Burmese refugees, constituting one of the largest group of refugees admitted to the United States, accounting for 21% of total admissions in the past decade. Using a multi-informed perspective, this research study sought to understand the help-seeking experiences of Burmese American refugee families regarding the diagnosis and treatment of autism spectrum disorder. In this study, we conducted semi-structured qualitative interviews with 16 individuals, including primary caregivers (=6), Burmese community leaders (=4), and healthcare workers (=6). Caregiver interviews were conducted in Burmese Chin languages by native speakers on the research team. Our results indicated systematic barriers and access to health care, health literacy, cultural stigma and perception surrounding families and community, professional and family interaction with multicultural consideration, and caregiver burnout collectively shape the complex landscape of help-seeking experiences among Burmese American families with children with ASD. We provided clinical recommendations for providers and community leaders to address the barriers found in our study.

Cultural values influence health beliefs, attitudes, and behaviors. Given the history of pre-colonial Philippines and under Spanish, American, and Japanese colonization, Filipinos have unique cultural values that are understudied in relation to health outcomes. The objectives of this study are to (1) create and validate measurement scales of surface level Filipino cultural values and (2) examine its associations with depressive symptoms and substance use in a sample of Filipino Americans. We analyzed data from the Midwest Longitudinal Studies of Asian American Families (MLSAAF) collected in 2013 of Filipino American parents (n=376). We implemented factor analyses to create and validate the scales and ordinary least squares and logistic regressions to examine the associations between Filipino cultural values and depressive symptoms and substance use. Factor analyses produced five scales: hiya (dignity or shame) from parent, hiya in general, utang na loob (gratitude or solidarity), pakikisama (companionship), and bahala na (determination). Hiya from parent was positively associated with depressive symptoms and hiya in general was negatively associated with depressive symptoms and alcohol use until passing out. The findings demonstrate the nuanced and complex means that Filipino cultural values have influenced health outcomes in Filipino Americans. This study is the first of its kind to quantitatively measure surface level Filipino cultural values. Future studies should consider using the measurement scales to better understand how intergenerational trauma and resilience through cultural values influence other health beliefs, behaviors, and outcomes in Filipinos in the Philippines and in the diaspora.

In the United States (US), rates of cervical cancer screening among Asian American women (notably Korean American women) lag far behind other populations. Thus, guided by the Health Belief Model, we developed a multi-component intervention to enhance Korean American women's knowledge and beliefs about screening and to increase screening uptake. The intervention group (N=341) received a culturally-relevant cancer education program and navigation services. The control group (N=335) received a similar program on cervical cancer risk and screening, along with information about free/low-cost screening sites. Women's knowledge and beliefs were measured at baseline and post-program, and screening behavior was assessed at 12-months post-program. It was hypothesized that the intervention would lead to positive changes in health beliefs and knowledge about cervical cancer and screening, which were then evaluated as potential mediators of the intervention on screening behavior. From pre- to post-program, the intervention group reported significantly greater increases in knowledge (<0.01) and perceived risk (=0.02) and significantly greater decreases in perceived barriers (<0.001) compared to the control group. However, changes in knowledge and health beliefs did not mediate intervention effects on screening behavior. Use of navigation services was associated with greater odds of obtaining screening (OR=3.15, 95% CI=2.28-4.01, <0.001) and attenuated the significant effect of group assignment (intervention vs. control) on screening behavior to non-significance. In conclusion, although our intervention program was effective in improving women's knowledge and beliefs about screening, delivery of navigation services was the critical component in increasing cervical cancer screening rates in this underserved population.

Many Asian American cancer patients face barriers to cancer care but little is known about their navigational needs. We designed and implemented a pilot study to provide culturally- and linguistically-appropriate navigation for Asian American cancer patients. We recruited Asian American adults age 21+ years, who spoke English, Cantonese, Mandarin, or Vietnamese, with newly diagnosed, stage I-III colorectal, liver, or lung cancer in the Northern California Bay Area. Participants were assigned a language-concordant patient navigator, who provided support and resources over 6 months. Surveys were administered at baseline, 3-, and 6-months to assess sociodemographic characteristics, healthcare access, quality of life (FACT-G), and cancer care needs. Participants' mean age was 65 years (range 38-81); 62% were men, 67% spoke Chinese, and 75% reported limited English proficiency. Forty-two percent of participants had lung, 38% colorectal, and 21% liver cancer. Of 24 participants who enrolled, 67% completed the program and 75% completed standard of care cancer treatment. The average total FACT-G score was 72.6 (SD 17) at baseline, 68.0 (SD 20) at 3 months, and 69.9 (SD 22) at 6 months. All participants reported that the program was culturally appropriate and would recommend it. Asian American cancer patients in a patient navigation program reported lower quality of life compared to the general adult cancer population. Even with navigation, 75% of participants reported completing standard of care treatment. While participants were satisfied with the program, more research is needed to address the quality of cancer care Asian American cancer patients receive.

