Dispelling the myth of the “model minority” with data uncovering invisible needs of aging Asian Americans

  • Research

The Asian-American population is often referred to as the “model minority” – well-educated, healthy, self-sufficient and problem-free. The work of Yuri Jang, professor at the USC Suzanne Dworak-Peck School of Social Work, has uncovered a very different scenario, particularly among aging Asian Americans. 

Approximately 22 million Asian Americans and Pacific Islanders (AAPI) live in the United States, representing over 30 countries and ethnic groups who speak more than 100 languages. The diversity of the AAPI population is one of the greatest challenges of working with this community, given the enormous variety of cultures without even a shared language to unify them. With Asian Americans projected to represent over 10% of the U.S. population by 2060, and become the largest immigrant group, Jang  found that accurately understanding who they are and what they need is essential.

Jang began her career as a gerontologist working with older Asian American populations in South Florida, but quickly discovered that a lack of accurate data on their health needs was leaving her clients overlooked and underserved. In fact, quite far from the “model minority” picture of Asian Americans. Jang found older adults in profound distress with few resources to help them.  She knew that solid data was needed to demonstrate the reality of what she was witnessing, so she pivoted her career into research and expanded it into the discipline of social work. 

“I always wanted to do research that has impact on individuals and the community,” said Jang, also a senior scientist at the USC Edward R. Roybal Institute on Aging. “It was a natural transition for me to get into the social work field because it’s a place where we can take action on research and practice.”

Jang has devoted her career to addressing misconceptions, data inaccuracies and myths around AAPI health needs, while expanding culturally tailored and translated services across the lifespan. 

English-only does not reflect full diversity of needs

In 2012, Jang first became aware of a growing issue in the aging immigrant AAPI communities of South Florida. In particular, she was focused on the Korean American population. Many were experiencing high levels of depressive symptoms and isolation due, in part, to the above average stress of their lives as immigrants. When she scoured the databases to find mental health counselors in the area who spoke Korean, she found only one in the entire state of Florida.

“The mode of treatment in mental health counseling is communication,” Jang said “If you live in a place where no counselor speaks the same language, then there is no way to get services.”

Unwilling to accept the situation, nearly a decade before COVID made telehealth a common practice, Jang created interstate partnerships with native-language providers in New York and New Jersey to provide services through videoconferencing. 

“At that time, telehealth was only used for geographically isolated rural populations,” Jang noted. “But for this population, the problem was language isolation.” 

This was the turning point in her career toward research and real-world application of the results. She realized that social work offered more opportunities for direct engagement with underserved communities, better understanding of their needs and the ability to provide services to meet them. However, once again she found that language isolation played a significant part in misunderstanding and underserving the Asian American population. Federal or statewide assessment surveys of American health needs have only rarely offered native Asian-language versions, despite the fact that over 70% of Asian American adults were born in another country and nearly half of those are not proficient in English. This meant that much of the Asian American experience was not being collected in these assessment surveys, which led to the creation the “model minority” stereotype. 

“Populations who are not proficient in English are automatically, systematically excluded from the national data,” Jang said. 

In 2016, Jang initiated what is arguably one of the most comprehensive and important contributions to Asian American health disparities research, the Asian American Quality of Life Survey (AAQoL). In partnership with the city of Austin, Texas, AAQoL translated the same questions posed by federal surveys into seven Asian languages. To recruit a research cohort that represented the full range of the AAPI experience, they implemented a street-level data collection process in the one place where people in AAPI communities frequent no matter their native language or socioeconomic status: Asian grocery stores. 

The results from Jang’s AAQoL study upended the notion of a monolithic Asian American experience and presented detailed health information by culture and demographics that more accurately represented the wide-ranging economic and social diversity of the population. For example, while federal data showed less than three percent of the Asian American population who had unmet health needs, Jang’s data found that number to be as much as six times higher among specific subgroups. 

In 2018, Jang built on the success of the AAQoL survey with the Study of Older Korean Americans (SOKA), a multi-state R01 research project funded by the National Institute of Aging (NIA) that studied a continuum of Korean population density across California, New York, Texas, Hawaii and Florida. 

The AAQoL and SOKA study results have provided the foundation for more than 55 published academic papers authored by Jang and her colleagues, and have made significant contributions to understanding the complex, unique and diverse range of AAPI health-related experiences. 

Translating self-care tools for dementia caregivers 

As the number of AAPI Californians living with Alzheimer’s is projected to more than double by 2040, so will the demands on caregivers. The impact of Alzheimer’s on family caregivers can be extraordinary, with the toll much more than physical or economic. Many caregivers also suffer from anxiety and depression, and have few social resources to call upon for help. For Asian American caregivers, this is exacerbated by the lack of evidence-based interventions available in languages other than English or Spanish, designed to provide help with the profound challenges. 

