AND MINORITY INDIVIDUALS · learn, limited access to educationally relevant resources, ethnic and...

ACADEMIC ACHIEVEMENTAND MINORITY INDIVIDUALS

The academic achievement of some minority individ-uals and groups remains a ubiquitous and seeminglyintractable problem in the United States. The problemis usually defined in terms of mean differences instandardized achievement test scores between certainracial or ethnic groups. There is good reason for con-cern because on virtually every measure of academicachievement, African American, Latino, and NativeAmerican students, as a group, score significantlylower that their peers from European backgrounds.Moreover, it appears that gaps first manifest early inschool, broaden during the elementary school years,and remain relatively fixed during the secondaryschool years.

THE NATURE AND SCOPE OF THE PROBLEMOF MINORITY ACADEMIC ACHIEVEMENT

One source of information that has documented aca-demic achievement trends among minorities for morethan three decades is the National Assessment of Educa-tional Progress testing program. If the term “minority”is defined as a racial or ethnic group within a largerpopulation, then the lower performance in achieve-ment is associated with students from certain minor-ity populations defined as African American andHispanic. If the term “majority” is used to define aracial or ethnic group that characterizes the larger popu-lation, then the higher performance in achievementis associated with students from European back-grounds. These data have consistently shown significant

achievement gaps between certain racial or ethnic groupson standardized tests in different subject areas and acrossgrade levels. Other measures of academic achievement,such as grades and class rankings, show similar differ-ences in minority and majority achievement.

Beyond the consistency of the disparities in minor-ity and majority achievement, it is by no means clearwhat these discrepant scores really mean. To character-ize racial and ethnic differences as minority differencessuggests that these groups have had similar experiencesand that these experiences influence their behavior ina similar way. However, this is not the case. There istremendous variability within and across racial andethnic groups even though they are ascribed minoritystatus in U.S. society. For example, native-born AfricanAmericans and immigrants of African ancestry are sim-ilar in terms of race and minority status, but they havehad different culturally mediated socialization experi-ences that affect their achievement motivation and aca-demic performance differently. However, becauseacademic achievement is usually reported as a meanscore for African Americans, it is difficult to differenti-ate the nature of the performance of either minoritygroup. But it is important to know which minoritygroups are performing high or low because such infor-mation is critical for informing appropriate interventionfor both groups.

FACTORS THAT INFLUENCELOW MINORITY ACHIEVEMENT

Since the 1960s, numerous perspectives have beenadvanced about the differences in academic achieve-ment among minority and majority students andgroups. Reasons include unequal opportunities to

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learn, limited access to educationally relevant resources,ethnic and racial stereotyping, and cultural incompat-ibility between the home and school culture. Each willbe discussed briefly.

Limited Opportunities to Learn

In reviewing the literature on who gets access torigorous curricula in schools, it appears that, on thebasis of standardized test results, a disproportionatenumber of racial and ethnic minority individuals, par-ticularly those from low-income backgrounds, arejudged as “low ability” and assigned to low-track orremedial classes. In contrast, individuals of Europeandescent, particularly those from high-income back-grounds, are more likely to be considered “gifted andtalented” and placed in enriched or accelerated pro-grams. Because track enrollment determines the levelof courses students take and the quality of the cur-riculum and instruction to which they are exposed,this means that minority students, on average, are lesslikely than their majority peers to engage in high-caliber curricula. Diminished opportunity to learn high-level material results in low academic achievement.

Limited Access to Institutionaland Other Resources

Well-equipped libraries, mentoring, tutoring, qual-ity teaching, rigorous curricula, low counselor–student and teacher–student ratios, small class sizes,extracurricular experiences, and computer and othertechnologies are examples of key resources in educa-tion that may be viewed as preconditions for enablinghigh levels of academic achievement. Unfortunately,a disproportionate number of individuals from certainminority groups (e.g., African Americans, Latinos,and Native Americans), particularly those from low-income backgrounds, are likely to attend schools withlimited access to these resources, thus minimizingtheir opportunity to do well academically. Moreover,many of these individuals live in economically dis-tressed communities where they experience poorhealth and inadequate nutrition, factors that placethem further at risk educationally.

