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Social Determinants of Health and Health Disparities in Asian Americans, Native Hawaiians, and Pacific Islanders Reading List
This reading list developed by the HHS Office of Minority Health (OMH) Knowledge Center contains resources focused on the social determinants of health (SDOH) that shape health outcomes for Asian Americans, Native Hawaiians, and Pacific Islanders (AA and NHPI). It aims both to provide a snapshot of the unique and shared health disparities facing AA and NHPI communities and to highlight how addressing SDOH factors can mitigate health disparities and improve health equity for this population.
The reading list highlights the five SDOH domains:
- Economic Stability
- Education Access and Quality
- Health Care Access and Quality
- Neighborhood and Built Environment
- Social and Community Context
The resources in this list are available to read and download for free. For more resources on the health of racial and ethnic minority populations, please visit the OMH Knowledge Center online catalog.
Economic Stability
Economic stability is a major social determinant of health. It refers to having a steady income and enough resources to meet basic needs such as food, housing, healthcare, and transportation. People with economic stability are more likely to have good health outcomes, while those who are struggling financially are more likely to experience health problems.
Asian Americans experience a wider range of economic outcomes than any other racial group in the United States.
- Contrasting the Experiences for High- and Low-Income Asian Americans during COVID-19. Yi, S. S., Ali, S. H., Chin, M., Russo, R. G., Đoàn, L. N., et al. Preventive Medicine Reports, v. 24 (December): Art. 101519, 2021.
- Food Insecurity Among Asian Americans: A Scoping Review Protocol. Ro, S., Pham, N. H., Huynh, V. N., Wafford, Q. E., and Vu, M. PLoS One, v. 18, #7 (July 3): Art. e0287895, 2023.
- Fruit and Vegetable Consumption Behavior Among Asian Americans: A Thematic Analysis. Dai, C. L., Sharma, M., Haider, T., and Sunchu, H. Journal of Primary Care & Community Health, v. 12 (January-December): 2150132720984776, 2021.
- Self-Rated Health Disparities Among Asian Americans: Mediating Roles of Education Level and Household Income. Ahmmad, Z., Wen, M., and Li, K. Journal of Immigrant and Minority Health, v. 23 (July 20), pp. 583–590, 2020.
- Social Determinants of Health Among Rural Asian and Pacific Islander Populations. Probst, J. C., and Ajmal, F. Rural and Minority Health Research Center, sc.edu, 2019.
Research indicates that economic instability among NHPIs may be correlated with a range of health complications, including diabetes, cardiovascular disease, and tooth loss.
- Examining Risk and Protective Predictors of Substance Use Among Low-Income Native Hawaiian and Pacific Islander Adolescents. Huang, C. Y., Nishioka, S. A., Zane, N. W., and Uchigakiuchi, P. American Journal of Orthopsychiatry, v. 92, #1, pp. 18–24, 2022.
- Housing and Food Insecurity and Chronic Disease Among Three Racial Groups in Hawaiʻi. Stupplebeen, D. A. Preventing Chronic Disease, v. 16 (January): Art. E13, 2019.
- Prevalence and Associations Between Food Insecurity and Overweight/Obesity Among Native Hawaiian and Pacific Islander Adolescents. Long, C. R., Narcisse, M. R., Selig, J. P., Willis, D. E., Gannon, M., et al. Public Health Nutrition, v. 26, #7 (July), pp. 1338–1344, 2023.
- Preventable Tooth Loss in Hawai‘i: The Role of Socioeconomic Status, Diabetes, and Dental Visits. Deguchi, M., Mau, M. K. L. M., Davis, J., and Niederman, R. Preventing Chronic Disease, v. 14 (November): Art. E115, 2017.
Education Access and Quality
Access to educational resources and quality education plays a significant role in health. Education equips individuals with the knowledge and skills to understand health information and make informed decisions about their health and the healthcare system.
The COVID-19 pandemic had a noticeable impact on education in Asian American families, from racism on college campuses to the challenges of homeschooling.
- Adapted Physical Education: The Perspective of Asian Parents. Kwon, E. H., Block, M., Healy, S., and Kim, T. E. International Journal of Environmental Research and Public Health, v. 19, #1 (December 22): Art. 91, 2021.
