COVID-19 and Asian Americans

Publication Date: 2022

Abstract

The racialization of COVID-19 in the United States contributed to a sharp increase in anti-Asian discrimination and violence against Asian Americans. So far, however, little research has been conducted to understand how Asian Americans have been affected by heightened levels of racial hostility during the COVID era. Previous research shows that individuals who experience racism and discrimination suffer profound short- and long-term impacts on their health. Guided by the Vulnerable Populations framework, this study explores the mental health outcomes (depression, posttraumatic stress disorder) during the pandemic and how these were mediated by resource availability (individual resilience, community mitigation) and relative risk (perceived discrimination, Anti-Asian discrimination). In this report, we describe preliminary findings from a survey of 357 Chinese/Taiwanese, Korean, and Vietnamese Americans and immigrants. In addition, we also analyze in-depth interviews with eight community organization and religious leaders. Survey results suggest that Asian Americans who experienced racial discrimination had higher rates of depression and posttraumatic stress disorder. The survey findings suggested that Vietnamese showed a significantly higher level of depression compared to Chinese/Taiwanese; immigrants, as compared to those born in the United States, showed a significantly lower level of depression. The results for PTSD showed that perceived discrimination was positively and significantly associated with PTSD when controlling for the other variables in the model. These findings suggest a critical need to further assess Vietnamese Americans and immigrants’ mental health status and connect them with timely and appropriate treatments and resources. Community organization and religious leaders confirmed these findings in the qualitative interviews. Interviewees also described potential interventions which could mitigate these negative outcomes. The findings of this research provide meaningful information to enhance individual, community, and policy-level decisions related to our target population in the face of a pandemic.

Introduction and Literature Review

There has been significant increase of discriminatory behaviors during the pandemic primarily target the Asian American and Pacific Islander (AAPI) population (Fighting Hate for Good, 2020¹), in part due to the geographic origin of COVID-19. A recent national report demonstrated that anti-Asian assaults, harassment, and hate crimes have increased amid COVID-19 in the United States (Yellow Horse et al., 2021²). Between March 19, 2020, and September 30, 2021, a total of 10,370 anti-Asian hate incidents have been reported to Stop AAPI Hate (SAH³); an increase of 11.3% over 2020 (Yellow Horse et al., 2021). In all likelihood, this alarming statistic is also an undercount because many victims do not report being harassed or assaulted (Yellow Horse et al., 2021). Of these incidents, more than three-fifths were verbal harassment (63.7%), followed by avoidance or shunning (16.3%) and physical assault (16.1%). The majority of these incidents occurred in public spaces (e.g., public transit, streets, parks), which make Asian Americans fear for their lives doing their daily routines.

Asian Americans are the fastest growing racial minority group in the United States, yet they are often either not included or inaccurately characterized in health research. Further, data about the pandemic’s impact on different Asian American subgroups continues to be disturbingly incomplete (Constante, 2020⁴). Limited research has provided ethnically disaggregated analysis about discrimination experiences, health, and factors associated with health outcomes among different Asian American groups during COVID-19. Discrimination experienced at community level and factors that help build resilience and mitigate negative impacts on Asian Americans also is understudied. Our research addresses these gaps by examining double victimization and health among Chinese/Taiwanese, Korean, and Vietnamese Americans and immigrants in Arizona, sizeable ethnic groups that report experiencing discriminatory behaviors during COVID-19 (Fighting Hate for Good, 2020). Among the three Asian American ethnic groups, many of them are foreign-born (71%) with limited English proficiency (14% among Chinese/Taiwanese, 11% among Korean, 25% among Vietnamese; Boas et al., 2020), which further increases their vulnerability.

This study is guided by the Vulnerable Populations framework (Flaskerud & Winslow, 1998⁵) which argues that health status reflects the dynamic interplay between resource availability and relative risk. Resource availability refers to resources that promote health and prevent diseases; relative risk refers to circumstances that increase exposure to health risks. Individuals who have more resources are more likely to reduce their exposure to risks, which, in turn, may result in better health outcomes. Individuals with fewer resources are exposed to greater risks, and consequently may experience worse health conditions. The framework posits that groups with the most depleted access to resources and highest exposure to risk will have increased levels of health-related morbidity and mortality.

