Substance abuse and Asian Americans: need for more research.

Substance abuse (alcohol, tobacco, and other drugs) is a major public health problem. In our country, substance abuse has been estimated to be responsible for 590,000 deaths and 40 million injuries and illnesses annually (McGinnis & Foege, 1999). The total economic costs of substance abuse have been estimated to be close to $428 billion (Rice, 1999). It has been estimated that approximately one fourth of Americans over the ages of 15 have physiological dependence on at least one substance with the trends pointing at mixed progress in our battle against this complex menace (United States Department of Health and Human Services, 2000).

Present data suggest no particular racial predilection for initiation or prevalence of substance abuse. However, there are glaring deficiencies with regard to data from the minority groups. One such minority group commonly classified in the United States is the group of Asian Americans and Pacific Islanders (AAPI). This is by far the most diverse group and classifying this group as a single entity causes serious problems. For example, the health needs of an American citizen with national origin from Saudi Arabia are entirely different than the health needs of an American citizen from Mongolia. This problem is further compounded by the fact that this group is a rapidly growing minority group in our country with over a 100 percent increase noted between the last two Censuses.

Despite these serious gaps in the quality and quantity of data magnified by misclassification, it has been found that Asian Americans bear a disproportionate burden of substance abuse, which is particularly marked among their children/youth. For example, the National Youth Tobacco Survey 2000 data demonstrated that in the last year of high school, one third of Asian American youth were smokers which is much greater compared to other ethnic groups (Appleyard, Messeri, & Haviland 2001). Recent published reviews of the tobacco industry have also revealed evidence of aggressive marketing efforts directed toward Asian Americans since the 1980's (Muggli, Pollay, Lew, & Joseph, 2002). There are several reasons for this aggressive marketing such as, rapid population growth within this community, higher purchasing power of subsection of Asian Americans, higher prevalence of tobacco use in countries of origin, higher proportion of retail businesses under Asian American ownerships, and mal-adaptation of Asian Americans in the mainstream due to cultural differences. When the vested interests can target this community for profit, why not public health practitioners and researchers for the benefit of this neglected community? Clearly, more epidemiological research is needed that visibly demarcates and identifies different distinct subsections of this community and their health needs. Meanwhile education researchers working in the area of alcohol and drug education need to design theoretically robust interventions for this community toward both prevention and cessation of substance abuse. These interventions need to be tailored specifically for members of this community and must keep in mind their unique cultures.

A myriad of educational interventions aimed at preventing the initiation of substance abuse are available such as teaching problem solving skills and affect management, developing refusal skills, developing media interpretation skills, restoring one's sense of purpose and meaning, training in relaxation, and meditation methods. One such area of educational interventions aimed at preventing initiation of substance abuse include interventions that build problem solving skills. The advantage of building problem solving skills is that these interventions build generic competencies that not only help with prevention of substance abuse, but also offer many other benefits. Such interventions are particularly valuable for children who are starting middle school and are highly susceptible to initiating substance abuse (Sharma, Petosa, & Heaney, 1999).

In Asian cultures children are taught to be more dependent on others in making decisions including their parents, family members, and even peers. As a result Asian American youth tend to get confused while making decisions that focus on everyday problems. So much so that the popular media and some sociologists have even labeled these children/youth as, ABCD (American Born Confused Desi) (Hidier, 2002). Hence, the decision- making skills in Asian Americans need enhancement particularly using the constructs of self-efficacy and self-control as described by Albert Bandura (1986, 1997) in the Social Cognitive Theory. Such improvements in problem solving abilities will aid in counteracting peer pressures, negating undue media influences, reducing substance abuse, enhancing cultural adaptation, and overall adoption of healthy lifestyles in the youth.

References

Appleyard, J., Messeri, P., & Haviland, M.L. (2001). Smoking among Asian American and Hawaiian/Pacific Islander youth: Data from the 2000 National Youth Tobacco Survey. Asian American Pacific Islander Journal of Health, 9, 5-14.

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, N.J.: Prentice Hall.

Bandura, A. (1997). Self-efficacy. The exercise of control. New York, W.H. Freeman and Company.

Hidier, T.D. (2002). Born confused. New York: Scholastic Press.

McGinnis, J.M., & Foege, W.H. (1999). Mortality and morbidity attributable to use of addictive substances in the United States. Proceedings of the Association of the American Physicians, 111, 109-118.

Muggli, M.E., Pollay. R.W., Lew, R., Joseph, A.M. (2002). Targeting of Asian Americans and Pacific Islanders by the tobacco industry: Results from the Minnesota Tobacco Document Depository. Tobacco Control, 11, 201-209.

Rice, D.P. (1999). Economic costs of substance abuse, 1995. Proceedings of the Association of the American Physicians, 111, 119-25.

Sharma, M., Petosa, R., & Heaney, C.A. (1999). Evaluation of a brief intervention based on social cognitive theory to develop problem solving skills among sixth-grade children. Health Education & Behavior, 26, 465-477.

Untied States Department of Health and Human Services. (2000). Healthy People 2010. Washington, DC: Author.

Manoj Sharma, MBBS, CHES, PhD. Editor