The Effects of Racial Stereotyping

Racial stereotyping is a deeply held, stigmatizingbelief in unalterable genetic or cultural inferiority that

many members of a majority population hold aboutindividuals and groups who have been assignedminority status in society. In the United States, theeffects of racial stereotyping have a particularlydevastating effect on the academic motivation andachievement of some individuals from racial andethnic minority groups, particularly those who havebeen brought into society involuntarily through slav-ery and conquest (e.g., African Americans, MexicanAmericans, and Native Americans). In the educationsphere, some individuals from these ascribed caste-like minority groups have rejected this form of stereo-typing by developing coping mechanisms to protecttheir identity. In so doing, these identity-protectionstrategies serve to dampen their achievement moti-vation, which, in turn, results in low academicachievement.

Cultural IncompatibilityBetween Home and School Culture

Schooling is ineffective for some children fromracial and ethnic minority groups because classroompractices may be incompatible with their cultural back-ground. Cultural incompatibilities include a lack ofrespect for children’s conversational style and collabo-rative participation structures. Such misunderstandingscan contribute to diminished commitment to academicengagement and academic underachievement.

RECOMMENDATIONS FORIMPROVING MINORITY ACHIEVEMENT

Reducing or eliminating the minority achievementgap remains one of the most serious challenges inU.S. education today. Efforts to close the gap shouldtake the following considerations into account.

Disaggregation of Data

Individuals from minority groups have differentsocialization experiences that have a differentialimpact on their academic motivation and perfor-mance. Disaggregation of achievement data is neces-sary to identify which minority individuals and groupsare doing poorly and which are doing well. Suchinformation on the variability in minority achievementmay then be used to target appropriate instruction fordifferent individuals and groups.

2———Academic Achievement and Minority Individuals


Adequate Exposure toSupplementary Education

School alone cannot ensure high academic achieve-ment. Indeed, parents or significant others of high-achieving students recognize the importance ofsupplementary education and routinely make it availableto their children over the course of their schooling.Examples of supplementary education include academicsummer camps, after-school and weekend tutoring, useof libraries and museums as resources for learning, andaccess to mentors and models who are themselves highachievers. Low-achieving minority students must haveadequate exposure to supplementary education.

Adequate Exposure toHigh-Quality Teaching

Low-achieving students must have adequate expo-sure to high-quality teaching that is responsive to theirstrengths, needs, and interests. This means not onlythat they must have opportunities to participate in cur-ricula and instructional activities that are known to beconducive to high academic achievement, but also thatthese experiences must be accommodative to theirlearning strengths and needs.

Access to EducationallyRelevant Resources

High-achieving students have access to educationallyrelevant resources in the schools they attend and throughtheir families and communities. Such resources must bemade available to low-achieving students as well.

—Eleanor Armour Thomas

See also The Bell Curve; Head Start; Intelligence Tests;Scholastic Assessment Test

FURTHER READING

Braswell, J. S., Lutkus, A. D., Grigg, W. S., Santapau, S. L.,Tay-Lim, B., & Johnson, M. (2001). The nation’s reportcard: Mathematics 2000. Washington, DC: NationalCenter for Education Statistics. Retrieved July 27, 2004,from http://nces.ed.gov

Gordon, E. W., & Bridglall, B. L. (2005). The challenge, contextand preconditions of academic development. In E. W.Gordon, B. L. Bridglall, & A. S. Meroe (Eds.), Supple-mentary education: The hidden curriculum of high academicachievement (pp. 10–34). New York: Rowman & Littlefield.

Miller, S. (1995). An American imperative: Acceleratingminority educational advancement. New Haven, CT: YaleUniversity Press.

Ogbu, J. N. (1987). Variability in minority responses to schooling:Nonimmigrant vs. immigrants. In G. Spindler & L. Spindler(Eds.), Interpretative ethnography of education: At home andabroad (pp. 255–278). Hillsdale, NJ: Lawrence Erlbaum.