Sleep-related issues may be one significant pathway through which socioeconomic disadvantages are associated with worse self-reported states in cancer. The present study examined the relationships between SES (income and education level) and two important biobehavioral factors (cancer-related fatigue and perceived stress), as well as mediation through sleep-related problems (sleep medication use, daytime dysfunction, and sleep quality) among a sample of Chinese American breast cancer survivors. 136 Chinese American breast cancer survivors completed a self-reported questionnaire. We found that relative to those with the lowest annual household income, those with the highest income have lower perceived stress. This relationship was mediated by lower sleep quality. Relative to those with a high school degree or less, those with graduate degrees have lower daytime dysfunction, and in turn lower cancer-related fatigue. Our findings point to the importance of addressing sleep-related issues, perceived stress, and cancer-related fatigue among Chinese American breast cancer survivors with low SES backgrounds.

The supportive care needs of people with metastatic cancer, particularly Asian Americans, are understudied. Distinct psychosocial support needs may exist across ethnocultural groups with Confucian-heritage values and norms. Cultural factors may shape how adults approach their oncologic care. This qualitative study represents the perspectives of 15 experienced healthcare professionals about the supportive care needs of Chinese-, Korean-, and Vietnamese-heritage (CKV) adults with metastatic solid cancers. Reflexive thematic analysis was conducted with transcripts from three semi-structured focus groups and five parallel-format individual interviews. Inductive coding and iterative theme development resulted in four themes describing the types of needs (basic, care-related, mental health, relational trust) that should be met for CKV patients with metastatic cancer, which may fall through the gaps when the healthcare system and patient's differing cultural contexts collide. In conclusion, greater involvement of psychosocial care specialists with cultural expertise is essential to promote patients' and families' well-being, prevent care disparities, and better support the healthcare team. Systemic changes that increase workforce diversity, reduce language and insurance barriers, and allow healthcare professionals to build relational trust with patients, are needed to improve quality of life for CKV patients with metastatic cancer.

Asian Americans have surpassed Hispanics as the fastest-growing racial/ethnic group in the United States and Chinese Americans are the largest Asian American subgroup. Cancer is the leading cause of death among Chinese Americans while heart disease remains the leading cause of death in the U.S. overall. Foreign-born immigrants are more likely to be diagnosed with advanced stage cancers than their native-born counterparts. Patients with advanced cancer have specific psychosocial needs, such as end-of-life concerns and existential distress. Meaning-Centered Psychotherapy (MCP), which enhances a sense of meaning in life to increase QOL, is among the most promising psychosocial treatments for advanced cancer patients, having demonstrated efficacy in several randomized controlled trials. Our preliminary qualitative work suggested a meaning-centered intervention was acceptable but required adaptation to ensure ecological validity among Chinese cancer patients. This paper presents the cultural and linguistic adaptation of Meaning-Centered Program for Chinese Americans with advanced cancer (MCP-Ch), which was informed by the Ecological Validity Model (EVM) and Psychotherapy Adaptation and Modification Framework (PAMF) for cultural adaptation of evidence-based interventions. Implementation considerations, which will be assessed in the next phase of the project, are also discussed. MCP-Ch is used as a case example to illustrate how to adapt culturally syntonic and sustainable evidence-based psychosocial interventions for racial/ethnic minority cancer populations.

