An Integrative Review of Relationships Between Discrimination and Asian American Health

AbstractPurpose: Many ethnic minorities in the United States experience disproportionate rates of adverse health outcomes or health disparities. Factors such as socioeconomic status do not fully explain how these disparities are generated and maintained. Research has demonstrated that chronic experiences of discrimination are harmful to the health of African Americans and Latinos. However, there is a dearth of research examining Asian Americans' experiences with discrimination and health disparities. The purpose of this integrative review was to summarize the current literature examining discrimination and the mental and physical health of Asian Americans.Design and Methods: Combinations of search terms related to discrimination, health, and Asian Americans were used to search five electronic databases. Inclusion criteria were primary research studies, published in English between 1980 and 2011, Asian American adults, and discrimination examined in relationship to a physical or mental health outcome. The search initially yielded 489 results; 14 quantitative studies met inclusion criteria.Findings and Conclusions: Quantitative studies in this review revealed several significant associations between discrimination and health outcomes in Asian Americans. Discrimination was significantly associated with depressive symptoms in seven studies. Three studies found associations between discrimination and physical health, including cardiovascular disease, respiratory conditions, obesity, and diabetes. Although the literature was limited by self-reported data, cross-sectional designs, and inconsistent definitions and measurement of discrimination, the findings suggest that discrimination is a significant contributor to poorer health and health disparities for Asian Americans. The findings clearly demonstrate the need for further nursing research in this area to inform evidence-based practice and social policy.Clinical Relevance: Patient care providers can recognize discrimination as a significant stressor or purveyor of illness and explore ways to facilitate coping and resilience with their Asian American patients. Community-based participatory research approaches can be implemented by clinicians, academicians, and Asian American community partners to address the issue of discrimination and Asian American health outcomes.Key wordsNursing, discrimination, racism, health outcomes, Asian American, health disparitiesHealth disparities pose complex social, economic, and personal problems for minorities in the United States (US). In a seminal report, the U.S. Surgeon General identified racial discrimination as a risk factor for mental disorders (U.S. Department of Health and Human Services [USDHHS], 2001). Studies have linked socioeconomic status, gender, and genetic factors with stressrelated illnesses and subsequent poorer health outcomes (Trinh-Shevrin, Islam, & Rey, 2009; Williams, Yu, & Jackson, 1997). However, these factors do not fully explain racial and ethnic health disparities (Williams et al., 1997). Recent studies have found significant relationships among discrimination, stress response, and health among African Americans and Latinos (Krieger & Sidney, 1996; Paradies, 2006). However, Asian Americans have been largely overlooked in the discrimination and health disparities literature (Gee, Ro, Gavin, & Takeuchi, 2008; Paradies, 2006); an in-depth examination of how discrimination impacts the health of Asian Americans is warranted.Background and SignificanceDisparities and Asian American HealthBy 2050, the Asian American population is expected to increase from 15.5 million to 40.6 million (Oh, Koeske, & Sales, 2002). Asian Americans are one of the most heterogeneous ethnic minority groups in the US and include more than 14 diverse subgroups (Trinh-Shevrin et al., 2009). Indian, Chinese, Filipino, Korean, and Vietnamese groups account for the majority of Asians in the US (U. …