Young Asian American Women Research Articles

Mechanisms of action in AWARE: A culturally informed intervention for 1.5- and 2nd-generation Asian American women.

Young Asian American women have high rates of depression and suicidality; however, few interventions address the urgent need for culturally informed care. Asian Women's Action for Resilience and Empowerment (AWARE) aims to be the first gender and culturally specific group psychotherapy intervention designed to improve mental and sexual health in Asian American women with trauma. This article specifically focuses on identifying the mechanisms of action that were responsible for improving mental health and well-being among those who participated in AWARE randomized controlled trial. Of the 435 women screened for the study, 63 Chinese, Korean, and Vietnamese women with histories of interpersonal violence were randomized into either the intervention (n = 32) or waitlist control groups (n = 31). Data from 16 posttrial focus group sessions were then thematically analyzed to explore the key themes and mechanisms of action of the AWARE intervention. Analysis revealed four cultural mechanisms that facilitated mental health improvements: psychoeducation on disempowering parenting, the reduction of mental illness-related stigma, community and relational building, and a heightened sense of empowerment. Results suggest that the AWARE intervention fosters Asian American women's well-being on an individual level and encourages social engagement through culturally salient messages. Women in the study were able to expand their social support network, engage in activism, and develop an empowered connection to their community. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Relationship between Intimate Partner Violence and Suicidal Ideation among Young Chinese, Korean, and Vietnamese American Women

ABSTRACTHigh depression and suicide rates are critical problems that have a significant impact on the lives of young Asian American women. Intimate partner violence (IPV) has been identified as a predictor of suicidality in general female samples, but no research study has examined the relationship between IPV and suicidality in a sample of 1.5 and second-generation Chinese, Korean, and Vietnamese American women. We used data collected from 173 women (aged 18-35 years) who were screened for eligibility to participate in the development and efficacy study of Asian American Women’s Action for Resilience and Empowerment (AWARE). We measured the prevalence of (a) IPV, (b) lifetime suicidal ideation/intent, and (c) childhood abuse and tested the association between IPV and lifetime suicidal ideation/intent among study participants who completed the clinical screening assessments. The results indicated that seven out of 10 women in our sample experienced lifetime suicidal ideation/intent, psychological aggression was the most commonly reported form of IPV during the last six months, followed by sexual coercion, and history of physical and/or sexual partner violence had the most robust association with lifetime suicidal ideation/intent after controlling for demographic factors and childhood abuse. Our study suggests that suicide prevention and intervention programs for young 1.5 and second-generation Asian American women should not only address experiences of childhood abuse, but also incorporate culturally adapted behavioral health approaches to identify and target physical and sexual partner violence. Furthermore, any such programs need to integrate a systemic approach in addressing IPV within the context of various marginalized experiences of Asian American women.

Accessing sexual and reproductive health care and information: Perspectives and recommendations from young Asian American women

ObjectivesUnderstanding the influence of culture on how sexual and reproductive health is perceived and addressed in Asian American communities is important for the effective provision of care and health information. This study aimed to explore how and when sexual and reproductive health information is shared within Asian American families and communities, barriers and facilitators to accessing sexual and reproductive health care and information for young Asian American women, and their recommendations to improve access. MethodsQualitative data were collected through six focus groups conducted with a total of 33 young Asian American women. ResultsThe majority of participants reported that stigma created a barrier to discussing these topics within their families and communities, and discussed ways in which they confidentially seek out care and information. Responses varied with respect to participants' preferred means of increasing access to care and information; some recommended strategies that would increase communication about these issues in their families and communities, while others expressed a desire to maintain confidentiality. ConclusionsThese findings suggest that diversified strategies are needed to connect Asian American women with sexual and reproductive health care and information in order to meet their varied preferences, including strategies that are community-driven and culturally appropriate.

