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Thursday May 13, 2010

Understanding STDs and Health Disparities in Asian American Communities

Professor Hyeouk Chris Hahm

Boston University School of Social Work

Working with diverse immigrant populations who suffered from various mental health disorders in New York City, Professor Hyeouk Chris Hahm had a first-hand look at health disparities among Asian American communities.  As a psychiatric social worker for 10 years, she saw a growing prevalence of young Asian American adults dealing with  substance use and sexually transmitted disease (STDs).   This led her to question the factors associated with risky health behavior patterns, as well as the protective factors of those behaviors including substance use and HIV/STDs risk behaviors among young Asian Americans.

However, Hahm soon discovered that understanding health risk behaviors was only half the problem.  "Even now, if you do a Medline search," she explained, "very little of the research specifically focuses on Asian American communities. From 1986-2000, if you search, only 0.2% of federal grants focused on Asian Americans. Moreover, only 0.01% of all published articles found in MEDLINE dealt with Asian Americans specifically. Yet, by 2050, 11 percent of the American population will be Asian.  We know there's a huge health disparity among Asians Americans including high rates of cervical cancer among Vietnamese, high rates of depression among Koreans, and high substance use among Hawaiians; however, we really don't understand the critical factors associated with these health disparities."

Furthermore, Hahm also pointed out that most studies examining health disparities and health risk behaviors among Asian Americans were unable to provide specific ethnic or gender information.  "This is problematic," she said, "since there are more than 20 Asian American ethnic groups according to the US Census Bureau, and given marked demographic and immigration differences, a 'one-size-fits-all' approach is likely to be ineffective with the different Asian American population."

Trying to bridge the data gap, Hahm and fellow colleagues from Boston University School of Social Work and School of Public Health, examined the population-based survey, the National Longitudinal Study of Adolescent Health (Add Health). "We wanted to know what proportion of Asian American youth ever had an STD, how those young adults with an STD differed from those without, and what factors were associated with an STD diagnosis."

Over the course the study, Hahm unmasked some myths common about Asian Americans. She said, "There's a perception that Asian Americans in particular aren't practicing sexually risky behaviors.  But we found that Asian American young women are at risk of high STDs.  For instance, Asian American women had a higher prevalence of STDs than White women in both 1995 (10.4% vs. 7.7) and 2001 (13.5% vs. 8.3%).  The incidence of STDs (not diagnosed with STDs in 1995, but developed STIs in 2001) among Asian American women was also higher than that of White women."

Moreover, the power dynamic between genders became immediately clear.   Asian American women were four times more likely to have a STD than their male counterparts. "This was shocking," said Hahm, "It was so much higher than the males."

Accounting for the gender disparity, Hahm suggested that again, culture may be playing a critical role. "Condom use is hard in a culture where women are raised to be accommodating and polite." She stated, "Asian and Pacific Islander women also have broader interracial dating patterns than Asian American men. This might explain why these women are exposed to higher rates of STDs."

Particularly troublesome to Hahm is the impending population boom of Asian Americans. "Forty years from now, Asian Americans are projected to be 11 percent of the national population. That could be a huge number of STD cases, in addition to related infections such as HIV/AIDS. It's a potential disaster for public health. We need to understand the problem and create an intervention that works for these communities."

Hahm's latest research proposal to the National Institute of Mental Health attempts to bridge this gap by examining health risk behaviors specifically in Vietnamese, Chinese and Korean populations. In addition to observing their sexual risk behaviors and substance use patterns, she hopes that her work will help educate social workers and other health practitioners.

"Sexual risk behaviors are socially constructed behaviors," she said, "and these behaviors can be quite different between countries of origin."

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