CHAPTER 5

Mental Health Care for Asian Americans and Pacific Islanders

Current Status

Asian Americans and Pacific Islanders represent very diverse populations in terms of ethnicity, language, culture, education, income level, English proficiency, and sociopolitical experience. Although cultural ties exist among the different AA/PI communities, it is important to recognize the differences among the groups.

Geographic Distribution

Asian Americans and Pacific Islanders are heavily concentrated in the western United States; more than half of this group (54%) lived in the West in 2000 (U.S Census Bureau, 2001b). However, a good number of AA/PIs also live in the South Guam was under U.S. Navy control from the time it was acquired during the Spanish American War in 1898 until its transfer to the Office of Insular Affairs in 1950. American Samoa was ceded to the United States in 1900 and transferred to the Office of Insular Affairs in 1951. In 1947, the United Nations grouped the Northern Mariana Islands, the Marshall Islands, and the Caroline Islands into the Trust Territory of the Pacific Islands. Authority over these islands was given to the U.S. Secretary of the Interior in 1951. The Northern Mariana Islands became a U.S. Commonwealth in 1976. In 1986, the Republic of the Marshall Islands and the Federated States of Micronesia became sovereign states and now maintain relations with the United States through the Department of State. In 1994, Palau joined the freely associated States.

Until recently, the Secretary of the Interior held broad authority over these islands, but the people living there now have their own elected legislatures and governors. Today the U.S.- Associated Pacific Basin jurisdictions remain as freely associated States affiliated with the (17%) and Northeast (18%). A growing number of AA/PIs live in the Midwest (11%). One reason for this distribution is that some Asian Americans are descendants of the Chinese laborers who came in the mid-1800s to work on the transcontinental railroad. Other Asian Americans are descendants of the Japanese immigrants who came to California in the late 19th and early 20th centuries. Since 1965, when Asians began arriving in greater numbers, more entered the United States through New York as well as California. According to 1997 data, 37 percent of all Asian Americans and Pacific Islanders lived in California, 10 percent lived in New York, and 7 percent lived in Hawaii (Population Reference Bureau, 1999).

The largest proportion of nearly every major Asian American ethnic group lives in California. The 1990 census showed that three-fifths of Chinese Americans lived in California or New York, while about two-thirds of Filipinos and Japanese lived in California and Hawaii. Asian Indian (or South Asians) and Korean populations are somewhat less concentrated geographically, although large communities have emerged in a handful of States, including Illinois, New Jersey, and Texas, as well as California and New York. Approximately 75 percent of Pacific Islanders lived in Hawaii and California. Southeast Asians are distributed in a different pattern because of Federal resettlement programs that created pockets of Southeast Asian refugees in a few States. Nearly two-fifths of the Hmong population, for example, lived in Minnesota and Wisconsin in 1990. One-tenth of Vietnamese Americans live in Texas—the largest concentration of Vietnamese Americans outside of California (Population Reference Bureau, 1999). The overwhelming majority (96%) of Asian Americans and Pacific Islanders live in metropolitan areas (U.S. Census Bureau, 2001b).

Family Structure

Compared with white Americans and African Americans, AA/PIs are more likely to live in households that are comprised exclusively of family members, an arrangement referred to as “family households.” In 2000, family households made up 75 percent of Asian American households, compared to 67 percent of non-Hispanic white and African American households (U.S. Census Bureau, 2001b). Asian Americans also have a relatively low percentage of female-headed households (13%), which is comparable to the rate for white Americans but much lower than the rates for other groups. Asian Indian, Chinese, Korean, and Japanese Americans all tend to have lower percentages of female-headed households, from 7 to 13 percent, while Vietnamese, Filipinos, and other Southeast Asians each have a rate of 18 percent (Lee, 1998). Pacific Islanders have larger families than most Asian Americans and other Americans. Pacific Islander family size averages 4.1 persons, compared to 3.8 for Asian American families and 3.2 for all American families (U.S. Census Bureau, 1990).