Resource Availability and Health

We examine resource availability at individual and community level. Resilience is defined as one’s capacity to recover from adversity and adapt to changing circumstances (Connor & Davidson, 2003⁶; Dyer & McGuinness, 1996⁷). Prior studies have demonstrated its protective role in facilitating better psychological health and subjective well-being in different populations (Burns et al., 2011⁸; Gao et al., 2017⁹; Ou et al., 2021¹⁰). Understanding resilience among Asian Americans and how it contributes to their health during the pandemic crisis is imperative to identifying resources that could address the suffering and needs of this marginalized population. The support and resources received from Asian American community and religious organizations also showed that online counseling programs, resource library, educational video series, against anti-Asian hate campaigns by media helped communities mitigate negative health outcomes (Asian American Day of Action, 2021¹¹; Stop AAPI Hate, n.d.; Asian American Christian Collaborative, 2021¹²).

Relative Risk and Health

Individuals who are subject to discrimination suffer immediate- and long-term negative health consequences during and after pandemics and disasters, including mental distress (Liu et al., 2020¹³) and poor physical and mental health and posttraumatic stress disorder (PTSD) symptoms (Chen et al., 2021), especially among less-acculturated immigrants (Chen et al., 2007a¹⁴, Chen et al., 2007b¹⁵). During the COVID-19 pandemic, Liu and colleagues (2020) reported that Asian Americans and non-Hispanic Blacks were more likely to perceive discrimination than other racial/ethnic groups. Chen and colleagues (2021) also suggested that Asian American college students’ perceived racial discrimination was negatively related to their depression and PTSD scores.

Methods

We used a mixed-methods approach, including a longitudinal survey and in-depth interviews of community leaders to examine the experiences and impact of COVID-19 on our target population. In this report, we provide preliminary findings about resource availability (individual resilience, community mitigation); relative risk (individual perceived discrimination, anti-Asian discrimination) and mental health (depression, PTSD); and community advocacy from the Wave I survey and leader interviews. We aim to achieve the following research objectives:

1. To assess resource availability (individual resilience, community mitigation), relative risk (individual perceived discrimination, anti-Asian discrimination), and mental health (depression, PTSD) during the pandemic based on the survey data and key informant interviews.

2. To examine the relationships between resource availability, relative risk, and two mental health outcomes (depression, PTSD) while controlling for sociodemographic variables based on the survey data.

3. To explore how Asian American community and religious organizations respond, including to anti-Asian discrimination, to mitigate damages associated with COVID-19 based on the key informant interviews.

Survey

Survey Sample and Sampling Procedures

We recruited a convenience sample in Arizona via our existing and new community partners (e.g., Asian Pacific Community in Action, Arizona Korean Association, Chinese, Korean and Vietnamese churches), snowballing (asked participants to assist in identifying other participants), and social media (e.g., community partners’ website, Facebook, Twitter). Inclusion criteria stated that respondents must: (a) be 18 years old or older; (b) self-identify as Chinese/Taiwanese, Korean, or Vietnamese; and (c) be able to read and write English, Chinese, Korean, or Vietnamese. We targeted Chinese/Taiwanese, Korean, and Vietnamese Americans/immigrants in AZ, as these three groups represent the sizeable ethnic groups that report experiencing discriminatory behaviors nationally during COVID-19 (Fighting Hate for Good, 2020). They also have the largest percentage of people with limited English proficiency among all Asian American groups in the state of Arizona (Calculation based on American Community Survey 2014-2018 5 year estimates).

We conducted the Wave I online survey via REDCap (Harris et al., 2009¹⁶), a web and database server located inside Arizona State University’s secure server environment protected by an enterprise level firewall. We included QR code and survey link on study flyers, so individuals who were interested participating could use either one to access the secured, online survey. Individuals would answer eligibility questions first and proceed to consent and survey questions if they met the inclusion criteria. Each participant received an incentive of 10 dollars for their time and effort completing the survey. Given the potential high risks for mental health and COVID-19 issues in our target sample, we provided a list of resources, including the SAMHSA national helpline number, which provides free, confidential, 24/7 treatment referral and information services, and the CDC website. We also encouraged them to contact the team for any concerns or questions, and to call 911 for emergencies. We received IRB approval prior to study implementation.

