Research shows that racial discrimination is related to illness among diverse racial and ethnic populations. Studies of racial discrimination and health among Asian Americans, however, remain underdeveloped. In this paper, the authors review evidence on racial discrimination and health among Asian Americans, identify gaps in the literature, and provide suggestions for future research. They identified 62 empirical articles assessing the relation between discrimination and health among Asian Americans. The majority of articles focused on mental health problems, followed by physical and behavioral problems. Most studies find that discrimination was associated with poorer health, although the most consistent findings were for mental health problems. This review suggests that future studies should continue to investigate the following: 1) the measurement of discrimination among Asian Americans, whose experiences may be qualitatively different from those of other racial minority groups; 2) the heterogeneity among Asian Americans, including those factors that are particularly salient in this population, such as ethnic ancestry and immigration history; and 3) the health implications of discrimination at multiple ecologic levels, ranging from the individual level to the structural level.

Racial discrimination may be an important factor related to weight gain among ethnic minorities.

Rationale: Little is known about how undocumented immigrants navigate healthcare utilization issues apart from access. Objective: We examine a unique population of undocumented immigrants who have access to healthcare -college students at the University of California -to identify how immigration status hinders mental health service utilization in the absence of barriers related to eligibility and insurance coverage. Method: We conducted semistructured interviews between March and July 2017 with 30 undocumented students at a University of California campus. Results: We argue that undocumented immigration status informs mental health-related illness cognitions to negatively affect students' ability to assess their own mental health and need for services. Students expressed low perceived need because they normalized mental strain as a natural product of their unstable immigration status. Many viewed treatment as futile because it could not address underlying immigration-related issues. They also anticipated stigmas associated with mental illness as well as their own undocumented status. Conclusion: Solutions to address utilization disparities must go beyond eliminating formal barriers to health access and address such psychosocial barriers, as well as the larger political and social context that produces them.

Research has established that being undocumented is a risk factor for mental and physical health conditions. Much of this work emphasizes undocumented immigrants' chronic stress, yet key questions about pathways to health remain. The mere state of being undocumented is viewed as a general stressor, without considering actual levels of stress or identifying dimensions of documentation status that contribute to overall stress levels. Drawing on surveys and interviews with undocumented students at the University of California, we uncover the everyday manifestations of four dimensions of immigrant "illegality": academic concerns, future concerns, financial concerns, and deportation concerns, and their association with reported stress levels and self-rated health. Survey data establish undocumented students' high levels of stress and poorer health, in comparison to previous research on other national samples. In a structural equation model, we found academic and future concerns to be significantly associated with higher stress, which was in turn, associated with poorer self-rated health. Financial concerns were not associated with higher perceived stress but were directly associated with poorer self-rated health. Notably, deportation concerns did not have any significant independent associations with stress or health. We use our qualitative data to identify specific stressors embedded within these four dimensions. Our findings inform understandings of the health risks arising from documentation status.

Researchers have become increasingly interested in the health patterns of immigrants with longer residence in the United States, as this reveals the health consequences of integration processes. The negative acculturation effect has been the dominant interpretation of duration patterns, despite empirical and theoretical uncertainties about this assumption. This theory assumes that immigrant health declines with longer residence in the United States because of poorer health behaviors and health risks that reflect Americanized lifestyles. This paper reviews the empirical support for the negative acculturation theory among Asian immigrants to determine if and when it is an appropriate interpretation for duration patterns. I conclude that empirical inconsistencies and methodological issues limit the negative acculturation theory as the primary interpretation for duration patterns. First, there is no consistent evidence that health behaviors decline with time. There is also substantial group heterogeneity in duration patterns as well as heterogeneity across health outcomes. The literature has not adequately addressed methodological shortcomings, such as confounding by cohort effects or non-linear duration patterns. Length of residence in the United States is still an important aspect of Asian immigrant health, but the mechanisms of this relationship are still understudied. I propose alternative frameworks between duration and health that consider environmental influences and end with future research directions to explore research gaps.

Studies find that longer-term immigrants have higher body mass index (BMI) than their more recently-arrived counterparts. Most interpretations of these health patterns by duration of U.S. residence rely on theories of immigrant integration; they posit that with increasing time in the United States, immigrants incorporate economically, socially, and culturally into aspects of U.S. society, and that these changes impact health. Few studies empirically examine whether these aspects of integration are indeed mediators of the association between duration of U.S. stay and BMI, and if their patterns differ across immigrant subgroups. This study examines data from the National Latino and Asian American Survey, using path analytic methods to simultaneously test six hypothesized mediators between duration and BMI: household income, English language ability, ethnic identity, family cohesion, acculturative stress and discrimination for both Latino and Asian immigrants, stratified by gender. We find little evidence for an association between duration and BMI for either Latino or Asian men. For women, duration and BMI have a significant and positive relationship, although the pathways differ between the two ethnic groups.For Latina women, household income and acculturative stress are significant indirect pathways, although they work in opposing directions. For Asian women, English proficiency and discrimination are significant indirect pathways. Our findings reveal complex pathways between duration and BMI that vary by ethnicity and gender and highlight limitations in the negative acculturation theory, which suggests that exposure to the United States should have a net negative impact on health. In contrast, our findings suggest not all groups show declining health with longer duration, as measured by BMI, and that integration processes do not always translate into health differences in the expected directions. Future research on duration patterns may need to consider alternative explanations beyond incorporation-based processes, such as cross-national health theories or age, period, cohort effects.3

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Undocumented status is widely recognized as an important social determinant of health. While undocumented immigrants have lower levels of health care access, they do not have consistently poorer physical health than the US-born or other immigrant groups. Furthermore, heterogeneity by race/ethnicity has been largely ignored in this growing literature. This paper used the 2001, 2004, 2008 panels of the restricted Survey of Income and Program Participation (SIPP), one of the only representative surveys equipped to adequately identify Asian undocumented immigrants, to compare health patterns between Asians and Latinos by immigration status. We examined three general measures of health/health access: self-rated health, disability, and current health insurance. Latino undocumented immigrants displayed some advantages in self-rated health and disability but had lower insurance coverage compared to US-born Latinos. In contrast, Asian undocumented immigrants did not differ from US-born Asians in any of the three outcomes. While undocumented status has been proposed as a fundamental cause of disease, we found no evidence that Latino and Asian undocumented immigrants consistently fare worse in health access or physical health outcomes than immigrants in other status categories. Different racial groups also appeared to have unique patterns between immigration status and health outcomes from one another.