This qualitative study analyzed how Chinese American (CA) and non-Hispanic White (NHW) breast cancer patients and their oncologists communicated about patients' emotional concerns. Data included twenty-four recordings of clinical encounters between oncologists and four CA and eight NHW women with a new breast cancer diagnosis between 2013 and 2015. Using an interactional sociolinguistics approach to discourse analysis, we examined how CA and NHW patients and their oncologists initiated conversations about patients' emotions. We also categorized oncologists' responses by whether oncologists turned toward, turned away, or remained neutral to patients' emotions. When bringing up emotions with oncologists, NHW patients brought up social and personal life topics, whereas CA patients only brought up biomedical topics. We also observed that oncologists initiated discussions about emotions with only English-speaking patients of both racial groups. There were no observed differences in how oncologists remained neutral to or turned away from both CA and NHW patients' emotional expressions. When oncologists turned away from patients' emotions, they did so to solve administrative or biomedical problems. In conclusion, the findings suggest that CA patients' racial backgrounds and the language spoken during the encounters may influence how patients and oncologists initiate discussion about patients' emotions. Furthermore, the findings suggest that oncologists remain neutral and turn away from CA and NHW patients' emotions in similar ways. This study provides preliminary data for more comprehensive investigations of Asian American cancer patients' actual communication with their providers regarding emotions and treatment decisions to facilitate patient-provider communication quality.

As the number of Asian cancer survivors continues to increase, there is a growing need for interventions to address their physiological and psychosocial needs. The aim of our systematic review was to assess the types and the impact of psychosocial or behavioral interventions for cancer survivorship among Asian Americans and Asian immigrants globally. The review included 18 articles reporting data from eight interventions, of which five were randomized controlled trials and three were one-group design interventions. All interventions were conducted with Asian Americans and fell into three categories: (a) expressive writing interventions that facilitated individual cognitive and emotional processing, (b) educational and social support interventions, and (c) healthy lifestyle interventions. Expressive writing studies that involved writing tasks facilitating emotional and stress disclosure and cognitive reappraisal were most beneficial for Chinese American survivors, and both in-person and longer virtual educational and social support interventions yielded improvements for survivors. The healthy lifestyle intervention was more beneficial for the mental health than the physical health of survivors. The small number of interventions in the United States and the lack of interventions with Asian immigrants outside of the United States highlights the need for more survivorship interventions for Asian cancer survivors. Successful cultural adaptation of cancer survivorship interventions often required multiple studies and extensive time and resources. The early success of culturally adapted interventions shows the path forward in developing effective survivorship interventions for Asian Americans and for testing and disseminating interventions among various cancer types and Asian subgroups in future research.

This study examined how Korean immigrant mothers' cultural orientations (i.e., acculturation and enculturation) were related to their mental health, specifically depression and the culturally specific syndrome of Hwa-byung (HB), and had direct and indirect relations to their parenting practices (i.e., authoritative, authoritarian, acceptance, rejection). In a sample of 412 Korean immigrant mothers (99.5% foreign-born; age = 45.31), a path analysis was conducted by using the maximum-likelihood and bootstrapping methods. Results revealed that mothers' cultural orientations were indirectly related to parenting practices via depression and HB. Specifically, mothers' acculturation and enculturation had positive indirect relationships to authoritative parenting and acceptance versus a negative relationship to rejection, via their links to depression. Mothers' acculturation had a negative relationship to rejection via its link to HB, while enculturation was not related to HB. Additionally, cultural orientations were directly associated with parenting. Overall, the current findings highlighted that HB holds a unique role in parenting after controlling for the effects of depression, which suggests the importance of assessing culture specific syndrome, above and beyond depression, to have a better understanding of Korean immigrant mothers' mental health and its relation to parenting. Implications for research and practice are discussed.

There is growing concern that Asian sexual minority men (SMM), including gay, bisexual, and other men who have sex with men, may be at elevated risk of psychological distress and suicidal ideation, yet limited attention has focused on how psychosocial stressors may affect them. This study seeks to (a) explore differences in psychosocial stressors, anxiety, depression, and suicidal ideation between Asian and White SMM and (b) evaluate the potential moderation of associations between psychosocial stressors and mental health by race. Data were obtained from the P18 Cohort Study. We restricted the sample to only those who identified as non-Hispanic Asian or White and used regression analysis to assess the associations of psychosocial stressors and mental health outcomes in the overall sample by race. Of the 217 participants in our analytic sample, 23% self-identified as Asian. Compared with White SMM, Asian SMM had a higher prevalence of loneliness, internalized homophobia, and public gay-related stigma. In regression analyses, most psychosocial stressors were significantly associated with anxiety, depression, and suicidal ideation in the overall sample. Associations between each stressor and mental health outcome primarily did not differ between Asian and White SMM. However, White SMM experiencing higher levels of public gay-related stigma had greater odds of suicidal ideation, although this was not observed for Asian SMM. Overall, Asian SMM may be experiencing similar effects of psychosocial stressors on mental health to White SMM. Health professionals may want to consider how these stressors impact the mental health and well-being of their Asian SMM clients.