Survey Measures

We chose valid and reliable measures assessing the main theoretical constructs: resource availability, relative risk, and health outcomes in the Vulnerable Population framework. We have tested some of these measures in our prior work (e.g., Chen et al., 2007a; Chen et al., 2007b; Leong et al., 2007a¹⁷, Leong et al., 2007b¹⁸; Li et al., 2010¹⁹). The survey additionally included questions regarding sociodemographic characteristics, such as age, gender, race/ethnicity, education attainment level, immigration history, and financial status. All measures and documents were translated into Chinese (traditional and simplified), Korean, and Vietnamese by bilingual and bicultural team members to address the linguistic and cultural needs of our target sample. In the survey, we used individual resilience to represent resource availability as resilience indicates emotional strength that allows an individual to cope during hardship. The 10-item Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003) was used to measure how well an individual is equipped to bounce back after stressful events, tragedy, or trauma. Respondents rate each item on a scale from 0 (not true at all) to 4 (true nearly all the time). The total score ranges from 0-40, with a higher score indicating higher resilience. Psychometric properties of the scale have been established in different populations, including Asian American populations (Chen et al., 2021²⁰; Connor & Davidson, 2003; Jung et al., 2012²¹; Meng et al., 2019²²).

To measure discrimination, we used the Multidimensional Scale of Perceived Discrimination (MSPD; Molero et al., 2013²³), which consists of 20 items measuring four aspects of perceived discrimination: blatant group discrimination (BGD), subtle group discrimination (SGD), blatant individual discrimination (BID), and subtle individual discrimination (SID). We used the 7-item BID subscale (e.g., I have felt personally rejected for being Asian/Asian American) to assess perceived discrimination. Respondents rate each item 0 (no) or 1 (yes) to indicate their experiences during the pandemic. Prior research has suggested satisfactory reliability and construct validity of the scale (Molero et al., 2013).

To assess levels of depression, we used the 9-item PHQ‐9 (Kroenke et al. 2002²⁴) scale, which asks about symptoms and severity of states of depression occurring in the past 2 weeks. Items are rated on a 4‐point Likert scale ranging from 0 (not at all) to 3 (nearly every day). A sum score is calculated (range 0-27) with higher scores indicating more severe depressive symptoms. Depressive symptoms are further classified by severity into five groups: minimal (0‐4), mild (5‐9), moderate (10‐14), moderately severe (15‐19), and severe (20‐27). This scale has been widely used and demonstrated strong psychometric properties in Asian American students (Chen et al., 2014²⁵; Chen et al., 2021; Keum et al., 2018²⁶).

To assess PTSD levels, we used the 5-item Primary Care PTSD Screen for DSM-5 (PC-PTSD-5; Prins et al., 2016²⁷), which is designed to identify individuals with probable PTSD. It begins with an item assessing whether respondents have had any exposure to traumatic events. The score will be zero if a respondent denies exposure. If respondents indicate a trauma history, five additional yes/no questions about how that trauma has affected them over the past month will be asked. The suggested cut-point is three (respondents answer "yes" to any three of five questions); respondents with a score three or higher are suggested to receive further assessment by mental health professionals. Diagnostic accuracy, respondent acceptability, reliability, and validity have been established in previous research (Jung et al., 2012; Prins et al., 2016).

Survey Data Analysis

We used descriptive statistics (e.g., mean, standard deviation, frequencies) to describe major characteristics of the target population. Analysis of Variance (ANOVA) and multiple regression were performed to compare ethnic group differences (Chinese/Taiwanese, Korean, Vietnamese) in key measures and to investigate the relationship among resource, relative risk, and mental health.

Survey Sample Characteristics

In the sample of 357 participants (166 Chinese/Taiwanese, 159 Vietnamese, 32 Korean) who provided complete data in the Wave I survey, the mean age was 37.06 (SD = 10.81; range 18-78) years old, and 59.44% were married or living with someone. About 52% identified themselves as immigrants and 83.80% used a language other than English at home. Approximately 73% had some college or more education, and 71.63% had health insurance. Regarding finances, about 36% indicated their situation was “somewhat, very or extremely difficult” before COVID-19, and 53% reported this during the pandemic. Further, 30% reported getting financial assistance from county, state, or federal resources.

