Social environmental determinants of smoking, substance use, and mental health services use among non-Hispanic Asian Americans

Recent evidence suggests that some Asian American subgroups are disproportionately experiencing health disparities related to smoking, substance use, and mental health services use. This dissertation will examine the disparities in the aforementioned health-related behaviors and their social environmental determinants among non-Hispanic Asian American population in the United States.;Using the 2004 California Chinese/Korean American Tobacco Use Surveys, I examined the ethnic difference in smoking behaviors between Korean Americans and Chinese Americans and the effect of workplace and household smoking restrictions on current smoking behavior in the first study. Findings showed that the ethnic discrepancy in current smoking prevalence between Korean and Chinese Americans might be due to their differential ever smoking prevalence given similar quit rates. An association between complete smoking bans in workplaces and households and a lower current smoking prevalence was observed among Korean American men.;Using the 2002 National Survey on Drug Use and Health (NSDUH) data, I investigated differences in substance use behaviors and the effect of perceived neighborhood norms between Asian Americans and Whites as well as between U.S.-born and foreign-born Asian Americans in the second study. Asian Americans reported lower prevalence of binge drinking, illicit drug use, and substance dependence or abuse than Whites. U.S.-born Asian Americans reported higher prevalence of binge drinking than their foreign-born peers. Perceived favorable neighborhood norms concerning trying marijuana or hashish was associated with greater odds of reporting illicit drug use in both racial.;Using data from the 2002--2004 NSDUH surveys, I examined the racial differences in prevalence of specific types of mental health services use between Asian Americans and Whites in the third study. Asian Americans had much lower odds of reporting outpatient care and medication use than did Whites even after adjusting for predisposing, enabling, and need-related factors. No racial difference was observed for inpatient care and alternative treatment. Lack of health insurance had a moderate impact on mental health services use among people screening positive for SMI who were under 65 years of age.;The above findings support two conclusions: (1) Ethnic disparities in smoking and racial disparities in substance use and specific types of mental health services use do exist among Asian Americans; (2) Certain social environmental factors need to be addressed in health behavior intervention programs for Asian Americans.