%0 Journal Article %J Soc Sci Med %D 2012 %T Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders. %A John, Dolly A %A de Castro, A B %A Martin, Diane P %A Duran, Bonnie %A Takeuchi, David T %K Adult %K Asian Americans %K Confidence Intervals %K Emigrants and Immigrants %K Employment %K Female %K Health Status %K Humans %K Logistic Models %K Male %K Mental Disorders %K Odds Ratio %K Population Surveillance %K Self Report %K Sex Distribution %K United States %X

A robust socioeconomic gradient in health is well-documented, with higher socioeconomic status (SES) associated with better health across the SES spectrum. However, recent studies of U.S. racial/ethnic minorities and immigrants show complex SES-health patterns (e.g., flat gradients), with individuals of low SES having similar or better health than their richer, U.S.-born and more acculturated counterparts, a so-called "epidemiological paradox" or "immigrant health paradox". To examine whether this exists among Asian Americans, we investigate how nativity and occupational class (white-collar, blue-collar, service, unemployed) are associated with subjective health (self-rated physical health, self-rated mental health) and 12-month DSM-IV mental disorders (any mental disorder, anxiety, depression). We analyzed data from 1530 Asian respondents to the 2002-2003 National Latino and Asian American Study in the labor force using hierarchical multivariate logistic regression models controlling for confounders, subjective social status (SSS), material and psychosocial factors theorized to explain health inequalities. Compared to U.S.-born Asians, immigrants had worse socioeconomic profiles, and controlling for age and gender, increased odds for reporting fair/poor mental health and decreased odds for any DSM-IV mental disorder and anxiety. No strong occupational class-health gradients were found. The foreign-born health-protective effect persisted after controlling for SSS but became nonsignificant after controlling for material and psychosocial factors. Speaking fair/poor English was strongly associated with all outcomes. Material and psychosocial factors were associated with some outcomes--perceived financial need with subjective health, uninsurance with self-rated mental health and depression, social support, discrimination and acculturative stress with all or most DSM-IV outcomes. Our findings caution against using terms like "immigrant health paradox" which oversimplify complex patterns and mask negative outcomes among underserved sub-groups (e.g., speaking fair/poor English, experiencing acculturative stress). We discuss implications for better measurement of SES and health given the absence of a gradient and seemingly contradictory finding of nativity-related differences in self-rated health and DSM-IV mental disorders.

%B Soc Sci Med %V 75 %P 2085-98 %8 2012 Dec %G eng %N 12 %R 10.1016/j.socscimed.2012.01.035 %0 Journal Article %J Am J Public Health %D 2010 %T Discrimination and mental health-related service use in a national study of Asian Americans. %A Spencer, Michael S %A Chen, Juan %A Gee, Gilbert C %A Fabian, Cathryn G %A Takeuchi, David T %K Adult %K Asia %K Asian Americans %K Communication Barriers %K Female %K Health Care Surveys %K Humans %K Male %K Mental Health Services %K Middle Aged %K Patient Acceptance of Health Care %K Perception %K Prejudice %K United States %X

OBJECTIVES: We examined the association between perceived discrimination and use of mental health services among a national sample of Asian Americans.

METHODS: Our data came from the National Latino and Asian American Study, the first national survey of Asian Americans. Our sample included 600 Chinese, 508 Filipinos, 520 Vietnamese, and 467 other Asians (n=2095). We used logistic regression to examine the association between discrimination and formal and informal service use and the interactive effect of discrimination and English language proficiency.

RESULTS: Perceived discrimination was associated with more use of informal services, but not with less use of formal services. Additionally, higher levels of perceived discrimination combined with lower English proficiency were associated with more use of informal services.

CONCLUSIONS: The effect of perceived discrimination and language proficiency on service use indicates a need for more bilingual services and more collaborations between formal service systems and community resources.

%B Am J Public Health %V 100 %P 2410-7 %8 2010 Dec %G eng %N 12 %R 10.2105/AJPH.2009.176321