Asian Americans Health Article

ASIAN AMERICANS

"Asian American" is a general term for Asians and Pacific Islanders (AAPI) living in the United States. According to U.S. Race and Ethnic Standards for Federal Statistics and Administrative Reporting (1978), Asian Americans and Pacific Islanders refer to persons who can trace their original background to the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands including Native Hawaiians.

In 1999, there were about 10.9 million AAPIs living in the United States and its Pacific Island jurisdictions. Of them, about half (53.1%) lived in the western region and more than 96 percent resided in metropolitan areas. Together, AAPIs represented approximately 4.0 percent of the total population in the United States, but they are projected to reach 11 percent (51.6 million) by 2070. The population growth of AAPIs exceeds any other race groups in the United States, and due to this growth rate, AAPIs are relatively younger than other races in the United States. The estimated median age of AAPIs in 1998 was 31.2 years— about 4 years younger than the median age for the U.S. population as a whole.

The key sociodemographic feature of the AAPI population is its great diversity. Six major ethnic subgroups account for more than 95 percent of the AAPI population: Chinese, Filipino, Japanese, Asian Indian, Korean, and Vietnamese. However, it is estimated that entire AAPI population comprises thirty-two different ethnic groups and speaks almost five hundred distinct languages and dialects. Since 1966, AAPI has been called a "model minority" because of their economic success, achievements, and good citizenship, suggested by such indicators as low crime rates and a low rate of welfare dependency. But AAPI, composed of many ethnic groups, is not a homogeneously preferred group. Due to high proportion of immigrants (about 60 percent of AAPIs in the United States were foreign born), a significant number (22.4 to 53.3%) of AAPIs cannot speak English fluently. There is also a high percentage of refugees. After the Vietnam War, more than 1.4 million Eastern Asian Indochinese refugees have been settled in the United States As a result, the population of AAPIs is extremely heterogeneous in terms of socioeconomic status as well as ethnic origin.

Probably influenced by Eastern culture, strong kinship and family ties are the basic characteristics of the AAPI family structure. There were 2.5 million AAPI families in the United States in 1999, 80 percent of which were married-couple families. AAPI families are often large: 21 percent had five or more family members, compared with 11 percent for non-Hispanic white families. AAPI children under 18 years of age were more likely to live with both parents (84%) than non-Hispanic white children (77%). AAPI parents usually encourage their offspring toward high academic achievement, and they are more likely to direct or supervise their children's educational activities than their white counterparts. As a result, among persons aged twenty-five and over, AAPIs had the highest proportion of bachelor's or higher degree; at 42 percent, compared to 27.7 percent for whites and 13.4 percent for all other ethnic groups combined. However, the AAPI population also consists of more people who lack education (3.4% have an educational level below fourth grade), compared with only 1.6 percent of the total population and0.6 percent of whites.

AAPIs had the highest median annual household income ($46,637) among the nation's racial groups in 1998. However, because AAPI households were larger than white households (3.15 people versus 2.47 people), the estimated income per household member was lower in the AAPI population ($19,107 for AAPI versus $22,633 for white). The distribution of household income also reflects AAPI's bipolar characteristics. Compared to white households (2.6% of which had an annual income less than $5,000; 21.3% had $75,000 and over), AAPI households had a higher percentage of both poorest and wealthiest households (4.8% had an annual income under $5,000; 28.1% had $75,000 and over). Of AAPIs, 12.5 percent live under the poverty level, which is also higher than the proportion of poor non-Hispanic whites (8.2%).

Generally speaking, U.S. Census data clearly indicate that AAPIs have bipolar sociodemographic characteristics. On average, they are younger and have higher incomes and educational achievement. But on the other hand, there is a significant number of AAPIs with low income, less education, and limited English-speaking capability.

In respect to general health status, AAPIs have the longest life expectancy (80.3 years in 1992), the lowest infant-mortality rate (5.3 per 1,000 live births in 1995), and the lowest age-adjusted mortality rate (282.8 per 100,000 in 1996) among different racial groups in the United States. The three leading causes of death for AAPIs are heart disease, cancer, and stroke, which are coincident with the top leading causes of death for the general population. But, among the different racial groups, AAPIs have the lowest mortality rates from heart disease and all cancers. Stroke is one of major diseases of which the death rate among AAPIs is higher than among whites. Type II diabetes mellitus is another illness with higher prevalence and incidence in the AAPI population, compared to non-Hispanic whites.

Although overall cancer rates for AAPIs are very low, the heterogeneity of AAPIs leads to significantly different ethnic patterns for various cancers. For example, the age-adjusted incidence rate of cervical cancer for Vietnamese women is 43 per 100,000 in 1992, which is the highest among different racial groups in the United States (5.7 times higher than the rate for non-Hispanic white women and 3.3 times higher than the rate for African-American women). Lack of knowledge and low Pap test utilization are two major areas that need great improvement for this group.

