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A SNAPSHOT OF BEHAVI ORAL HEALTH ISSUES FOR AS IAN AMERICAN/ NATIVE HAWAIIAN/PACIFIC ISLANDER BOYS AND MEN: JUMPSTARTING AN OVERDUE CONVERSATION PURPOSE OF THE BRIEF address these issues need to be documented. Recognizing that this brief is not a comprehensive, As part of the Substance Abuse and Mental Health in-depth discussion of all the pertinent behavioral Services Administration’s (SAMHSA) efforts to health issues for each AANHPI subgroup, this brief promote behavioral health equity and to support represents a start to a much overdue conversation and President Obama’s “My Brother’s Keeper” Initiative action strategy. to address opportunity gaps for boys and young men of color, SAMHSA and the American Psychological WHO IS THIS BRIEF FOR? Association co-sponsored the “Pathways to Behavioral Health Equity: Addressing Disparities The primary audiences for this brief are policy­ Experienced by Men and Boys of Color” conference makers, clinicians and practitioners, researchers, in March 2015. The purpose of the conference was to national/regional and state leaders, community address the knowledge gap on behavioral health and leaders and consumers, and men and boys of color overall well-being for boys and young men of color. and their families and communities. Issues discussed included (a) gender and identity, (b) social determinants of health and well-being, (c) mental health, substance use, and sexual health, (d) WHO ARE ASIAN AMERICANS, misdiagnosis, treatment bias, and the lack of NATIVE HAWAIIANS, AND culturally competent screening instruments and PACIFIC ISLANDERS? treatment strategies in behavioral health, (d) the impact of profiling and stereotypes on behavior, and The AANHPI population consists of over 50 distinct (e) unique culturally based strategies and programs. ethnicities in the U.S. Historically, Asian Americans, Native Hawaiians, and Pacific Islanders have been This brief highlights these issues specific to Asian lumped into an umbrella racial category. Since 2000, American, Native Hawaiian, and Pacific Islander the U.S. Census made the Native Hawaiian and (AANHPI) boys and men. This is a diverse Pacific Islander (NHPI) a distinct racial category population that is often overlooked, underserved, and from the Asian American category. not well understood. The challenges specific to AANHPI males need to be elevated, and strategies to SOME HIGHLIGHTS ABOUT THE AANHPI . The population of Asian Americans (alone or in POPULATION INCLUDE: combination) is projected to increase to 48 million, or 11.7% of the U.S. population by . Asian Americans are the fastest growing 2060.2 racial/ethnic minority group in the U.S. Currently, there are 17.3 million Asian . The total population of NHPIs, including those of Americans, comprising nearly 5% of the total more than one race, was 1.4 million of the U.S. U.S. population, with an additional 4 million population.3 identifying as multiracial Asian Americans.1 . There are approximately 518,000 Native . The largest racial groups include (in order): Hawaiians, 174,000 Samoans, and 108,000 Chinese, Filipino, Asian Indian, Vietnamese, Guamanians or Chamorros in the U.S.3 Korean, Japanese, Pakistani, Cambodian, Hmong, and Laotian.1 . By 2060, there will be more than 2.9 million people of Native Hawaiian and Other Pacific Islander heritage in the U.S.2 PAGE | 2 AANHPI HISTORICAL CONTEXT . The Immigration and Nationality Act of 1965 abolished national quota systems, resulting in a AND GENERATIONAL resurgence of Asian immigration, consisting CONSIDERATIONS primarily of educated individuals in health and science careers (e.g., doctors, nurses, and Each Asian American community has a unique engineers).4 historical context and experience in the U.S.: . In 1975, Southeast Asian refugees (primarily . The first Asian American arrivals in the U.S. from Vietnam, Cambodia, and Laos), fleeing were Filipinos (1587), Chinese (1840s), Japanese wars, oppression, and other tragic conditions, (1860s), Asian Indians (1880s), and Koreans began to resettle in the U.S. They usually came (1940s). Most of these early immigrants were without formal education, money, or resources.4 laborers who worked in very poor conditions on railroads and in canneries, farms, and mines,4 and . Today, Asians immigrate to the U.S. for a variety some were students or sojourners who expected of reasons, many joining family members who to return to their countries of origin. have already settled in various parts of the U.S., especially California, New York, New Jersey, . The Chinese Exclusion Act of 1882 and the 1924 Hawaii, and Texas.4 Immigration Act limited the number of Asian immigrants into the U.S., essentially halting 4 Asian immigration for several decades. ADAPTED FROM HIXSON, L., HEPLER, B.B., & KIM, M.O. (2012). THE NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER POPULATION: 2010. WASHINGTON DC: U.S. CENSUS BUREAU. PAGE | 3 For Native Hawaiians and Pacific Islanders, historical . A range of educational experiences and context includes American colonization, resulting in opportunities, with some groups attaining the unique experiences in both the mainland U.S. and highest levels of education, while other groups their native Pacific Islands. receiving limited education and experiencing high rates of high school dropouts.7 . The U.S. acquired Hawaii and Guam after the Spanish American War of 1898. Hawaii . A range of socioeconomic status, with AANHPIs th remained a U.S. territory until it became the 50 represented among the wealthiest and the most 7 state in the U.S. in 1959, while Guam officially impoverished groups in the U.S. Challenges became a U.S. territory in 1950.5 related to socioeconomic status include low incomes (especially among some Southeast . The U.S. acquired the islands of Tutuila in 1900 Asians and NHPIs), under-employment, and the island of Manu‘a in 1904. In 1929, the relatively low salaries compared to education U.S. declared the islands as American Samoa and level and other qualifications, and barriers to it became a U.S. territory.5 upward mobility in employment, especially at the higher levels (in particular for Asian . In the 1950s, Native Hawaiians, Chamorros, Americans).8 Samoans, and Other Pacific Islanders began migrating to the U.S. mainland in search of . Variations in the prevalence of physical chronic economic and educational opportunities. Today, diseases for many AANHPI subgroups; for most Pacific Islanders in the U.S. reside in instance, Filipino Americans and NHPIs report Hawaii or California.5 higher prevalence of cardiovascular disease, obesity, and diabetes than East Asian Americans.9,10 EMPHASIZING THE DIVERSITY OF THE AANHPI POPULATION A simplistic, stereotypical understanding of the AANHPIs does a disservice to the many cultures When discussing AANHPIs, it is critical to recognize represented and their unique strengths, traditions, and the heterogeneity of the group. AANHPIs are not all values. It also obscures the disparities in economic the same. Rather, this group consists of: and educational attainment and psychosocial well­ being, often generating biases that limit opportunities . Over 50 unique countries of origin, with distinct and minimize health and behavioral health issues. languages, cultural values, family customs and traditions, indigenous practices, and colonial histories. BEHAVIORAL HEALTH CONCERNS FOR AANHPI MEN . Over 20 major religions, including Hinduism, Buddhism, Sikhism, Catholicism, Taoism, AND BOYS Confucianism, Protestant Christianity, animism, and polytheism. The National Latino and Asian American Study (NLAAS) was the first large national dataset that . A diversity of phenotypes and physical investigated the mental health statuses of Latinos and characteristics, including a spectrum of skin Asian Americans. While they did not examine tones, eye shapes, hair textures, and other traits. experiences of NHPIs, some findings on Asian Americans have been notable: . A range of generations – from recent immigrants th to 4 generation AANHPIs in the U.S. 17.2% of Asian American men reported any lifetime presence of a psychiatric disorder, such . A spectrum of sociocultural experiences in the as depression, anxiety, or a substance abuse U.S., including racism, discrimination, and disorder, which is similar to Asian American exclusion. While widespread among the women (17.4%),6 but well below the U.S. AANHPI populations, discrimination and racism national average of 46% for both American men are often directly targeted at immigrants, and women of all racial groups.6 refugees, and individuals who do not speak English well.6 PAGE | 4 . Asian American men who spoke English well victimized (e.g., physically assaulted and were less likely to report lifetime psychiatric verbally teased), which increases the risk for disorders compared to men less fluent in depressive symptoms.15 English.6 . Gay Asian American men who experience their . On the contrary, Asian American men who were racial group as being devalued were more likely born and raised in the U.S. were more likely to to report depressive symptoms and were also report some sort of psychiatric disorder, more likely to engage in risky sexual behaviors particularly substance use disorders, than Asian than those who did not view their racial group as American immigrant men.6 devalued.16 Given this, it is important to understand how . While Native Hawaiians reported more behavioral health manifests through different depressive symptoms than Whites, there were no psychological symptoms, as well as for different gender
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