HEAR US: a qualitative study of racial discrimination in Boston's Chinatown and empowering change from within the community.

Objective: To qualitatively explore the impact of anti-Asian racism in a Chinese community in the greater Boston area. Methods: Individual semi-structured interviews (n = 27) were conducted between June and September 2021. Eligible participants were ethnic Chinese immigrants living in the Boston area, who were recruited through a community-based organization and by word-of-mouth. Interviews were conducted in Mandarin and Cantonese and translated into English. Data were coded and analyzed using a directed approach to content analysis. Results: The majority of participants reported personal experiences of anti-Asian racism, ranging from microaggressions to violent attacks. Although lockdown and isolation during COVID-19 affected all communities, the Chinese community suffered unique and prolonged trauma stemming from the fear of violent attacks against Asians. The older person/people, in particular, were severely isolated due to fear of exposure to anti-Asian hate crimes. Participants reported a variety of emotional, mental, and physical health effects associated with feelings of fear, anxiety, isolation, and powerlessness. Many preferred to engage in self-protective behavior changes rather than relying on external resources. Conclusion: Participants advocated for more education, community, and governmental support, and increased allyship between communities of color. These findings provide cultural context on the trauma this population faces and can inform further actions to address the wide range of reported health effects.

Cultural-Responsiveness of the Mental Health First Aid Training for Asian Immigrant Populations in Greater Boston, Massachusetts.

Background: The COVID-19 pandemic and rise in anti-Asian racism have had adverse mental health impacts in Asian communities. The lack of culturally-responsive and linguistically-accessible mental health trainings hinders access to mental health services for Asian populations. In this study, we assessed the mental health needs of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond. Methods: This community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition employed two phases. In phase 1, we conducted focus groups with BCNC and AWFH staff and peer educators to assess mental health priorities of Asian populations in Boston. Findings informed phase 2, which evaluated cultural responsiveness of the MHFA through pre- and post-training questionnaires and focus groups with community participants. The pre-training questionnaire asked about mental health needs and barriers, help-seeking behaviors, and literacy; and personal and Asian community stigma. The post-training questionnaire and focus group with community participants asked about cultural competence of MHFA training for Asian populations. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews. Results: In total, 10 staff/educators and 8 community members participated in focus groups. They identified common mental health needs and workforce and culturally-responsive community strategies to support persons with mental health issues. Twenty-four community participants completed pre- and post-training questionnaires. They reported the MHFA training reduced mental health care stigma and increased mental health literacy. Recommendations to increase cultural-responsiveness of the MHFA were to include mental health case studies common in Asian populations and provide the training in other languages (e.g., Chinese, Vietnamese). Conclusion: Cultural responsiveness of the MHFA for Asian populations could be improved with the inclusion of case studies specific to the Asian communities and accessibility of the training in other languages. Increasing the cultural relevance and language accessibility of these trainings could help reduce mental health stigma and gaps in mental health awareness and service utilization among Asian populations.

Unpacking the root causes of gambling in the Asian community: Contesting the myth of the Asian gambling culture.

Introduction: Problem gambling is a public health issue both in the United States and internationally and can lead to mental health and socioeconomic concerns for individuals, families, and communities. Large epidemiological studies on problem gambling have neglected to include working-class, immigrant Asian Americans, who are at higher risk for problem gambling. The lack of data on Asian American gambling may explain a subsequent lack of culturally and linguistically appropriate treatment and prevention services. Additionally, the invisibility of Asian American data in published literature has helped to perpetuate a commonly held myth of an Asian gambling culture. This stereotype of the "Asian gambler" is a form of anti-Asian racism which serves to ignore and minimize the root causes of problem gambling in the Asian American community. Methods: Utilizing a community-based participatory research approach, 40 interviews were conducted with the local Khmer (n = 12), Chinese (n = 20), Korean (n = 3), and Vietnamese (n = 5) immigrant communities in the Greater Boston region to assess how problem gambling manifests in the local Asian community. Interviews were conducted in language by bilingual/bicultural community fieldworkers experienced in serving their respective communities. Flyers and social media were used to recruit participants. The interviews were coded into themes which provided a better understanding of the patterns of systemic issues contributing to problem gambling in the Asian American community. Results: Interviewees provided insights into the underlying issues of poverty and social and cultural loss due to immigration as root causes for problem gambling in the Asian American community. The interviews indicate that many individuals in these Asian immigrant communities, who are striving to make a living off low-wage and stressful jobs, struggle to integrate into American society. They often lack culturally appropriate and accessible social and recreational activities, a void that casinos capitalize on through targeted behaviors. Discussion: Research must address the social and structural barriers in the Asian American communities rather than relying on the "Asian gambler" stereotype and assuming interventions for a general American problem gambler will work for Asian immigrants. The research points to a need for gambling interventions and services that are centered on lived experiences.