O’Sullivan, C. Y., Lauko, M. A., Grigg, W. S., Qian, J., &Zhang, J. (2003). The nation’s report card: Reading 2002.Washington, DC: National Center for Education Statistics.Retrieved July 27, 2004, from http://nces.ed.gov

Steele, C. M. (1997). A threat in the air: How stereotypesshape intellectual identity and performance. AmericanPsychologist, 52(6), 613–629.

ACCESSIBILITY OF HEALTH CARE

DEFINITION AND SCOPEOF HEALTH CARE ACCESS

The health disparities and health care inequalities expe-rienced by major American ethnic groups (comparedwith CaucasianAmericans) have been well documented.Health disparities are defined as higher rates of chronicand disabling illness, infectious disease, and mortalityexperienced by members of ethnic minority groupscompared with Caucasians. One of the most importantfactors contributing to health disparities is limited accessto health care. Therefore, improving access to healthcare is considered one of the greatest opportunities forreducing health disparities in the United States.

Access to health care can be considered at two levels:primary access and secondary access. Primary accessinvolves entry into the health care system and access tobasic care. Secondary access involves the quality of carereceived by individuals with primary access. Primaryand secondary health care access will be discussedwith respect to four major cultural groups in the UnitedStates: African Americans, Hispanic Americans, AsianAmericans and Pacific Islanders, and American Indiansand Alaska Natives. Primary access issues include healthinsurance rates and the accessibility of health care facili-ties. Secondary access issues include quality of care,access to specialists, access to culturally similar healthcare personnel, language barriers, and discrimination.

AFRICAN AMERICANS

Lack of insurance is considered the most significantbarrier to health care, and for a majority of Americans,health insurance provided by employers makes healthcare affordable. The uninsured rate for AfricanAmericans under age 65 is 19.9%. Unemployment is

Accessibility of Health Care———3


strongly tied to the lack of insurance among AfricanAmericans; however, a disproportionate number ofAfrican American workers whose employers do notprovide health insurance are also counted among theuninsured. Among African Americans, poverty andunemployment rates are 24.4% and 11.6%, respec-tively, compared with 8.2% and 5.6%, respectively,for Caucasians.

Another primary health care access issue for AfricanAmericans is the availability of health care providers.In poor, ethnic communities, there is a limited supplyof health resources, primarily because patients in thesecommunities cannot afford to pay for the services pro-vided. As a result, health care facilities cannot be main-tained. This reality has driven the creation of communityhealth centers and hospital-based providers. Reducedgeographic proximity to health care providers has aparticularly strong impact on urban African Americancommunities that rely heavily on public transportation,which increases the time and cost of accessing care.

A major secondary access issue is the quality ofcare received by African Americans. Inequalities inmedical care exist even when African Americans haveinsurance plans that are similar to majority groupmembers. For example, African American patientswith health maintenance organization (HMO) insur-ance report more difficulty seeing a specialist andobtaining tests and treatment, suggesting that barriersexist well beyond entry into the health care system.

Another secondary access issue is the lower num-ber of physicians from ethnic minority groups. Thisdecreases health care access for minority patientsbecause prospective patients are often reluctant tovisit health care providers who may be racially or eth-nically different from them.

Language barriers also influence secondary access.Patient–physician communication has been reportedto be more problematic for African American patientsthan for Caucasian patients, even though both patientsand physicians may speak the same language. Finally,discrimination is a major barrier to secondary access,affecting physicians’ perceptions of patients as well astreatment decisions. For example, a negative percep-tion of African American patients is associated with alower likelihood of recommending treatment.