The present study examined the associations between biculturalism and cigarette and betel nut use and the potential mediating roles of cigarette and betel nut use risk perception and resistance to peer and adult influence among adolescents in Guam. Participants were 673 ethnically diverse students (49% female; = 12.7, = .89) from eight public middle schools. The results showed that biculturalism was not associated with cigarette use directly; however, this association was mediated by cigarette use risk perception and resistance to peer and adult influence. In other words, higher biculturalism was associated with more risk perception and then more resistance to peer and adult influence, which sequentially predicted less cigarette use. Similarly, the association between biculturalism and betel nut use was mediated by betel nut use risk perception and resistance to peer and adult influence. Higher biculturalism was associated with greater risk perception and then more resistance to peer and adult influence, which in turn resulted in less betel nut use. These findings can be used to inform the design and implementation of intervention and prevention programs targeting youth who are vulnerable to substance use.

This study used focus group methodology to identify culturally-specific barriers to, and facilitators of, eating disorder (ED) treatment-seeking for South Asian (SA) American women. Seven focus groups were conducted with 54 participants (=20.11 years, =2.52), all of whom had lived in the United States (US) for at least three years (63.0% of the sample was born in the US). Transcripts were independently coded by a team of researchers (=4) and the final codebook included codes present in at least half of the transcripts. Thematic analysis identified salient themes (barriers, =6; facilitators, =3) for SA American women. Barriers to ED-treatment seeking were inextricable from barriers to mental health treatment, more broadly. In addition to generalized mental health stigma, participants cited (i.e., a pervasive fear of social ostracization), as a significant treatment-seeking barrier. Additional barriers were: cultural influences on the etiology and treatment of mental illness, parents' unresolved mental health concerns (usually tied to immigration), healthcare providers' biases, general lack of knowledge about EDs, and minimal SA representation within ED research/clinical care. To address these obstacles, participants recommended that clinicians facilitate intergenerational conversations about mental health and EDs, partner with SA communities to create targeted ED psychoeducational health campaigns, and train providers in culturally-sensitive practices for detecting and treating EDs. SA American women face multiple family, community, and institutional barriers to accessing mental health treatment generally, which limits their ability to access ED-specific care. Recommendations to improve ED treatment access include: (a) campaigns to destigmatize mental health more systematically, (b) collaboration with SA communities and, (c) and training providers in culturally-sensitive care.

Although Asian/Pacific Islanders are considered a single ethnic/racial category in national studies, Native Hawaiians/other Pacific Islanders (NHOPIs) and Asians show marked disparities in health outcomes and risk behaviors, including substance use. Currently, knowledge regarding the psychosocial mechanisms by which NHOPI ethnicity is associated with increased substance use, compared with Asian or White, is limited, especially among emerging adults. The present study tested a model in which the relationship between NHOPI ethnicity and higher substance use (i.e., current tobacco, alcohol, marijuana, and illicit drug use) was hypothesized to be mediated through higher emerging adulthood stress (e.g., feeling "in-between," instability), higher self-reported racial/ethnic discrimination, substance use in one's social networks, and poorer mental health symptomology (i.e., depression, anxiety). Data collected at a single time-point from 2,344 college students ( age = 21.2 [SD = 2.1]; 54% Women; 24% NHOPI, 49% Asian, 27% White) were analyzed by employing structural equation modeling. NHOPI and Asian ethnicity were dummy coded with reference to White, and separate analyses were run for NHOPI and Asian groups, with White as the reference group. Results indicated that the association between NHOPI ethnicity and higher substance use was mediated in two steps, via higher racial/ethnic discrimination and poorer mental health symptomatology. NHOPI ethnicity, but not Asian, was associated with higher identification with emerging adulthood attributes, which in turn was associated with increased substance use. Implications are discussed in the context of reducing health disparities faced by NHOPIs.