According to the National Cancer Institute, liver carcinoma is more likely to prevail among AAPIs. Compared to non-Hispanic whites (incidence of liver cancer: 3.3 per 100,000), Vietnamese men have the highest incidence of liver cancer(41.8 per 100,000), followed by Korean men (24.8 per 100,000), Chinese men (20.8 per 100,000), Filipino men (10.5 per 100,000), and Korean women (10.0 per 100,000). The most likely etiology of this high incidence of liver malignancy for AAPIs is the high viral hepatitis infection rate in this group. The prevalence rates of Hepatitis B surface antigen (HBsAg) for AAPIs range from 5 percent for Koreans to about 15 percent for Southeast Asians. High chronic HBsAg carrier rates in pregnant Asian women also contribute to high incidence rates of liver cirrhosis and primary hepatocellular carcinoma for AAPIs.

The incidence rate of nasopharynx cancer in Chinese men (10.8 per 100,000) is the highest among racial groups. Compared to non-Hispanic whites (0.6 per 100,000 for white men and 0.3 per 100,000 for white women), other AAPI groups also have high incidence of nasopharynx cancer (Vietnamese men 7.7, Chinese women and Filipino men 3.9 per 100,000). Korean men (48.9 per 100,000) and Japanese men (30.5 per 100,000) have highest incidence of stomach cancer in the United States.

Tuberculosis (TB) infections are extremely prevalent in the AAPI population (36.6 per 100,000), compared to other racial groups, including African Americans (17.8 per 100,000), Hispanics (13.6 per 100,000), and non-Hispanic whites(2.3 per 100,000). Compared with 1994, the number of reported TB cases in 1995 decreased in each gender, age, and racial group except AAPI, for whom a 2.9 percent increase was reported.

The access to health care is generally a barrier to improve health status for the poor, newly immigrated AAPIs. On one hand, a significant number of AAPIs (21.1% in 1998) who lack health insurance coverage cannot afford health care expenses. On the other hand, the lack of availability of culturally competent health professionals in the U.S. health care system is an overwhelming, ethnicity-specific obstacle to health care access. As a result, low rates of health services utilization, high rates of emergency room use, and inadequacy of prenatal care can be often seen in the AAPI population.

Asian traditional medicine serves as a buffer to ease the unmet need of formal medical care access, especially for new immigrants and AAPI refugees and an important alternative for AAPIs in maintaining health and mitigating suffering from sickness. Asian traditional medicine, such as acupuncture, herbal medicine, and massage, consists of techniques and theories believed to be able to balance the "ying and yang" of the human body and establish a harmonious "flow of energy." The comprehensive and holistic strategies of care within Asian traditional medicine have attracted substantial attention from the general American population. However, lack of an accepted scientific basis has retarded the utilization of Asian traditional medicine by the general public. Lead poisoning is occasionally reported from Asian traditional or folk remedies.

AAPIs also have unique risk behaviors. AAPIs have a higher rate of abstinence from alcohol than do other racial groups. However, important variations among different Asian groups have also been found. Compared to whites, a significant number (30 to 50%) of Asians who are deficient in aldehyde dehydrogenase activity tend to exhibit more intense reactions to alcohol and generate higher levels of the metabolite acetaldehyde. The genetic predisposition may be the major reason that AAPIs drink less and are also less likely to be alcoholic. In addition, acculturation, social norms, attitudes toward alcohol, and expectations from drinking are also significant factors that shape the AAPIs drinking patterns.

According to the 1998 Report of the Surgeon General, 15.3 percent of AAPI adults (men and women combined) were current smokers in 1995, lower than the national average (22.4% in 1995) and also the lowest rate among various racial adult populations. Among smokers, AAPIs tend to smoke fewer cigarettes per day than their white counterparts. The percentage of cigarette smoking among adult AAPI males (25.1% in 1995) is significantly higher than among adult AAPI females (5.8% in 1995). Significant variations of smoking rates can also be found among AAPI groups. Much higher smoking rates are seen among Southeast Asians(e.g., Vietnamese and Laotian) and Koreans than among other AAPI ethnic groups. Smoking prevalence among AAPI youths is the second lowest among different racial youth groups (20.6% for AAPI male adolescents and the 13.8% for AAPI female adolescents in 1994).

From a macro standpoint, Asian Americans are a "model minority" with a high household income, high education, and low mortality rate. However, as a demographic designation, Asian American also encompasses a diversity of ethnic groups. Census data and literature always illustrate their bipolar characteristics in socioeconomic status and health indices. People from lower-income AAPI groups and refugees are experiencing limited access to health care and lower health status, resulting from linguistic, cultural, financial, and systemic barriers. Cultural influences, including Asian traditional medicine and folk beliefs, also play an important role in health status. In order to promote better health for Asian Americans, a locally tailored health promotion policy and a community-based health care system are needed.

TED CHEN

CHIH-CHENG HSU

(SEE ALSO: Acculturation; Chinese Traditional Medicine; Cultural Anthropology; Ethnicity and Health; Pacific Islanders, Micronesians, Melanesians; Traditional Health Beliefs, Practices)