by strict, yet fair disciplinary rules coupled with high levels of support from adults. On the other hand, Asian American youth faced higher odds of experiencing hate speech if they were involved in school fights. Authoritative school climate and exposure to fights are malleable and can be shaped directly by broader school climate related policies, programs and interventions. Accordingly, efforts to promote stronger authoritative climates and reduce exposure to physical fights hold considerable potential in protecting Asian American youth from hate speech at school.

“I Was Determined to Fulfill This Image of Myself That I Wanted of a ‘Good Asian Student’”: A Photovoice Study of Asian American College Student Mental Health

Asian American (AsA) youth and emerging adults are growing at a faster rate than all other racial and ethnic populations in the United States. Burgeoning empirical evidence shows that they are experiencing increased adverse mental health outcomes since the start of the COVID-19 pandemic. Additionally, trends in AsA youth and emerging adults’ utilization and help-seeking behaviors remain low. Health equity scholars posit that the model minority stereotype continues to obscure and minimize these mental health disparities. The current study aims to contribute to this vital research through a Photovoice study with AsA emerging adults. Fourteen AsA undergraduate students (M age = 19.77 years old; SD = 1.12) produced photographs and captions and participated in semi-structured interviews to describe mental health. Four themes were developed: (1) mind–body health connection and the belief that mental health is about the synchronization of one’s mind and body; (2) environmental connectedness and the view that mental health is connected to nature; (3) social connectedness and how interpersonal relationships influence mental health; and (4) the internalization of the “good Asian student” stereotype and its impact on mental health. Implications for culturally tailored prevention and intervention strategies are discussed to ultimately improve health equity.

Breaking the Silence: An Epidemiological Report on Asian American and Pacific Islander Youth Mental Health and Suicide (1999-2021).

Limited studies have focused on recent trends in Asian American and Pacific Islander (AAPI) youth suicide. This study aimed to evaluate epidemiological trends in AAPI youth suicide and reports of depressive symptoms among Asian and Pacific Islander youth in the USA. This cross-sectional study analyzed mortality data from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) and reports of depressive symptoms from the Youth Risk Behaviour Surveillance System (YRBSS). Data from 1999 to 2021 were analyzed for suicide rates and methods used among AAPI youth aged 5-24 years. YRBSS data from 1991 to 2021 were analyzed for depressive symptoms reported by Asian American (AA) 9th-12th graders. From 1999 to 2021, 4747 AAPI youth died by suicide in the USA. Rates of suicide doubled from 3.6 to 7.1 per 100,000 during 1999-2021, with an increasing trend observed from 2014 onwards. The most common methods of suicide deaths in this population were suffocation, firearms and poisoning. Rates of suicide were higher among AA males than females, although more AA females reported depressive symptoms, including suicidal planning and attempts. This study shows a concerning increase in suicide rates among AAPI youth over 1999-2021. Suffocation, firearms and poisoning were the most common methods used. While more AAPI males died by suicide, AA females reported higher rates of depressive symptoms. These findings highlight the urgent need for targeted prevention strategies and clinical interventions for this vulnerable population. The study also emphasizes the importance of addressing mental health stigma to improve reporting and support for Asian American, Native Hawaiian and Pacific Islander (AANHPI) youth.

Abstract P206: Family Food Study: Findings From a Mixed Methods Pilot Study Examining Diet Among Chinese American Families in New York City

Introduction: Asian American youth experience a disproportionately high burden of diet-related diseases including non-alcoholic fatty liver disease and type 2 diabetes mellitus. Family support and co-participation are essential to maintaining a healthy diet during childhood/adolescence and may be particularly important for Asian American youth given the cultural emphasis on family. However, no studies, to our knowledge, have examined how the diets of Asian American youth correlate with those of their families. Objective: To determine the correlation in diets of Chinese American families and understand the mechanisms through which families influence youth's diets. Methods: We recruited 10 Chinese American families from New York City to participate in the Family Food study. Between June and July of 2023, we administered phone-based surveys to 1 parent and 2 children aged 10-17 years within each family. One child per family conducted a follow-up, phone-based interview on the social and environmental determinants of diet. Dietary intake was measured using the validated and culturally adapted 26-item Dietary Screener Questionnaire. Intraclass correlation coefficients (ICCs) were calculated from linear mixed models with age and sex as fixed effects, family as a random effect, and either 1) predicted fruit and vegetable intake or 2) frequency of intake of each food/beverage group as the outcome. Rapid qualitative analysis was used to identify key themes from the youth interviews. Results: On average, youth were 13 years old, 55% were male, and 15% were born in China. All parents were female and born in China, and 30% of households were SNAP recipients. Predicted mean intake of fruits and vegetables was 2.8 (SD: 0.9) cups/day, and correlation in intake among family members was slight (ICC=0.10). Correlations in frequency of intake of food/beverage groups among family members ranged from 0.01 to 0.46 (i.e., virtually no similarity to fair), with the strongest correlations for 100% fruit juice (0.46), milk (0.35), cheese (0.35), and fried potatoes (0.35). Our qualitative analysis indicated that convenience and time were the most common determinants of dietary choices, particularly among high schoolers. Most junk foods youth consumed were American, while dinner was generally Chinese cuisine prepared by their mother or grandmother. This echoed quantitative findings that families ate dinner together most days (6.3 days/week), that 90% of mothers were the main person responsible for food preparation, and that 40% of mothers did not like or know how to prepare American foods. Conclusions: Among Chinese American families, intake of dairy items, high-sugar, and high-fat items tended to be the most strongly correlated. Future research should aim to replicate this work in a larger sample size and to better understand how convenience, time, and family meals shape diet- and health-related decisions.

Asian American adolescents’ adaptation to American society

As presented by the National Longitudinal Study of Adolescent to Adult Health in 2019, suicide was the most common cause of death among 15-24 years old Asian American youth. Such devastating influence includes many factors like generation gaps, language fluency, cultural differences, and family problems. Asian American adolescents have gone through experiences of discrimination from prejudices and stereotypes, and many scholars have conducted research on the mental health effects. This paper focuses on Asian American adolescents’ adaptation to conditions in American society today. It can help readers understand how resilience is important in this growing American society and provide a reference for other adolescents on how mental health awareness needs to be considered.

How education research perceives queer Asian American youths: a literature review

Academia has long neglected lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, and nonbinary (LGBTQIA+, queer) Asian American youth. Indeed, most available literature that examines queer Asian American issues falls victim to the matrix of domination. Succumbing to this matrix effectively amplifies the voices that are the least stratified within a broader social group (i.e. cisgender, gay, white men within the queer community). This literature review examines works between 1998-2023 to deliberately expand the existing lexicon for queer Asian American youth and hopes to catalyze future scholarly efforts in this area.

Crossing swords and cutting sleeves: The cross-cultural impact of Chinese fandom fan fiction on Asian American youths

Chinese dramas such as The Untamed and other popular media productions have opened further discussions about China’s cultural impact outside its national borders. With the increasing visibility of Chinese pop culture on the international market, more and more Chinese Americans have entered into a variety of cultural and national exchanges through their interactions with Chinese media and its subsequent fan productions, such as English-language fan fiction inspired by non-English productions.

Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6–18 years

BackgroundWaist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide.MethodsWe used ten population-based cross-sectional data on 24,605 children and adolescents aged 6–18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6–18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors.ResultsBased on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA).ConclusionsThe proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.