Drawing on Bronfenbrenner's (1977), this study examined the antecedents and outcomes of internalized model minority myth (MMM) within the microsystem of family and the macrosystem of culture. Among Korean immigrant families, we examined how mothers' internalized MMM (i.e., achievement orientation, unrestricted mobility) and youth's cultural orientations (i.e., acculturation, enculturation) were related to youth's internalized MMM and had direct and indirect relations to youth outcomes (i.e., life satisfaction, depression, antisocial behaviors, and academic performance). In a sample of 334 Korean immigrant mother-youth dyads (155 female youth; 132 foreign-born youth; of youth = 16.37; of mothers = 46.94), we conducted a path analysis by using the maximum likelihood and bootstrapping methods. A path analysis revealed mothers' achievement orientation was indirectly related to youth's academic performance via youth's beliefs in unrestricted mobility. In general, mothers' internalized MMM had harmful relationships to youth's depression and antisocial behaviors versus mixed relationships to academic performance. Importantly, mothers' internalized MMM indicated greater direct and indirect associations with youth outcomes than youth's own internalized MMM. A follow-up analysis of moderated mediation ruled out the possibility that academic performance moderated the relations of youth's internalized MMM and outcomes and thus masked any significant associations. Overall, the current findings highlighted the importance of understanding the internalized MMM within the microsystem of the close-knit Korean immigrant family relations. Implications for research, family intervention, parent education and outreach were discussed.

While past research has examined the deleterious effects of racism on Asian Americans, fewer studies have investigated lesbian, gay, bisexual, and transgender (LGBT) Asian Americans' unique experiences of oppression and unbelonging within the broader LGBT community. Guided by intersectionality and minority stress theoretical frameworks, the present study examined the effect of discomfort due to one's race/ethnicity within the LBGT community on psychological wellbeing in a national sample of 480 LGBT Asian Americans from the Social Justice Sexuality Project. The moderating role of how important one considered their race/ethnicity to their identity was also examined. Regression analyses revealed that greater discomfort due to one's race/ethnicity within the LGBT community was associated with reduced psychological wellbeing for LGBT Asian Americans who viewed their racial/ethnic identity as moderately or highly important, whereas this association was not significant for LGBT Asian Americans who considered their racial/ethnic identity as less important. These findings highlight the necessity of examining the role of racial/ethnic discomfort in relation to LGBT Asian Americans' psychological wellbeing, as well as the extent to which LGBT Asian Americans consider their race/ethnicity as important.

Over 100,000 ethnically Nepalese, "Lhotshampa," people experienced systematic oppression, disenfranchisement, and violence during the latter part of the 20 century. The Lhotshampa people were forced to flee their homes in southern Bhutan and enter refugee camps in Nepal for over 20 years. As of this writing, most Bhutanese refugees have been resettled in other countries (primarily the United States, Canada, and Australia). As the two remaining Nepalese refugee camps prepare to close, a growing suicide crisis is developing among many Bhutanese refugees. Bhutanese refugees resettled in the United States are dying by suicide at approximately twice the rate of the general U.S. population. It is crucial to examine, qualitatively, the nature of both risk and protective factors from the perspective of Bhutanese refugees, themselves. Our study included 15 Bhutanese refugees (8 men, 7 women) recruited from a community sample as part of a parent project examining culturally responsive suicide risk assessment. Mean age across both genders was 38.4 years (range of 22-55 years). Participants in our study were asked open-ended questions about suicide risk and prevention. We conducted a thematic analysis, synthesized risk and protective themes, and applied a socio-ecological framework to the data. We found risk themes included psychological distress and vulnerability, substance use, social and familial discord, interpersonal violence, isolation, and postmigration stressors. Protective themes included low levels of substance use, de-stigmatization of mental health concerns, strong social connections, reduced postmigration stressors, increased access to mental health care, and strong awareness within the host community of migration-related challenges.

Suicide and associated behaviors represent a significant health disparity among refugees and displaced persons. Despite this burden, evidence for prevention programing in these populations is limited. This study aimed to inform the selection and implementation of suicide prevention strategies in refugee camps in Northwestern, Thailand - camps that had experienced recent spikes in suicides and suicide attempts at the time of the study. We leveraged Community Based System Dynamics modeling through a series of four workshops with key local stakeholders and suicide prevention experts, to build a qualitative systems model that accounts for complexities and is aimed at assisting local partners with selecting the most promising strategies for implementation and evaluation. The process expanded local understanding of the causes and consequences of suicide and resulted in selection of priority interventions aimed at reducing suicide in this context. Our research illustrates the application of a novel methodology that aims to account for the complexities of suicide prevention in the context of displacement and helps to optimize local suicide prevention efforts.