Currently, Jang is engaged in a long-term research and intervention project for Korean-American caregivers, funded by the NIA, with the goal of addressing the needs of caregivers with limited English proficiency who are not included in most evidence-based interventions. Jang and her team are creating and testing a cultural adaptation of Savvy, the most widely used program for Alzheimer’s caregivers, developed in the early 2000s by Dr. Ken Hepburn and previously adapted for Spanish-speaking audiences with great success. Jang emphasizes that her project goes beyond a simple translation and is a much more comprehensive analysis of the cultural context.

“Language translation is important,” Jang said. “But you have to go beyond that to make cultural adaptations based on the experiences and challenges of real people in the community, how they think, and what they recommend for future directions.” 

Jang selected the Savvy program for its natural relevance to several aspects of Korean American culture, including its strong emphasis on teaching and learning, and core values of self-efficacy and sense of control. To date, the research team has completed in-depth qualitative interviews with Korean American social services providers and caregivers, completed an initial translation, selected trainers for the pilot, and completed an implementation  with a small group of Korean American caregivers for family members with dementia, who are not fully proficient in English and showed signs of low to moderate depression. She also documented the process of cultural adaption and outcomes. 

An interesting early finding is that the concept of “self-care for the caregiver” is somewhat foreign to the collectivist orientation of the Korean culture, where individual benefits are often perceived as selfish. To overcome this ingrained cultural barrier, Jang found success in focusing on how caring for yourself promotes family harmony which, in turn, improves the overall situation. 

Results of the first phase of the study with cultural adaptation and initial efficacy were published in BMC Geriatrics. Despite the fact that caregivers have extraordinarily high levels of stress, limited time and conflicting priorities, the pilot reported a 100% participant retention rate and 98% session completion rate over the six-week program. In addition, participants reported an overall satisfaction score of 31.1 out of a possible 32. Jang also found there was a long-term impact on depressive symptoms among caregivers, which was sustained after six months, and hopes to build on these results with a randomized clinical trial in fall 2024.

Bullying a growing problem in senior housing

Jang’s research has also uncovered an underrecognized issue of resident bullying in Asian American senior housing facilities, and its negative impact on mental health. Bullying can be expressed in the form of physical, verbal or antisocial behaviors. At the suggestion of a longtime community partner, Jang and her colleagues incorporated several questions about bullying and the witnessing of bullying into a recent needs assessment study of older Korean Americans living in subsidized senior housing with predominantly Asian American residents. Jang was shocked to find that 18% of residents responded in the survey that they had experienced some form of bullying by other residents, and another 31% said that they had witnessed bullying. Jang notes that the fact that the percentage of witnessed bullying is higher suggests that the actual figures of experienced bullying may be higher. According to Jang and her co-investigators, being a target of bullying was a significant predictor for both depressive symptoms and anxiety, and even witnessing bullying increased the probability of anxiety. 

This issue appears to be consistent among senior housing facilities, based on the scarce academic studies to date, but may be even more significant with residents who rely on their own ethnic community as an emotional resource and whose socioeconomic and linguistic disadvantages may greatly limit their options for alternative housing. As noted in “Mental Health Impact of Bullying by Ethnic Peers in Senior Housing: A Study with Older Korean American Residents in the Greater Los Angeles Area,” published in the Journal of Gerontological Social Work, senior housing residents who are ethnic immigrants often rely on a sense of belonging and acceptance within their ethnic community as a critical resource. Therefore, the negative impact can be even greater when bullying comes from other residents within their own ethnic community. In the case of senior housing, both target and perpetrator live in the same facility so the behavior can be difficult to escape from, which can add to the impact of depression and anxiety.

“Family connections and the social resources of the ethnic community are really valuable as protective factors,” Jang said. “But sometimes we neglect the other side of that notion. When the negative interactions happen, they have a huge impact on mental health.” She is now planning on launching a network-based intervention to promote the health and well-being of senior housing residents addressing the core concepts of social capital, bonding, bridging and bullying. 

The common core of Jang’s research is a passion for the expansion of understanding and appreciation for the full diversity of the older adult experience. Not only in terms of racial and ethnic populations, but also in how the aging experience has its own distinct phases and milestones. 

“In traditional lifespan development terms, everyone over the age of 65 is lumped together into one big block,” Jang said. “But today, people can live another 30 or 40 years. There are amazing differences in experiences, achievements and changes that occur in those years of life. It is fascinating to be able to see the diversity within the aging population and so rewarding to be able to make an impact on individuals and communities with this research.” 

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