- Ethnic Differences in Response to COVID-19: A Study of American-Asian and Non-Asian College Students. Zhao, Y., Ding, Y., Chekired, H., Wu, Y., and Wang, Q. Behavioral Sciences, v. 13, #4 (April 10): Art. 325, 2023.
- Longitudinal Relations Among School Context, School-Based Parent Involvement, and Academic Achievement of Chinese American Children in Immigrant Families. Curtis, K., Anicama, C., and Zhou, Q. Journal of School Psychology, v. 88 (October), pp. 1–17, 2021.
- NotTheSame: Asian American Subgroups Moderate the Relation Between Campus Racial Climate and Perceived Burdensomeness During the COVID-19 Pandemic. Jin, J., Zhou, V., Taone, T., and Ichimura, E. Frontiers in Public Health, v. 11 (March 20): Art. 982535, 2023.
- When Home Becomes Classroom: The Shifting Roles of Korean Immigrant Mothers in the Management of Children's Education During COVID-19 in the US. Jung, G., Yim, S. S., and Jang, S. H. Women’s Studies International Forum, v. 92 (May-June): Art. 102598, 2022.
These resources highlight the interplay between quality education and health for NHPIs and the importance of supporting and strengthening NHPI-serving educational institutions.
- The Electronic Health Literacy and Utilization of Technology for Health in a Remote Hawaiian Community: Lana‘i. Witten, N. A., and Humphry, J. Hawai'i Journal of Medicine & Public Health, v. 77, #3 (March), pp. 51-59, 2018.
- The Importance of Considering Educational Inequity and Health Literacy to Understand Racial/Ethnic Health Disparities. Sentell, T., Zhang, W., and Ching, L. K. Hawai'i Journal of Medicine & Public Health, v. 74, #7 (July), pp. 244–247, 2015.
- Native Hawaiians and Pacific Islanders in Higher Education: A Rural Pacific Learning Tour. Soon-Ludes, J., Ajinkya, J., Teranishi, R. T., Le, A., Gutierrez, E. A. E., et al. APIA Scholars, apiascholars.org, 2020.
- Strengthening Asian American and Native American Pacific Islander Serving Institutions Through Policy and Practice. Nguyen, M. H., Espinoza, K. J., Gogue, D. T.-L., and Dinh, D. National Council of Asian Pacific Americans, ncapaonline.org, 2020.
- The Validation of a School-Based, Culturally Grounded Drug Prevention Curriculum for Rural Hawaiian Youth. Okamoto, S. K., Helm, S., Ostrowski, L. K., and Flood, L. Health Promotion Practice, v. 19, #3 (May), pp. 369–376, 2018.
Health Care Access and Quality
Health care access and quality of care is a fundamental social determinant of health. Geographic proximity, affordability, and availability of healthcare providers all influence how easily people can get the care they need. Approximately 10% of the U.S. population does not have health insurance, which can prevent individuals from seeking out healthcare services. Difficulty navigating the healthcare system and lack of culturally and linguistically appropriate care providers can also affect access to quality care.
Acculturation among Asian immigrants can affect health outcomes, from an increase of chronic medical conditions such as diabetes and breast cancer to an increase in leisure physical activity.
- Acculturation and Self-Rated Health Among Chinese and Korean Immigrants Aged 49 to 75. Ryu, S., Morey, B. N., Shi, Y., and Lee, S. Frontiers in Public Health, v. 11 (December 19): Art. 1272428, 2023.
- The Characteristics of Asian American Breast Cancer Survivors with Low Quality of Life: A Decision Tree Analysis. Im, E. O., Yi, J. S., and Chee, W. Journal of Cancer Education, v. 38, #4 (January 11), pp. 1–9, 2023.
- Human Papillomavirus (HPV) and HPV Vaccine Awareness Among Korean American Immigrants in Alabama: Would Internet Use Improve Health Awareness? Lee, H. Y., Won, C. R., Luo, Y., and Lee, M. H. Asian Pacific Journal of Cancer Prevention, v. 24, #8 (August), pp. 2575–2581, 2023.
- Perceived Racial Discrimination and Mental Health in Diverse Groups of Asian Americans: The Differing Impacts by Age, Education, and Ethnicity. Cho, Y. J., Lee, W. J., Oh, H., Lee, J. O., Kim, B. E., et al. Journal of Immigrant and Minority Health, v. 24, #4 (September 20), pp. 970–976, 2022.