Frequently hard to reach and underserved, Asian Americans are the racial group whose chief cause of mortality is cancer. Efficacious survivorship care is important, but little is known about extant intervention efforts for this community and how culture has been integrated into these efforts. This study examined cancer survivorship interventions for Asian Americans and how culture has been addressed, using an integrated framework consisting of goals, theory, methods, and cultural concordance in the persons of the interventions. Mixed methods comprising a systematic review and critical analyses were employed. Results indicate that only 13 interventions have been delivered to this community, with six of them pilot studies, and that they used a narrow range of focus on cancer type, with all interventions focusing on breast cancer survivorship. Applications of theory and methods were incongruent with cultural valuation of emotion expression and help seeking behavior. Cultural concordance was operationalized mostly as the racial ethnic match between interventionists and survivors. Deep culture factors including cultural beliefs and values were rarely specified. Theory and research should move beyond the currently prevalent definition of culture as race, ethnicity, or language, and interventions should consider the role of culture in their goals, theory, methods, and persons. Advances in theory and research are needed, as neither reliance on the Western paradigm nor assumptions about Asian Americans can be appropriate for achieving cultural validity. Future conceptualization and operationalization should consider culture more than race, ethnicity, or language.

By using the conceptual framework of bilinear acculturation, this study examined Korean immigrant mothers' parenting practices among 389 mother-youth (adolescent children in middle or high school) dyads. We examined (a) how mothers' acculturation and enculturation were related to mainstream (i.e., authoritarian vs. authoritative styles, communication, warmth/bonding, autonomy support) versus culture specific parenting practices (i.e., interdependence, commitment to education, academic control) and (b) how parenting practices were, in turn, linked to youth outcomes of depression, antisocial behaviors, and academic performance as measured 1.5 years later. Mothers and youth had significant perceptual gaps in parenting practices, especially in autonomy support and parental commitment to education. Therefore, path analyses were conducted separately for mother-reported versus youth-reported parenting. As hypothesized, mothers' acculturation was more closely related to mainstream parenting, while enculturation was to culture specific parenting. Mother-reported autonomy support predicted higher academic performance, while youth-reported authoritarian parenting predicted lower academic performance. Youth-reported communication predicted lower depression and antisocial behaviors. The current findings have implications for parenting and family interventions to optimize Korean immigrant youth's wellbeing in the bicultural context. Additionally, bilinear acculturation was found to be a useful conceptual framework in studying immigrant parenting.

The purpose of the current study was to examine the association between daily academic satisfaction and ethnic/racial identity of Asian American adolescents. Based on ecological systems theory and social comparison theory the moderating roles of objective and subjective peer diversity at school in this association were also examined. Daily diary and survey responses of 102 Asian American adolescents were included in this study (Age: =15.26, =0.71; Female=70.60%; US-born=74.50%). Using hierarchical linear modeling, no direct association between daily academic satisfaction and ethnic/racial identity was observed in the full sample. However, when objective and subjective peer diversity at school were considered a positive association was observed among the adolescents who perceived a high percentage of Asian American peers at school. The interpretation and implications for the results are discussed.

While a variety of health concerns have been documented, little is presently known about the mental health challenges facing Samoan Americans in Southern California. This community-based research study investigated the perspectives of Samoan healthcare providers affiliated with two Los Angeles County agencies regarding: 1) mental health challenges; 2) obstacles to use of formal services to address mental health concerns, and 3) recommendations and needed resources for development of culturally responsive interventions to address mental health challenges. Eleven healthcare advocates affiliated with two agencies specializing in health and social services for Samoans participated in a 90-minute group discussion and/or an individual interview. Qualitative data were analyzed using a thematic data analytic approach based on grounded theory. Participants strongly self-identified as Samoan or mixed-race Samoan and were primarily female (73%). Key themes from these discussions are presented to highlight this seminal discussion. Despite concerns regarding substance use, depression, and suicide, significant cultural resources were noted as sources of resilience that could be incorporated into prevention and intervention for Samoan Americans coping with mental health problems. The perspectives of these community advocates for the Samoan community reflect a low level of mental health awareness and identify urgent unmet mental health needs among Samoan Americans in Southern California. Findings support prioritization of mental health awareness interventions and education regarding available services. Systemic efforts to integrate physical and mental health care services may be aligned with traditional Pacific Islander concepts of mental health and facilitate addressing the unmet mental health needs of underserved Samoan Americans.