HISPANICS

The majority of the 35 million individuals in theUnited States counted as Hispanic or Latino are of

Mexican heritage, and the remainder are fromCaribbean and South American backgrounds. Theuninsured rate for Hispanics under 65 years old is33%, the highest rate among the major ethnic groupsin the United States. The high uninsured rate amongHispanic populations is largely tied to immigrationstatus. An estimated 72% of foreign-born persons inthis group are not American citizens, and public insur-ance programs such as Medicaid deny services toimmigrants. Furthermore, immigrants are more likelyto work in low-wage, low-benefit jobs that do notoffer health insurance. Hispanic Americans also relyheavily on public transportation, which necessitatestraveling greater distances and incurring greater costsfor medical care.

With regard to secondary access, Hispanic patientsexperience barriers similar to those of African Americans,including a lower quality of care afforded by lower-endinsurance plans and discrimination. The language bar-rier is a significant secondary access issue for Hispanicgroups: Limited English proficiency on the part ofHispanic patients, combined with a lack of Spanish-speaking health care providers, can result in misdiag-nosis and inappropriate treatment of symptoms.

ASIAN AMERICANS ANDPACIFIC ISLANDERS

Asian Americans and Pacific Islanders (AAPIs) repre-sent a diverse group with more than 60 differentnational and ethnic origins and more than 100 differ-ent languages. This group makes up about 5% ofthe total U.S. population (more than 12 million).According to the Institute of Medicine, the uninsuredrate for AAPIs under age 65 is 22%. The rates varysignificantly, however, among subgroups, and thehighest rate is found among Korean Americans (34%),who experience higher rates of poverty. The rates arealso higher for Southeast Asian and South Asiangroups. In addition to poverty, immigrant status isa significant barrier to obtaining insurance. Of theAAPIs who are foreign born, 52.9% are not Americancitizens and therefore cannot access publicly fundedinsurance programs.

Even for AAPIs who have health insurance, poorperceived quality of care is a major secondary accessissue. A large survey of individuals in a West CoastHMO revealed that AAPIs consistently had the worstaccess ratings across a variety of measures comparedwith other minorities. Limited English proficiency is

4———Accessibility of Health Care


also a significant secondary access issue for AAPIs.Census data from 1993 estimated that more than1.5 million AAPIs live in “linguistically isolated”households, that is, those in which no person over age14 speaks English “very well.”

Finally, discrimination affects secondary healthcare access for AAPIs. Because of their achievementsin the socioeconomic and educational spheres, AAPIshave been labeled the “model minority.” This label ismisleading because it fails to recognize the tremen-dous diversity within the AAPI group and because itcan blind people to the real needs and problems ofAAPI subgroups.

AMERICAN INDIANS ANDALASKA NATIVES

American Indians and Alaska Natives (AIANs) repre-sent a variety of culturally diverse and distinctivegroups who speak more than 300 languages and com-prise 562 federally recognized tribes. According to the2002 U.S. Census, 4.1 million people (1.5%) identifythemselves as AIANs. The health care situation ofAIANs is somewhat unique compared with other eth-nic groups because the U.S. government is obligatedby treaty and federal statutes to provide health care tomembers of federally recognized American Indiantribes. The federal Indian Health Service (IHS) wasestablished in 1955 to meet this need. Those AIANswho can readily access IHS services can receive freeprimary care; limited specialty services are availablefree of charge through contracts with private providers.Unfortunately, the IHS faces a number of obstacles toproviding health care access to those it was intendedto help. These obstacles include limited funding andgeographical limitations. The IHS has 34 urban Indianhealth programs, but these programs represent only1% of the total IHS budget. As a result of the limitedfunding, many areas have no services. In addition, IHSfacilities are located on or near reservations, althoughthe majority of AIANs live in urban areas away fromtheir home reservations.

The gap between the need for IHS services andaccess to these services was highlighted by a 2004Kaiser Foundation study, which revealed that morethan one-third (35%) of AIANs under age 65 are unin-sured and only 19% have access to IHS services. Theproblem is worse among low-income AIANs, almosthalf of whom (48%) are uninsured. Only 23% of unin-sured, low-income AIANs have access to IHS services.

Finally, communication difficulties are importantsecondary access issues for AIANs. Compared withCaucasians, AIANs report more dissatisfaction withthe quality of care received and poorer communica-tion with health care providers.