Abstract P6-10-10: Association between mammographic density and breast cancer subtypes among Chinese women

Abstract Epidemiological studies have shown that associations between breast cancer risk and risk factors vary by tumor pathology such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status. Mammographic density (MD) is a strong risk factor for breast cancer, but data on the association between MD and breast cancer subtypes have been inconsistent and most studies have been conducted among Western women. The goal of this study was to evaluate the association between MD and breast cancer subtypes in an Asian population where the proportion of dense breast tissue is higher but the overall breast cancer incidence rate is much lower compared with Western countries. Breast cancer cases from a cancer hospital in Beijing, China with MD and ER, PR, and HER2 immunohistochemical (IHC) data were included in this analysis. To reduce subtype misclassification, we excluded cases that were HER2 2+ for IHC but had no FISH data. Tumor subtypes were defined as Luminal A (ER+ or PR+ and HER2-, N=376), Luminal B (ER+ or PR+ and HER2+, N=97), HER2-overexpressing (ER- and PR- and HER2+, N=71), and triple negative (TN, ER- and PR- and HER2-, N=66). MD was assessed on digital mammograms and categorized into four levels using the Breast Imaging Reporting and Data System (BI-RADS) scoring system (a=almost entirely fat, b=scattered fibroglandular densities, c=heterogeneously dense, and d=extremely dense). Because there were few cases with almost entirely fat breasts, we combined MD levels "a" and "b" as our reference group. Polychotomous logistic regression was used to assess the association between MD and breast cancer subtypes with the adjustment of age, menopausal status, parity, age at menarche, and body mass index (BMI) since all these variables showed significant inverse associations with MD (P=0.002 for age at menarche and P<0.0001 for all others). Compared with luminal A cases, cases with HER2-overexpressing tumors were significantly more likely to have extremely dense breasts (Odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2-5.7). Cases with luminal B (OR, 2.1, 95% CI, 1.2-3.9) and TN (OR, 2.9, 95% CI, 1.5-5.8) tumors had significantly higher proportions of heterogeneously dense but not extremely dense tissue compared with luminal A cases. Our data suggest that higher MD is associated with more aggressive tumor subtypes, particularly the HER2-overexpressing subtype among Chinese breast cancer cases. If confirmed in larger studies, these results may provide insight into the higher incidence rates of HER2-overexpressing breast cancer seen among young Asian American and Asian women. Citation Format: Yang XR, Li J, Li E-N, Guida JL, Li M, Sung H, Lu N, Hu N, Gierach GL. Association between mammographic density and breast cancer subtypes among Chinese women. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-10.

Exploring Coping Strategies Among Young Asian American Women Breast Cancer Survivors.

In recent years, breast cancer rates among young Asian American women have been increasing. Despite increases in breast cancer among young Asian American women, little is known about how this population copes throughout diagnosis, treatment, and survivorship. This study was a qualitative exploration of how young Asian American women cope with breast cancer diagnosis, treatment, and survivorship. In-depth interviews with 22 young (under the age of 50) Asian American women diagnosed with early stage breast cancer were conducted. Through qualitative data analysis, three major themes emerged including moving from managing the emotions of others to expressing emotional vulnerability, moving from work and productivity to work-life balance, and moving beyond the family and reaching out to breast cancer survivors. At diagnosis, participants worked to maintain normalcy including caring for others and working during treatment. Once treatment was over, women worked to find ways to use their experience as a transformative one and also to develop more positive coping skills including expressing emotional vulnerability and reaching out to others. Further studies are needed to create and test culturally tailored supportive interventions that enhance positive coping tools among young Asian American women diagnosed by breast cancer.

Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide.

BackgroundDespite the substantially high prevalence of depression, suicidal ideation and suicide attempts among Asian American women who are children of immigrants, little is known about the prevalence of mental health utilization and the perceived barriers to accessing care.MethodsThe data were from the Asian American Women’s Sexual Health Initiative Project (AWSHIP), a 5-year mixed methods study at Boston University. The quantitative analysis examined the differential proportion of mental health utilization among 701 survey participants based on their mental health risk profile determined by current moderate to severe depression symptoms and lifetime history of suicidality. Mental health risk groups were created based on participants’ current depression symptoms and history of suicide behaviors: Group 1–low-risk; Group 2–medium-risk; Group 3–high-risk. Mental health care utilization outcomes were measured by any mental health care, minimally adequate mental health care, and intensive mental health care. The qualitative analysis explored the perceived barriers to mental health care among 17 participants from the medium and high-risk groups.ResultsAmong 701 participants, 43 % of women (n = 299) reported that they either suffered from current moderate to severe depression symptoms or a lifetime history of suicidal ideation or suicide attempt. Although the high-risk group demonstrated statistically significant higher mental health utilization compared to the low and medium-risk groups, more than 60 % of the high-risk group did not access any mental health care, and more than 80 % did not receive minimally adequate care. The qualitative analysis identified three underutilization factors: Asian family contributions to mental health stigma, Asian community contributions to mental health stigma, and a mismatch between cultural needs and available services.ConclusionsDespite the high prevalence of depression and suicidal behaviors among young Asian American women in the sample, the proportion of mental health care utilization was extremely low. The qualitative analysis underscores the influence of Asian family and community stigma on mental health utilization and the lack of culturally appropriate mental health interventions. Prevention and intervention efforts should focus on raising mental health awareness in the Asian American community and offering culturally sensitive services.