This research study examined the overall and ethnic-specific effects of parental emotional and instrumental support, parent-adolescent interpersonal conflict, and negative life events (i.e., major life stressors, such as parental job loss or school suspension) on the substance use of Caucasian, Asian-American, Filipino, and Native Hawaiian and other Pacific Islander (NHOPI) youth in Hawai'i. Adolescents ( = 3,561) from 10 public middle/intermediate schools completed paper/pencil surveys, and multiple regression and structural equation models were developed to examine overall and ethnic-specific effects. Parental support was found to buffer against the influence of negative life events on substance use in the overall sample; however, this effect was not observed for either Caucasian or NHOPI youth in ethnic-specific analyses. The impact of parent-adolescent conflict and negative life events on substance use was more pronounced for both Filipino and NHOPI youth. While the study may have had some limitations related to regional specificity and measurement, the findings nonetheless point to the differential effects of risk and protective factors for NHOPI youth, compared with other youth ethnic groups in Hawai'i. Implications of these findings for culturally specific, family-focused prevention research and practice for NHOPI youth are discussed.

This study reports on the drug use outcomes in an efficacy trial of a culturally grounded, school-based, substance abuse prevention curriculum in rural Hawai'i. The curriculum (Ho'ouna Pono) was developed through a series of pre-prevention and pilot/feasibility studies funded by the National Institute on Drug Abuse, and focuses on culturally relevant drug resistance skills training. The present study used a dynamic wait-listed control group design (Brown, Wyman, Guo, & Pena, 2006), in which cohorts of middle/intermediate public schools on Hawai'i Island were exposed to the curriculum at different time periods over a two-year time frame. Four-hundred and eighty six youth participated in the study. Approximately 90% of these youth were 11 or 12 years of age at the start of the trial. Growth curve modeling over six waves of data was conducted for alcohol, marijuana, cigarettes/e-cigarettes, crystal methamphetamine, and other hard drugs. The findings for alcohol use were contrary to the hypothesized effects of the intervention, but may have been a reflection of a lack equivalence among the cohorts in risk factors that were unaccounted for in the study. Despite this issue, the findings also indicated small, statistically significant changes in the intended direction for cigarette/e-cigarette and hard drug use. The present study compliments prior pilot research on the curriculum, and has implications for addressing Native Hawaiian and Pacific Islander health disparities.

We used a convergent parallel design to explore NHPI men's multi-level perspectives of the factors that influence healthy eating, physical activity, and weight, to elicit recommendations for lifestyle interventions, and to understand the intersection of masculinity and health from a social constructionist perspective. From June to December 2017, NHPI men 18 years and older were recruited to participate in a survey and focus groups. The survey included demographic questions and questions about physical and cultural activities men engage in, perceived social support for lifestyle behaviors, dietary behaviors, masculine characteristics and values important to NHPI men. The Kessler Psychological Distress Scale was used to assess psychological distress. Focus groups were audio recorded and transcribed for a thematic analysis. Descriptive statistics were computed for survey data. We conducted eight focus groups with 89 NHPI men (50% Samoan, 20% Native Hawaiian, 30% Marshallese). The mean age of participants was 39 years, 43% reported some college or college graduate, 64% were currently married, and 63% were working full time. Ninety percent of men scored 20 or higher on the K10 scale indicating mild to severe psychological distress. Men described food as a major part of their culture and their identity. Men's roles were defined as provider and protector, with little attention is paid to their own health. Our study found that hegemonic, or traditional masculinity and social norms may encourage some men to put their health at risk but may also be used to motivate healthy behaviors.

The way in which behavioral health interventions are designed, implemented, and evaluated must be responsive to the ethnocultural characteristics of the targeted youth and their families, schools, and communities. The goal of this paper is to examine the relationship between ethnocultural identity measures and substance use among Native Hawaiian compared to non-Hawaiian youth. A cross-sectional analysis was conducted from baseline data drawn from an efficacy trial of a culturally-grounded drug prevention curriculum, Hoòuna Pono. The sample (N=486) included youth from 13 rural, public middle schools who identified as Native Hawaiian, as well as other Pacific Islander, Asian, and other ethnicities. Ethnocultural identity measures used to explore the relationship between 30-day substance use included items from the Hawaiian Culture Scale (Hishinuma et al., 2000) and from Phinney's (1992) Multigroup Ethnic Identity Measure. Among the total sample, prevalence rates indicated that 11.2% of participants reported having been offered substances, and 9.7% reported having used one or more substances in the past month. For Hawaiian youth relative to the non-Hawaiian group, higher levels of Native Hawaiian ethnocultural independent variables were moderately associated with fewer offers to use substances and less gateway drug use. Other results were mixed regarding the relationship between ethnocultural variables and substance use. The present study found that selected ethnocultural variables were moderately associated with fewer drug offers and lower levels of gateway drug use for Hawaiian versus non-Hawaiian youth.