Interview

Interview Sample, Sampling, and Procedures

We interviewed a total of eight Asian American organization and community leaders, religious leaders, political representatives, and public safety and medical personnel to explore how Asian American community and religious organizations responded, including to anti-Asian discrimination, to mitigate damages associated with COVID-19. To participate, individuals had to: (a) be 18 years old or older; (b) self-identify as Asian American; and (3) be able to speak English, Chinese (Mandarin, Cantonese, or Taiwanese), Korean, or Vietnamese. Interviewees (key informants) were nominated by our community and organizational partners who worked with our target population during the pandemic. Due to feasibility and concerns regarding COVID-19, the eight key informants who represented and/or primarily worked with Chinese/Taiwanese, Korean and Vietnamese communities were invited to participate in a 60-minute Zoom meeting at a time and place convenient to them. Each key informant received 30 dollars for his/her time and effort.

Interview Questions

The interview guide included 10 probing questions regarding experiences/assessment of COVID-19; anti-Asian discrimination and racism (identity; whether the individual experienced, witnessed, or heard about anti-Asian incidents); and what services the interviewee organization provided for their respective constituencies. We also asked key informants about community collective responses and mitigation measures for COVID-19, as well as relevant contextual factors, such as community leadership and advocacy provided to assist Chinese/Taiwanese, Korean, and Vietnamese Americans to battle discrimination, prevent COVID-19, and connect them to needed resources, including COVID-19 vaccines.

Qualitative Analysis

Our bilingual investigators translated and transcribed the digital files. Two researchers reviewed and cross-checked for accuracy and consistency. We used a mixture of inductive and deductive coding methods to develop themes for content analysis (Fereday & Muir-Cochrane, 2006²⁸). Primary level coding included themes such as ‘impact of pandemic,’ ‘concerns related to COVID,’ ‘discrimination issues,’ ‘supportive resources,’ and ‘vaccination.’ Secondary coding were conducted under each primary coding theme. For instance, ‘supportive resources’ included support from church, local or state officials, and specific community organization. Each of the two researchers individually completed the qualitative analysis of the transcripts and discussed with the entire team to summarize the findings.

Results

To address the three research objectives, we first assessed resource availability (resilience), relative risk (discrimination), and mental health (depression, PTSD) during the pandemic; then controlling sociodemographic characteristics to analyze the relationship between mental health and resources and relative risks. Interviews supplemented the survey finding to substantiate the findings on impact of covid, discrimination and support with nuanced information. Majority of the results from Wave I survey and interviews were consistent with our theoretical framework.

For the target sample, the mean resilience score was 24.58 (SD = 8.06; range 4-40), representing a moderate level of resilience. The mean score of perceived racial discrimination (MSPD-BID) during COVID-19 was 1.48 (SD = 1.77; range 0-7), suggesting a relatively low level of perceived racial discrimination. Regarding mental health, 6.82% of our survey sample reported a clinically significant PTSD score (4 or 5). Further, the respondents reported moderate (14.71%), moderately severe (6.18%), and severe depression (0.88%). Individuals in the “moderate depression” category are recommended to consider counseling, follow-up, and/or pharmacotherapy. Those in the “moderately severe” category should seek pharmacotherapy treatment and/or psychotherapy, and those in the “severe” category should immediately initiate pharmacotherapy (Kroenke & Spitzer, 2002).

Ethnic Group Comparison

Based on the result of one-way ANOVA with Tukey honestly significant difference test was used to compare means of the following measures across three ethnic groups: perceived discrimination at the time of the survey; resilience; and depression and PTSD. Multiple comparison results show no difference in perceived discrimination, and PTSD among three ethnic groups. On the other hand, there were significant differences between groups for resilience and depression measures. For resilience, the difference between Chinese/Taiwanese (27.56) and Vietnamese (20.92) and the difference between Korean (28.03) and Vietnamese (20.92) were significant at the alpha level of .05. For depression, the difference between Chinese/Taiwanese (3.92) and Vietnamese (7.87) and the difference between Korean (3.03) and Vietnamese (7.87) were significant at the alpha level of .05.

Racial Discrimination and Mental Health Outcomes

Multiple regression models were used to examine the associations of depression and PTSD with perceived discrimination and resilience, controlling for ethnicity, financial difficulty, marital status, age, immigration status, and education. The results showed that depression was positively and significantly associated with perceived discrimination, controlling for the other predictors and the covariates. Further, Vietnamese showed a significantly higher level of depression compared to Chinese/Taiwanese; immigrants (vs. born in the United States) showed a significantly lower level of depression. The results for PTSD showed that perceived discrimination was positively and significantly associated with PTSD when controlling for the other variables in the model.

Resource Availability and Health Outcomes

In the regression models, individual resilience did not show statistically significant association with both health outcomes with or without controlling for covariates.

