Mental health and risky health behaviors issues are a growing concern among Asian American adolescents in the United States. Prior studies have shown that Asian American adolescents are at greater risk for depressive symptoms and substance use, particularly when they face difficulties adjusting to a new or unwelcoming culture. Research has indicated that social cohesion, sense of belonging, and community safety are significant predictors for the level of immigrant adolescents’ depressive symptoms. A number of studies have found that depressive symptoms have a strong influence on substance use among Asian American adolescents. Therefore, the pathway of social cohesion, a sense of belonging, community safety, depressive symptoms, and substance use needs attention based on an understanding of unique Asian culture. This study tested the influence of social cohesion, sense of belonging, and community safety on depressive symptoms and substance use. A systematic scoping review of the impact of acculturation on depressive symptoms and substance use. And a hierarchical multiple linear regression was performed to examine the regression effect in the relationship of social cohesion and community safety to depressive symptoms. Lastly, structural equation modeling (SEM) was conducted to examine in the relationship of social cohesion, sense of belonging, and community safety to substance use mediated by depressive symptoms among Asian American adolescents. A systematic scoping review results showed that Asian American adolescents reported high depressive symptoms but low substance use. Family, school, peer relationships, and neighborhood and community environments were strong acculturation related protective factors for depressive symptoms and substance use. Hierarchical multiple linear regression analysis research result showed that higher social cohesion and community safety level is statistically significantly associated with Asian American adolescents’ depressive symptoms. Finally, the SEM analysis research result examined that social cohesion strongly negatively influences Asian American adolescents’ depressive symptoms and substance use. The findings in this study highlight that social cohesion, sense of belonging, and community safety are important factors in reducing mental health problems and risky health behaviors among the Asian American adolescent population. Furthermore, the current research contributes to ongoing policy, practice, and research discussions about mental health and behavioral health for Asian American adolescent populations. The significant impact of acculturation, other cultural and immigration influences, social cohesion, sense of belonging, and community safety on psychosocial behaviors in Asian American adolescent populations reflects the importance of addressing these issues in prevention and intervention efforts. Finally, these findings shed light on how to develop effective immigration and acculturation strategies from a positive perspective by treating Asian American adolescents as a new citizen group and by reducing discrimination on the basis of race and ethnicity in the United States.

The purpose of this dissertation study was to examine the relationships among perceived parental warmth, intergenerational family conflict, and racial discrimination distress, and how they are associated with depressive symptoms and substance use in Korean American adolescents. The specific aims were to (a) test the hypothesized model predicting the effects of perceived parental warmth on depressive symptoms among Korean American adolescents, as mediated by intergenerational family conflict; (b) examine relationships between racial discrimination distress and substance use among Korean American adolescents, potentially moderated by perceived parental warmth; and (c) explore Korean American adolescents' perception of parental warmth with the use of open-ended questions. Using convenience and networking sampling methods, 101 Korean American adolescents, ages 14 to 18, were recruited from the Pacific Northwest area. Measurement scales included the Center for Epidemiologic Studies Depression Scale (CESD)-10, the Child Parental Acceptance-Rejection Questionnaire (CPARQ), the Adolescent Discrimination Distress Index (ADDI), and the Asian American Family Conflicts Scale (AAFCS). A substance use index created by the researcher was also used. Open-ended questions were constructed to assess how Korean American adolescents perceive acceptance and rejection from their parents. The first paper examines the mediating effects of intergenerational family conflict between perceived parental warmth and depressive symptoms. It reveals that mother-adolescent conflict was significantly