CONCLUSION

Ethnic minorities in the United States have poorerhealth status and less access to health care thanCaucasians, largely as a result of lower rates of insur-ance coverage. Although health insurance coverageaddresses the primary access issue, it does notaddress the myriad secondary access issues thatminority Americans face after they get their foot inthe door of the U.S. health care system. These sec-ondary access issues include less accessible facilities,poorer quality of care, language and communicationbarriers, and discrimination. Greater attention to bothprimary and secondary health care access issues isneeded to elucidate the processes that place minoritygroup members at a disadvantage when they seekhealth care.

—Lisa C. Campbell—Tamara Duckworth Warner

FURTHER READING

Collins, K. S., Hughes, D. L., Doty, M. M., Ives, B. L.,Edwards, J. N., & Tenney, K. (2002). Diverse communities,common concerns: Assessing health care quality forminority Americans. New York: The Commonwealth Fund.Retrieved January 13, 2006, from http://www.cmwf.org

Lillie-Blanton, M., Rushing, O. E., & Ruiz, S. (2003). Keyfacts: Race, ethnicity, and medical care. Menlo Park, CA:Henry J. Kaiser Family Foundation. Retrieved January 28,2006, from http://www.kff.org/minorityhealth/6069-index.cfm

Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2002).Unequal treatment: Confronting racial and ethnic dispari-ties in health care. Washington, DC: National AcademiesPress. Retrieved January 13, 2006, from http://www.nap.edu/books/030908265X/html/

Sohler, N., Walmsley, P. J., Lubetkin, E., & Geiger, H. J.(2003). The right to equal treatment: An annotated bibli-ography of studies on racial and ethnic disparities inhealthcare, their causes, and related issues. New York:Physicians for Human Rights. Retrieved January 13, 2006,from http://www.phrusa.org/research/domestic/race/race_report/report.html

U.S. Census Bureau. (2003). Income, poverty, and health cover-age in the United States: 2003. Retrieved January 28, 2006,from http://www.census.gov/hhes/www/poverty.html

Accessibility of Health Care———5


ACCULTURATION

Early conceptualizations of acculturation describedan interpersonal transformation that occurs whencultures come into sustained contact. Social scientistsnoted complex changes that can take place, includingthe conversion of values, the blending or separation ofcultures, and personality and developmental growth.

Researchers attempted to use the acculturationprocess to examine the impact of modernization andindustrialization on various communities and culturesduring the 19th and 20th centuries. In the early part ofthe 20th century in the United States, acculturationbecame synonymous with assimilation, the loss ofone’s original culture and the adoption of a new hostculture. This process was used to describe the experi-ences of immigrants from an array of places (e.g.,Europe, China, Japan, and Mexico). The ultimate goalof American acculturation became the achievement ofassimilation into a melting pot society.

Today, acculturation is considered a more dynamicprocess that occurs along various dimensions ratherthan a simple movement from a culture of origintoward assimilation. In addition, acculturation canoccur on both the group and the individual levels, thusconsidering more of the consequent psychologicaladaptation and adjustment. Four acculturative stageshave been described: contact, conflict, crisis, andadaptation. Furthermore, adaptation can include sev-eral strategies: (1) assimilation—the individual orgroup gives up (or is forced to give up) the culturalidentity of origin and desires a positive relationshipwith the host culture; (2) separation—the individualor group retains the original culture (or is restrictedfrom adopting the new culture through segregation)and desires no positive relationship with the host cul-ture; (3) integration—the individual or group desiresto retain the culture of origin as well as maintaina positive relationship with the host culture; and(4) marginalization—the individual or group no longerretains the original culture and has no desire (or is notallowed) to have a positive relationship with the hostculture.

The dynamic quality of acculturation is furtherexpressed by the gradual changes that occur in severalareas (or dimensions) and affect the individual andpotentially the cultural group as a whole (e.g., lan-guage, cognitive style, behavioral patterns, personal-ity, identity, attitudes, and values).