Disparities in Human Papillomavirus Vaccine Literacy and Vaccine Completion Among Asian American Pacific Islander Undergraduates: Implications for Cancer Health Equity

Purpose: Low rates of human papillomavirus (HPV) vaccination among young Asian American and Pacific Islander (AAPI) women need to be addressed, particularly given the high incidence of cervical cancer in this population. The current study aims to investigate predictors of HPV vaccination in young AAPI and non-Latina white (NLW) women. Methods: A secondary data analysis was conducted of a health survey administered to college-aged women (N = 2,270) at a large public university in the Midwest. Andersen's behavioral model of health services utilization guided the study theoretically, and hierarchical logistic regression analysis was conducted to investigate research aim. Results: NLW women had a significantly higher rate of vaccine completion than AAPI women (NLW = 60.7%; AAPI = 38.6%). NLW women also scored higher on all 5 measures of HPV vaccine literacy than AAPI women. Both groups of undergraduate women reported that increasing age, knowledge about HPV, greater use of gynecological services, and knowing someone who had cancer were significant factors related to HPV vaccination completion. In the NLW group, father's income was also found to be a predictor of HPV vaccination completion. Conclusions: Rate and predictors of HPV vaccination completion vary between NLW and AAPI women. Greater promotion of HPV literacy and gynecological service use should be made to young AAPI women to increase their HPV uptake. Further research should examine sociocultural factors that could hinder or promote HPV vaccination in young AAPI women.

Intersection of suicidality and substance abuse among young Asian-American women: implications for developing interventions in young adulthood.

The purpose of this paper is to provide a review of the current literature uncovering specific factors associated with self-harm and suicidality among young Asian American women, as well as to present the Fractured Identity Model as a framework for understanding these factors. This paper offers concrete suggestions for the development of culturally competent interventions to target suicidality, substance abuse, and mental illness among young Asian American women. Empirical studies and theory-based papers featured in peer-reviewed journals between 1990 and 2014 were identified through scholarly databases, such as PubMed, MEDLINE, PsycINFO, JSTOR, and Google Scholar. We identified several factors associated with suicidality among young Asian American women: (1) family dynamics, or having lived in a household where parents practice "disempowering parenting styles," (2) substance use/abuse, and (3) untreated mental illness(es), which are exacerbated by the stigma and shame attached to seeking out mental health services. The Fractured Identity Model by Hahm et al. (2014) is presented as a possible pathway from disempowering parenting to suicidal and self-harm behaviors among this population, with substance abuse playing a significant mediating role. Research limitations/implications - Our review focused on Asian American women, substance use among Asian Americans, and mental health among Asian Americans. Literature that focused on Asians living in Asia or elsewhere outside of the USA was excluded from this review; the review was limited to research conducted in the USA and written in the English language. The complex interplay among Asian American culture, family dynamics, gender roles/expectations, and mental health justifies the development of a suicide and substance abuse intervention that is tailored to the culture- and gender-specific needs of Asian Pacific Islander young women. It is imperative for professionals in the fields of public health, mental health, medicine, and substance abuse to proactively combat the "model minority" myth and to design and implement interventions targeting family dynamics, coping with immigration/acculturative stresses, mental illnesses, suicidal behaviors, and substance abuse among Asian-American populations across the developmental lifespan. This paper provides specific suggestions for interventions to adequately respond to the mental health needs of young Asian-American women. These include addressing the cultural stigma and shame of seeking help, underlying family origin issues, and excessive alcohol and drug use as unsafe coping, as well as incorporating empowerment-based and mind-body components to foster an intervention targeting suicidality among Asian-American women in early adulthood.