mediating between perceived maternal warmth and depressive symptoms among Korean American adolescents in the study. The second paper describes how Korean American adolescents perceive racial discrimination distress and their patterns of substance use, followed by an examination of the moderating effect of perceived parental warmth between two variables. The outcome demonstrated an association between perceived racial discrimination distress and substance use, but perceived parental warmth did not moderate between two variables. The third paper uses content analysis to present the main themes of when and how the adolescents felt loved or not loved by their parents. It also examines the similarities and differences between the answers of open-ended data and survey data. The results showed that the Korean American adolescents perceived parental acceptance through verbal affirmation, acts of service and/or sacrifice, time spent together, physical contact, gift-giving, and parental prayer. Parental rejection was perceived when participants experienced verbal hostility, neglect, uncaring behavior, physical punishment, and argument engagement. These findings suggest that health care professionals and counselors should screen for depressive symptoms and substance use in Korean American adolescents. This dissertation study will contribute to developing culturally and developmentally appropriate interventions for Korean American adolescents and their parents.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Neighborhood context and parental influences are two major factors that are known to impact the mental health development of adolescents. Both factors have been extensively studied in either contributing or preventing youth from developing internalizing or externalizing mental health problems, such as depression and antisocial behavior (ASB). Specifically, researchers have investigated how perceived neighborhood safety, family cohesion, parental-engagement, and parent-child communication either serves as a protective factor or a risk factor for mental health problems within adolescents. This is consistent with Bronfenbrenner's Ecological Systems Theory (1977) that highlights the influence of numerous systems in adolescent mental health development, where appropriate levels of parental influences and a safe neighborhood will lead to positive mental health development. Neighborhood context and parental influences falls under the microsystem, which has a direct impact on adolescent mental health development due to these contexts being the 'immediate' social setting in which the adolescent is involved in (Lomas. 2015). Researchers have also documented that when youth develop mental health problems, racial/ethnic disparities exist in whether youth access mental health services to address those problems. Specifically, Latinx and African American youth demonstrate higher levels of unmet mental health need relative to their White counterparts, and these disparities often depend on the type of mental health problems (internalizing vs. externalizing) exhibited in youth. The current study examined the extent to which perceived neighborhood safety and parental influences were associated with mental health status and whether this led to receipt of mental health services and how that differed by problem type and ethnicity. The study goals were achieved using multigroup structural equation modeling in MPLUS, version 8.0 (Muthén & Muthén, 2017). Results revealed that the path between perceived neighborhood safety and externalizing ASB was significant. However, the path between perceived neighborhood safety and internalizing depressive symptoms was non-significant. The paths between parental influence and internalizing depressive symptoms as well as and externalizing ASB behaviors were also significant. Lastly, the path between internalizing depressive symptoms and mental health service use was significant but did not vary by race/ethnicity strongly based on beta coefficients. Results did illustrate that African American youth were likely to receive services when exhibiting depressive symptoms in comparison to Latinx and White youths. The current study has multiple policy implications; the study suggests that there should be interventions specifically targeted at improving neighborhood contexts and parenting characteristics as they can serve as protective factors against mental health status (Kruger et al., 2007; Yu et al., 2006). Additionally, research shows that there are racial/ethnic disparities in mental health service use; however based on the current study findings, there should also be an increased awareness of how these disparities vary by problem type (Martinez, Gudiño, & Lau, 2013).