While subgroup differences exist, Asian Americans tend to wait longer to have children and to have fewer children than other major ethnic groups. Only 6 percent of all live births occur to Asian American women under the age of 20 years. This is strikingly different from the percentages for white Americans (10%), African Americans (23%), and Latinos (18%) (Lee, 1998). Fertility rate data suggest that the AA/PI population will change, and that some ethnic group numbers will decrease over time. The fertility rates of Chinese American women (1.4 children per woman) and Japanese American women (1.1) are lower than the replacement level of 2.1 (the number of children needed for a generation to replace itself). Among Southeast Asian Americans, however, women have high fertility rates and tend to have children at earlier ages than Chinese and Japanese Americans (Lee, 1998). If fertility becomes a more dominant factor than immigration, the proportion of Southeast Asian Americans can be expected to rise compared to that of Chinese and Japanese Americans.

Education

On average, Asian Americans have attained more education than any other ethnic group in the United States. In 2000, 44 percent of Asian Americans age 25 years or older had a college or professional degree, whereas only 28 percent of the white population had achieved that level of education (U.S. Census Bureau, 2001b). According to 1997 data, 58 percent of Americans who descended from natives of the Indian subcontinent (India, Pakistan, Bangladesh, and Sri Lanka) had under-graduate, graduate, or professional degrees.

Some groups of AA/PIs did not have high educational attainment, however. In 1990, only 12 percent of Hawaiians and 10 percent of non-Hawaiian Pacific Islanders had achieved a bachelor’s degree or more. Furthermore, almost two-thirds of Cambodians, Hmong, and Laotians had not completed high school. Many of these Southeast Asians were not able to complete school, but their offspring are clearly taking advantage of the academic opportunities in the United States. In 1990, 49 percent of Vietnamese, 45 percent of Cambodian, 32 percent of Hmong, and 26 percent of Laotians between the ages of 18 and 24 years were enrolled in college.

Income

Three factors are important to note when examining the income characteristics of AA/PIs. First, there are substantial ethnic group differences in average income. Second, it is important to control for family size because AA/PIs tend to have large extended families. Finally, in some groups, income averages may disguise the bimodal income distribution within a population.

In 1998, the per capita income of AA/PIs was $18,709, compared to $22,952 for non-Hispanic whites. The average family income for AA/PIs tends to be higher than the national average. About one-third of Asian American and Pacific Islander families had incomes of $75,000 or more, compared with 29 percent for non-Hispanic white families. However, because Asian families often include extended family members, per capita income (i.e., income per each member of the family) is highest for whites, followed by Asian Americans.

Approximately 25 percent of the Asian Indian population had household incomes that exceeded $75,000, while less than 5 percent of the Cambodian, Hmong, and Laotian populations had similar household incomes.

In 1990, for which detailed information on specific AA/PI groups is available, approximately 14 percent of all Asian Americans were living in poverty. Again, variations in poverty rates were evident when specific Asian ethnic groups were compared. The rates of poverty were Chinese Americans (14%), Korean Americans (14%), Thai Americans (13%), Asian Indian Americans (10%), Japanese Americans (7%), and Filipino Americans (6 %). Southeast Asians experienced much higher rates of poverty: Vietnamese (26%), Laotian (35%), Cambodian (43%), and Hmong (64%). Rates of poverty were also high among Pacific Islanders. In 1990, approximately 17 percent of Pacific Islanders were living in poverty, with Samoans (26%) and Tongans (23%) reporting the highest levels of poverty.

Physical Health Status

The small number of studies that report health status by different subgroups limits an examination of overall physical health among Asian Americans and Pacific Islanders. While administrative data and health surveys include AA/PIs as a category, more often than not they do not have adequate comparable data for specific ethnic subgroups. Accordingly, an overall assessment of the AA/PI ethnic category leads to simple but misleading conclusions.

When it is reported that Asian Americans and Pacific Islanders have lower death rates attributable to cancer and heart disease than other minority groups, some might be misled and conclude that AA/PIs enjoy better health than other groups in the United States. However, when subgroup data are available, more accurate statements about the health profile of AA/PIs can be made (Zane, et al., 1994). For example, Native Hawaiian men have higher rates of lung cancer than white men do, and the incidence of cervical cancer among Vietnamese women in the United States is more than five times greater than that among white women (Kuo & Porter, 1998). While coronary heart disease and stroke kill nearly as many Americans as all other diseases combined, mortality from heart disease for Asian Americans and Pacific Islanders is 40 percent lower than that for whites.