- Sociodemographic, Health-Related, and Acculturation Determinants of Physical Activity Participation Among Asian American Women. Sheng, J., Abshire, D. A., Heiney, S. P., Wu, H. S., and Wirth, M. D. Preventive Medicine Reports, v. 33 (June): Art. 102193, 2023.
Due to a constellation of factors that include providers’ deficits in cultural and linguistic understanding, racial discrimination, historical health policy, and underrepresentation in health research, the NHPI population experiences significant health disparities and access barriers.
- Beyond the Ability to Pay: The Health Status of Native Hawaiians and Other Pacific Islanders in Relationship to Health Insurance. Morisako, A. K., Tauali'i, M., Ambrose, A. J. H., and Withy, K. Hawai'i Journal of Medicine & Public Health, v. 76, #3 Supplement (March), pp. 36–41, 2017.
- Effect of US Health Policies on Health Care Access for Marshallese Migrants. McElfish, P. A., Hallgren, E., and Yamada, S. American Journal of Public Health, v. 105, #4 (April), pp. 637–643, 2015.
- 'Just Doing the Best We Can': Health Care Providers’ Perceptions of Barriers to Providing Care to Marshallese Patients in Arkansas. McElfish, P. A., Chughtai, A., Low, L. K., Garner, R., and Purvis, R. S. Ethnicity & Health, v. 25, #7 (October), pp. 1004–1017, 2020.
- Perceived Barriers and Benefits of COVID-19 Testing Among Pacific Islanders on Guam. Leon Guerrero, R. T., Mummert, A. G., Rios, D. C., Mian, N. C., Cruz, T. P., et al. International Journal of Environmental Research and Public Health, v. 20, #13 (July): Art. 6302, 2023.
Neighborhood and Built Environment
Neighborhoods play a key role in health. Where you live can significantly impact your health and well-being. Unfortunately, racial and ethnic minority populations and low-income residents are more likely to live in neighborhoods with higher health risks. Creating neighborhoods and environments that promote health and safety, like walkable communities and accessible greenspaces, can help improve health outcomes and quality of life.
Studies show that Asian American communities within cities face poorer health conditions due to social factors like lack of health insurance and higher poverty rates.
- Associations of Neighborhood Factors and Activity Behaviors: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Yi, S. S., Kanaya, A. M., Wen, M., Russo, R., and Kandula, N. Journal of Immigrant and Minority Health, v. 23, #1 (February), pp. 54–61, 2021.
- Effects of Neighborhood Ethnic Density and Psychosocial Factors on Colorectal Cancer Screening Behavior Among Asian American Adults, Greater Philadelphia and New Jersey, United States, 2014–2019. Bhimla, A., Mann-Barnes, T., Park, H., Yeh, M. C., Do, P., et al. Preventing Chronic Disease, v. 18 (September 30): Art. E90, 2021.
- Environment Matters: How Are Neighborhood Structural Indexes Associated with Parenting Stress Among Asian Immigrant Families? Pei, F., Yoon, S., Zhai, F., and Gao, Q. PloS One, v. 18, #11 (November 29): Art. e0293594, 2023.
- Neighborhood Contexts and Breast Cancer Among Asian American Women. Morey, B. N., Gee, G. C., Wang, M. C., von Ehrenstein, O. S., Shariff-Marco, S., et al. Journal of Immigrant and Minority Health, v. 24, #2 (April 12), pp. 445–454, 2022.
- Neighborhood-Level Asian American Populations, Social Determinants of Health, and Health Outcomes in 500 US Cities. Spoer, B. R., Juul, F., Hsieh, P. Y., Thorpe, L. E., Gourevitch, M. N., et al. Ethnicity & Disease, v. 31, #3 (July 15), pp. 433–444, 2021.
Studies show that NHPI populations view neighborhood factors such as social cohesion and access to healthy foods as integral to their health and well-being.
- Examining Variation in Life Expectancy Estimates by ZIP Code Tabulation Area (ZCTA) in Hawaii’s Four Main Counties, 2008–2012. Holmes, J. R., Tootoo, J. L., Chosy, E. J., Bowie, A. Y., and Starr, R. R. Preventing Chronic Disease, v. 15 (September 20): Art. E114, 2018.