Ethnic Group Comparison

Chinese/Taiwanese (27.56) and Korean (28.03) have a relatively higher level of resilience score compared to Vietnamese (20.92), and the difference (4.13) was significant at the alpha level of .05. Vietnamese (7.87) showed a significantly higher level of depression compared to Chinese/Taiwanese (3.92). Meanwhile, Chinese/Taiwanese (1.03), Korean (.58), and Vietnamese (1.46) showed a similar level of PTSD.

Qualitative Interviews

Several themes associated with discrimination and community mitigations were reported by the community and organization leaders who have worked with our target population.

Anti-Asian discrimination

COVID-19 has intensified existing challenges (e.g., financial difficulties, lack of healthcare coverage and transportation, lack of culturally and linguistically congruent materials and services). Further, the pandemic has become an impetus and excuse for surging anti-Asian incidents nationwide in which people verbally harass or even conduct violent acts against Asian Americans. A pan-Asian organization leader noted that, “From the beginnings of the pandemic…the first offenses were seen in the fact that people were reporting a lot of anti-Asian discrimination that was happening…and those kinds of things are actually continuing to happen right now.” This finding confirms with the national trend that Yellowhorse et al. (2021) reported. The SAH statistics showed 43 anti-Asian incidents were reported in Arizona as of early 2021, but increased to 125 by late September (personal communication; Yellowhorse et al. (2021).

The danger of misinformation and politicizing COVID-19

Community and church leaders pointed out how widespread misinformation and politicization of COVID-19 have negatively impacted their work. The representative from one pan-Asian American organization noted the difficulty of combatting misinformation: “Translation services are readily available when you’re translating from English to other languages for conspiracy theories, but not as readily available for medically accurate information, and that’s been really unfortunate. All of the conspiracies—even the thing with they’re going to insert a microchip and things like that.” A Chinese public charter primary school teacher noted that, “Students are not getting the correct information from their parents, so that when they are talking to their friends, they are saying something that is not the right information.” Moreover, some leaders in the communities decided not to advocate vaccination, even though they know it is the right thing to do, as they fear political backlash will put their lives in danger. A Korean pastor said, “I support vaccinations, but I don't see my role (pastor) as someone who should advocate for the vaccine…Even like publicly endorsing the vaccine can come across as political, which is a little, you know, dangerous for somebody in my position, and so I stay away from that.” Similarly, people felt mask-wearing being politicized as a weapon: “Even when I wear my mask and I'm walking around my neighborhood and stuff, I sometimes feel unsafe because a lot of people don't wear mask when they're walking out. I feel like they just assume a political affiliation or something. It's really tragic that it's become a politicized thing when it's a public health thing.”

Community mitigation as an important resource

As noted by Connor & Davidson (2003), resiliency is an important resource in mitigating negative impacts. Our interviewees confirm that resources provided by community organizations, ethnic churches, schools and elderly housing were important mitigating factors to overcome the negative impacts by the pandemic and discrimination. The negative impacts of the pandemic and hate incidents called for more actions to battle anti-Asian hatred and discrimination. Local Asian American—either ethnic group-specific or pan-Asian American—community organizations, churches, and schools provided some critical assistance to their respective constituencies to mitigate the negative impacts of anti-Asian discrimination. Our interviews provided rich details on how the various local Asian American community organizations have played important roles in mitigating damages associated with COVID-19. Their strategies were multi-pronged, primarily involving battling misinformation/politicizing COVID-19 and anti-Asian hatred while tapping into their networks to provide in-language assistance around and beyond this pandemic.

Discussion of Preliminary Findings

Our study aimed to address time-sensitive research questions that examine the roles of racial dynamics, including racial discrimination, relevant to vulnerability and resiliency amid COVID-19 among Chinese/Taiwanese, Korean, and Vietnamese Americans and immigrants in Arizona. Similar to the U.S. Census (2020b²⁹), more than half of our sample are immigrants and the majority of them speak a language other than English at home.