Fractured Identity: A Framework for Understanding Young Asian American Women’s Self-harm and Suicidal Behaviors

Despite the high suicide rate among young Asian American women, the reasons for this phenomenon remain unclear. This qualitative study explored the family experiences of 16 young Asian American women who are children of immigrants and report a history of self-harm and/or suicidal behaviors. Our findings suggest that the participants experienced multiple types of “disempowering parenting styles” that are characterized as: abusive, burdening, culturally disjointed, disengaged, and gender-prescriptive parenting. Tied to these family dynamics is the double bind that participants suffer. Exposed to multiple types of negative parenting, the women felt paralyzed by opposing forces, caught between a deep desire to satisfy their parents’ expectations as well as societal expectations and to simultaneously rebel against the image of “the perfect Asian woman.” Torn by the double bind, these women developed a “fractured identity,” which led to the use of “unsafe coping” strategies. Trapped in a “web of pain,” the young women suffered alone and engaged in self-harm and suicidal behaviors.

The influence of childhood and adolescent environmental exposure to a westernized environment on the relation between body mass index and adiposity in young Asian American women

Asians who have a healthy body mass index (BMI) range have been observed to have higher levels of obesity and risk of cardiovascular disease than whites, which suggests that the relation between BMI and adiposity may be different for Asians. The primary aim of this study was to investigate the influence of childhood and adolescent exposure to a westernized environment on the relation between BMI and percentage body fat in young Asian American women. Secondary data from 129 Asian women, aged 20-25 y, with variable lengths of residence in the United States and 327 white women of comparable ages who had participated in the Latina and Asian Bone Health Study (1999-2000) and the Berkeley Bone Health Study (1998-2000), respectively, were analyzed by using multiple linear regression with percentage body fat as the outcome variable and place of birth, ethnicity, length of US residency, and BMI as predictor variables. Asians who lived in the United States <12 y showed the same relation between BMI and percentage body fat as did whites. In contrast, Asians who had lived in the United States ≥12 y had higher percentage body fat than did whites for BMIs (in kg/m(2)) <20.5 and lower percentage body fat for BMIs in the overweight and obese range. Our findings suggest that childhood environments may influence the relation between BMI and adiposity. Research is warranted on the role that childhood environments play in the accumulation and distribution of body fat and hence metabolic disease risk later in life.

Gender power control, sexual experiences, safer sex practices, and potential HIV risk behaviors among young Asian-American women.

We examined the prevalence of three domains of sexual behaviors among young Asian-American women: sexual experiences, safer sex practices, and potential HIV risk behaviors. We also investigated the impact of gender power control on these domains. Among sexually experienced women, 51% reported using condoms during their most recent sex act, 63% reported inconsistent condom use, and 18% reported ever having forced sex. Multiple logistic regression analyses revealed that women's perceived lower relationship power control was not associated with vaginal sex or safer sex practices, but it was powerfully associated with forced sex and all three potential HIV risk behaviors. This study demonstrates that control within young Asian-American women's intimate relationships exerts different associations depending on the type of sexual behavior. The application of the Theory of Gender and Power should be employed with prudence when designing HIV interventions for this population.

Asian American Women's Retrospective Reports of Their Sexual Socialization

This study used qualitative research methods to investigate the sexual socialization experiences of young Asian American women, a group often overlooked in psychological research on sexuality. Focus group interviews were conducted with 30 ethnically diverse young Asian American women to explore their perceptions and interpretations of the direct and indirect sexual communication they received from parents during adolescence. Interviews were analyzed using open and focused coding techniques based on principles of grounded theory. Although most participants initially reported that sexuality was a closed or taboo topic of discussion in their family, they described several indirect, implicit, and nonverbal strategies their parents used to clearly convey their sexual attitudes and expectations, most of which were restrictive in nature. Women interpreted parents' silence and restrictiveness about sexuality as tied to their upbringing and cultural heritage and as a feature characterizing Asian parents more broadly.

ASIAN AMERICAN WOMEN's RETROSPECTIVE REPORTS OF THEIR SEXUAL SOCIALIZATION

This study used qualitative research methods to investigate the sexual socialization experiences of young Asian American women, a group often overlooked in psychological research on sexuality. Focus group interviews were conducted with 30 ethnically diverse young Asian American women to explore their perceptions and interpretations of the direct and indirect sexual communication they received from parents during adolescence. Interviews were analyzed using open and focused coding techniques based on principles of grounded theory. Although most participants initially reported that sexuality was a closed or taboo topic of discussion in their family, they described several indirect, implicit, and nonverbal strategies their parents used to clearly convey their sexual attitudes and expectations, most of which were restrictive in nature. Women interpreted parents' silence and restrictiveness about sexuality as tied to their upbringing and cultural heritage and as a feature characterizing Asian parents more broadly.