The purpose of the current study was to examine the relationships between body image, eating disorders, and treatment-seeking motivations among Asian American women in emerging adulthood (ages 18-24). Twenty-six Asian American women participated in qualitative focus groups of 4 to 6 individuals each from December 2015 to February 2016. Constructivist grounded theory was used to analyze focus group data. The resulting theoretical model, the "Asian American Body Image Evolutionary Model," maintains that a central phenomenon of perceptions and interpretation of messages about body image and eating, is rooted in three influencing factors: (1) Societal influence of mainstream White culture and Asian culture; (2) interpersonal influences of immediate family and close others; and (3) individual influence. An individual's perceptions and subsequent interpretation of messages may lead to disordered eating and decisions around treatment-seeking. The model developed can be utilized by practitioners or clinicians to help obtain a better understanding of the societal, interpersonal, and intrapersonal forces that may shape conceptualizations about body image and eating behaviors among Asian American women. In addition, findings from this study can be incorporated into prevention programs and interventions that focus on mental health among this population.

Although conceptual models of cultural adaptations of psychotherapy have been developed, little is known about how therapists apply these models in clinical practice. The purpose of the current study was to examine, using a directed content analysis, how therapists culturally adapt cognitive-behavioral therapy (CBT), one of the most widely used evidence-based approaches, for application with clients of Asian ancestry. The study also examined if there were major differences in adaptation strategies between therapists who practice in the United States ( = 9), a predominantly individualistic society as opposed to those who practice in Japan ( = 6), a predominantly collectivistic society. Semi-structured, open-ended interviews revealed that interdependent conceptualizations of the self and indirect communication were addressed by therapists in both countries, and therapist credibility issues were addressed only by therapists in the United States. These results imply that when culturally adapting psychotherapy, therapists incorporate elements of conceptual models that are relevant to their clients' cultures.

Filipino American adolescents are at higher risk for suicidal ideation and attempts compared to other ethnic subgroups. Results of prior studies suggest the need to engage Filipino parents in the use of culturally tailored, best-practice child rearing strategies. The Incredible Years® is an evidence-based preventive parenting intervention for the school-age years that can reduce children's high risk behaviors. Qualitative research methods and community advisory board meetings were primarily used during the formative research phases in producing a theory-based, culturally-tailored video to increase awareness about adolescent suicide and promote enrollment in the Incredible Years® among Filipino American parents. A 14-minute video was created to increase knowledge about adolescent risky behaviors among Filipino American youth (i.e., suicidal behavior, drug use) and to motivate Filipino parents using constructs from the Health Belief Model and Theory of Planned Behavior. The video presented parent and grandparent testimonials with whom a target audience can identify and health and mental health providers who discussed behavioral health disparities. The content and format of the video included culturally-tailored cues and modeling to influence Filipinos decision to enroll in a parenting intervention. Perceived susceptibility to future adolescent risky behaviors, perceived benefits and barriers to participate in parenting interventions, and knowledge of behavioral health disparities can be effectively targeted in a video format in order to promote enrollment of Filipino parents in evidence-based parenting interventions.

Suicidal behavior and death by suicide are significant and pressing problems in the Bhutanese refugee community. Currently, Bhutanese refugees are dying by suicide at a rate nearly two times that of the general U.S. population. Proper identification of risk factors for suicide saves lives; however, if risk is underestimated due to culturally inflexible risk assessments, preventable deaths may continue to occur. In this review, we examine specific cultural factors related to psychopathology and suicide among Bhutanese refugees. To contextualize the current suicide crisis among Bhutanese refugees, we propose an integration of the interpersonal psychological theory of suicide (Joiner, 2005) and the cultural model of suicide (Chu, Goldblum, Floyd, & Bongar, 2010). We provide recommendations for preventing suicide from a systems framework and discuss practical lessons from a preliminary study designed to test a culturally-responsive model of suicide in Bhutanese refugees.