Rising Levels of Hate and Mental Strain. While COVID-19 incur negative health and mental health strain to all population, Asian Americans become double victims of both COVID-19 pandemic and anti-Asian hate. People were afraid of going outside to resume their daily routines in fear of hate incidents just because how they look, especially among elders. Asian American community organizations provided mitigation to the extend they can to help reduce such mental strain. Emerging Financial and Mental Health Struggles. Our target population presented several challenges similar to other research, including financial challenges and suboptimal mental health outcomes (Chen et al., 2021; Czeisler et al., 2020³⁰; Kantamneni, 2020³¹). The large percentage of our target sample reporting clinically significant symptoms for PTSD and depression during the pandemic. This finding is particularly concerning given the cultural taboo for Asian Americans to seek mental health services (Lee, 2019³²) and lack of culturally and linguistically appropriate healthcare providers, interventions, and services for this population (Chieh et al., 2017³³; Iwamasa, 2012³⁴; Jang et al., 2018³⁵).

Relative Risk and Mental Health

Our sample also reported a moderate level of perceived racial discrimination. Consistent with other research during the COVID-19 pandemic on Asian Americans and immigrants (e.g., Chen et al., 2021), our study finds an alarming positive association between racial discrimination and mental health.

Resource Availability and Mental Health

Although our survey finding did not reveal a positive association between individual resilience and mental health outcomes, our community and religious organization leaders indicated the critical roles they play in mitigating the negative impacts during the pandemic, as they are deeply-rooted in local communities and familiar with their language and culture. They can thus effectively serve as bridges between their community and mainstream resources and services. These leaders found linguistically and culturally responsive strategies and resources were most helpful for community people during the pandemic. Importantly, some of them pointed out the lack of timely resources and support (e.g., funding, information using language that non-English speakers could understand) from governmental agencies and warned about the risks associated with inconsistent information regarding COVID19, vaccines and health that communities had received over time.

When comparing ethnic group difference, Korean and Chinese/Taiwanese participants reported statistically higher resilience scores than the Vietnamese group. Further, the Vietnamese group reported statistically higher depression score than their Chinese/Taiwanese and Korean counterparts. Beyond the fact many older generation Vietnamese Americans are war refugees, this group also has the highest percentage of limited English proficiency in Arizona (26.1%, about twice as high compared to the 13.7% among Chinese/Taiwanese and 11.1% among Koreans (United States Census Bureau, 2020b). Compared to Vietnamese as the more recent arrival group, Chinese Americans are long established in AZ and their immigration history dated to the 19th century prior to AZ became a state (Luckingham, 1994³⁶). Similarly Korean Americans also settled in AZ for a longtime, so both groups have more complete community structure with various kinds of churches, schools and other organizations.

Limitations

There were several limitations to the study. Our sample was a convenience sample with relatively small sample size (e.g., Korean American group in particular). Although we provided surveys with different languages and recruited our target sample from multiple outlets, the access to the survey might be limited to certain individuals. Despite these limitations, the anonymous nature of the study may minimize the self-report bias. Future research may strive for a larger, more comprehensive sample in each of the Asian American ethnic subgroups to allow meaningful comparisons. Longitudinal studies that explore changes over time and additional factors (e.g., new policies, resources) influencing our target population’s health is also warranted.

Conclusions and Implications

Given the current resurgence of COVID-19 infection in the nation and globally, and the federal government’s emphasis on community-based preventive behaviors, this study is timely and urgent for identification of community-specific preventive behaviors and resources to further advance behavior modification in Asian American communities.

Scholars (e.g., Devakumar et al., 2020³⁷) have warned about the negative impacts of racism and discrimination in COVID-19 responses and advocate for policies that reflect practices of social inclusion, justice, and solidarity for the public good and health. Currently, the Asian population in Arizona is about 3.7% of the total population (United States Census Bureau, 2021³⁸). Although several Asian American community forums have responded to this crisis, most of these responses have been in states (California, New York, Washington, and Illinois) with large concentrations of Asian Americans. We uniquely researched Asian American health disparities by collecting ethnic disaggregated data among three fast-growing Asian American groups in Arizona (United States Census Bureau, 2020a[^United States Census Bureau, 2020a]) and addressed the double victimization in our target population: by COVID-19 and by anti-Asian discrimination. This time-sensitive research collected perishable data to identify and understand the underlying factors influencing the unequal mental health outcomes in our target population in order to provide culturally, linguistically, and context-relevant resources and interventions. These resources and interventions can help to mitigate risks and prevent COVID-19 associated morbidity and mortality at individual and community levels. The findings of this research provide meaningful information to enhance individual, community, and policy-level decisions related to our target population and other ethnic and racial minority groups who encounter similar challenges in the face of a pandemic.

References