Adolescent onset of depression is a public health concern because it is common and has been linked with subsequent episodes of depression, substance abuse, impaired social and academic functioning, and suicidal tendencies (Emslie et al, 2008; Kovacs, 1996; Kovacs et al.,1984; Weissman et al., 1999). Diminished positive affect and disrupted reward function, seen as the neural characteristic of positive affect, are implicated in early episodes of depression and also predict recurrent episodes of depression (Forbes, 2011; Joiner, Lewinsohn, & Seeley, 2002; Nandrino et al., 2004). Thus, studying positive affect and reward during the developmental period of adolescence may help us better understand the emergence of depression. An increasing number of studies acknowledge the importance of examining the role of culture in the expression of depression. However, few studies have looked specifically at culture and reward dysfunction, and even fewer have looked at these constructs during a developmental period when depression is emerging. The expression of positive affect is shown to be shaped by cultural norms, with Asian Americans in general reporting less intense positive emotions than European Americans due to the cultural emphasis to control and moderate emotion (Eid & Diener, 2001; Russell & Yik, 1996). In order to better understand the emergence of depression within this population, it may be useful to assess positive affect with measures that are less influenced by subjective experience. Prior research suggests that while culture may alter the subjective experience of emotion, there may be less contribution of culture with regards to physiological response (Levenson, 1999). Disrupted reward anticipation has been examined using electroencephalographic (EEG) measurements and several studies have found abnormal reward circuitry when comparing depressed to nondepressed samples (Davidson, 1998; Debener et al., 2000; Foti et al., 2011). The overarching goal of this study is to explore how culture affects the expression of positive affect and reward among depressed Asian American and European American adolescents using multiple methods of data collection. The following hypotheses were examined: (1) whether race/ethnicity affects the relation between self-reported positive affect and depressive symptoms; (2) whether neural reactivity, measured using ERP P3 amplitude, towards both monetary and social reward predicts depressive symptoms and if this association is affected by race/ethnicity; and (3) if acculturation moderates the expression of positive affect and reward for Asian American adolescents. Data was gathered in two phases in order to evaluate study hypotheses. In Phase One, 825 participants ages 18-19 were asked to fill out self-report measures online that assess for depression, positive affect, and acculturation. In Phase Two, 68 females were selected from Phase One based on race/ethnicity. Asian American participants were matched with European American counterparts based on depression severity on the PHQ-9 depression measure (Spitzer, Kroenke, & Williams, 1999). During the Phase Two lab visit, ERP data were collected during a cued go/no-go task. Participants also completed a structured depression interview on the YA-DISC-IV (Shaffer, 2000). Results suggest the negative association between positive affect and depression was significantly stronger for European American participants compared to Asian Americans. In addition, a trend towards significance was found with European American participants exhibiting increased P3 reactivity towards smiling European American faces as level of depression increased. Results from the proposed study can be used to guide the development of culturally sensitive ways to detect, prevent, and intervene with depression in Asian American youth.

This study explored the relationship between neighborhood (disadvantage, Chinese concentration, and social cohesion), parenting (parental home and school involvement, and parent-adolescent conflict) and Chinese American adolescents achievement and depressive symptoms. Data for this study were taken from the Early Adolescent Cohort study (EAC). A total of 221 Chinese American adolescents participated. Structural equation modeling was used to examine the relationship between neighborhood, parenting and Chinese American achievement and depressive symptoms as well as the mediating role of parenting. The results revealed that higher Chinese concentration was marginally but meaningfully related to lower achievement. Higher levels of parent-adolescent conflict were a powerful predictor of both lower achievement and higher levels of depressive symptoms. Moreover, results of the study revealed that parental home and school involvement were negatively influenced by neighborhood disadvantage. Compared to parents living in less disadvantaged neighborhoods, parents who resided in more disadvantaged neighborhoods were less involved in their youths learning at home and school.

Every year, about 30,000 people die by suicide in the U.S., and some 650,000 receive emergency treatment after a suicide attempt. Often, those most at risk are the least able to access professional help. Reducing Suicide provides a blueprint for addressing this tragic and costly problem: how we can build an appropriate infrastructure, conduct needed research, and improve our ability to recognize suicide risk and effectively intervene. Rich in data, the book also strikes an intensely personal chord, featuring compelling quotes about people's experience with suicide. The book explores the factors that raise a person's risk of suicide: psychological and biological factors including substance abuse, the link between childhood trauma and later suicide, and the impact of family life, economic status, religion, and other social and cultural conditions. The authors review the effectiveness of existing interventions, including mental health practitioners' ability to assess suicide risk among patients. They present lessons learned from the Air Force suicide prevention program and other prevention initiatives. And they identify barriers to effective research and treatment. This new volume will be of special interest to policy makers, administrators, researchers, practitioners, and journalists working in the field of mental health.