- Integrating Electronic Health Record, Cancer Registry, and Geospatial Data to Study Lung Cancer in Asian American, Native Hawaiian, and Pacific Islander Ethnic Groups. DeRouen, M. C., Thompson, C. A., Canchola, A. J., Jin, A., Nie, S., et al. Cancer Epidemiology, Biomarkers & Prevention, v. 30, #8 (August), pp. 1506–1516, 2021.
- Neighborhood Level Facilitators and Barriers to Hypertension Management: A Native Hawaiian Perspective. Ing, C. T., Park, M. L. N., Vegas, J. K., Haumea, S., and Kaholokula, J. K. Heliyon, v. 9, #2 (February): Art. e13180, 2023.
- Neighborhood-Level Stressors and Individual-Level Cardiovascular Disease Risk in Native Hawaiians: A Cross-Sectional Study. Ing, C. T., Ahn, H. J., Antonio, M. C. K., Dillard, A. Y., Kekauoha, B. P., et al. Preventing Chronic Disease, v. 21 (February 15): Art. E11, 2024.
Social and Community Context
Social connections matter. Relationships with family, friends, and community provide support, reduce stress, and influence healthy behaviors. Strong social connections and a sense of belonging within a community foster well-being. Discrimination, unsafe neighborhoods, and lack of resources can hinder getting the social support needed for good health.
Family communication is essential for Asian American families due to the complex interplay between cultural values and mental and physical health.
- Awareness, Knowledge, Social Norms, and Vaccination Intentions Among Khmer Mother–Daughter Pairs. Lee, H., Kim, D., Kiang, P. N., Cooley, M. E., Shi, L, et al. Ethnicity & Health, v. 26, #3 (August 24), pp. 379–391, 2018.
- Generation 1.5: Years in the United States and Other Factors Affecting Smoking Behaviors Among Asian Americans. Shi, L., Mayorga, M., Su, D., Li, Y., Martin, E., et al. Ethnicity & Disease, v. 32, #2 (April 21), pp. 75–80, 2022.
- Learning about Grandparents’ Past Life: Reflections of Grandchildren in an Intergenerational Reminiscence Project for Asian American Families. Xu, L., Hagedorn, A., and Raval, M. Behavioral Sciences, v. 13, #9 (September 1): Art. 733, 2023.
- Let’s Chat: Development of a Family Group Chat Cancer Prevention Intervention for Vietnamese Families. Duong HT, Hopfer S. Health Education & Behavior, v. 48, #2 (February 13), pp. 208–2019, 2021.
- Second-Generation Asian American Women's Gendered Racial Socialization. Ahn, L. H., Keum, B. T., Meizys, G. M., Choudry, A., Gomes, M. A., et al. Journal of Counseling Psychology, v. 69, #2 (March), pp. 129–145, 2022.
The stress of racism and discrimination has been shown to impact the mental health of NHPI individuals. Strong social support systems can be a mitigating factor for adverse health outcomes.
- Association Between Stress and Social Support Among Young Adult Pacific Islander Smokers. Kwan, P. P., Pike, J. R., Co, D. E., Esmundo, S., Vaivao, D. E. S., et al. Hawai'i Journal of Health & Social Welfare, v. 82, #2 (February), pp. 31–38, 2023.
- The Effects of Perceived Racism on Psychological Distress Mediated by Venting and Disengagement Coping in Native Hawaiians. Kaholokula, J. K., Antonio, M. C., Ing, C. K., Hermosura, A., Hall, K. E., et al. BMC Psychology, v. 5 (January 12): Art. 2, 2017.
- The Paradox of Discrimination, the "Aloha Spirit," and Symptoms of Depression in Hawai'i. Mossakowski, K. N., and Wongkaren, T. S. Hawai'i Journal of Medicine & Public Health, v. 75, #1 (January), pp. 8–12, 2016.
- Self-Reported Experiences of Discrimination and Depression in Native Hawaiians. Antonio, M. C. K., Ahn, H. J., Ing, C. T., Dillard, A., Cassel, K., et al. Hawai'i Journal of Medicine & Public Health, v. 75, #9 (September), pp. 266–272, 2016.
- Stressful Life Events and Social Support Among Pregnant Marshallese Women. Bogulski, C. A., Willis, D. E., Williams, C. A., Ayers, B. L., Andersen, J. A., et al. Maternal and Child Health Journal, v. 26, #6 (June), pp. 1194–1202, 2022.