One particular negative consequence of the accul-turation process is the phenomenon of acculturativestress. Acculturative stress is defined as negative ten-sion that can be directly related to threats, conflicts, orcrises centered on one’s cultural identity, values, orother emotional and behavioral patterns of living.Prolonged stress, especially of an extremely high level,can manifest itself in both psychological symptoms ofdistress (e.g., anxiety, depression) and physiologicalsymptoms of distress (e.g., pain, fatigue, dizziness).

MEASUREMENT OF ACCULTURATION

One of the greatest challenges in understanding therole of acculturation in adjustment is the assessmentof this construct. Despite the shift in the conceptual-ization of acculturation from a one-dimensionalprocess to a multidimensional one, the measurementof acculturation has failed to reflect this reformula-tion. Indeed, most of the published acculturationscales require respondents to choose among terms thatassess the unidirectional movement of individualsfrom traditional culture to majority culture, or theyinclude scoring techniques that reflect this unidirec-tional movement. However, there are a very smallnumber of measures developed recently to assess thevarious dimensions of acculturation by measuring twoor more cultures independently of each other. Thismeasurement approach is consistent with the conceptof biculturalism (or bicultural competence), namelythat adaptation to a host culture is possible withoutcompletely abandoning the culture of origin.

The most commonly measured aspect of accultura-tion is language, including spoken or written lan-guage, language preference, and language proficiency.Cultural preferences—such as the preference forengagement with people from one’s culture of originversus the host culture, a sense of acceptance by a par-ticular cultural group, or cultural pride—are otherpopular indicators of acculturation. In addition, it iscommon for many scales to use demographic or proxyvariables of acculturation (e.g., generation of respon-dent, place of birth, language of interview).

In a small number of acculturation scales, an assess-ment of adherence to cultural traditions, beliefs, and val-ues is provided. Measures that focus on these culturalindexes may be particularly important for culturalgroups such as African Americans or American Indians,for whom English-language issues, length of U.S. resi-dency, and immigration status may be less pertinent.

6———Acculturation


Indeed, certain ethnic groups have been significantlyunderresearched in regard to acculturation. It has beensuggested that greater attention be given to developingtheories of acculturation that are specific to thesegroups’cultures to inform the development of sound andappropriate measures. Similarly, little attention has beenfocused on acculturation in children and youth; greaterconsideration to acculturation across the life span wouldincrease our knowledge of the specific challenges andadaptations related to the age of the individual.

THE RELATIONSHIP OFACCULTURATION TO ADJUSTMENT

Measures of acculturation are often used to predict psy-chological and physical distress symptomatology (e.g.,depression, anxiety, substance abuse, physical pain,fatigue). Research conducted primarily with Latino andAsian American immigrants suggests that the relation-ship of acculturation to adjustment is a complex one.Some studies suggest that newly arrived immigrants aremore vulnerable to symptoms because of a heightenedlevel of acculturative stress. In particular, low Englishproficiency seems to be one of the most consistent pre-dictors of psychological distress in these groups.However, in most of these studies, it is difficult to knowwhether preexisting stressors (e.g., experience of tortureand persecution, loss of loved ones and material posses-sions) encountered in the country of origin may havepredisposed these groups to experience the negativeimpact of acculturation to a new culture. Demographicvariables such as age, sex, and socioeconomic statusmay lessen the effects of acculturative stress.

Other studies indicate a higher level of accultura-tion may be related to higher levels of psychologicaland physical distress. For example, an immigrant whohas lived in the United States for a long period of timemay be more vulnerable to psychological problemsbecause of the loss of traditional cultural beliefs, val-ues, or behaviors, which may offer protection fromstress. In addition, long-term U.S. resident immi-grants or U.S.-born members of cultural groups maybe exposed to racial discrimination, social oppression,and new cultural standards, leading them to engagein risky behaviors (e.g., casual sexual encounters orincreased consumption of alcohol). Some largestudies have found this to be the case in certain Latinogroups, such as Mexican Americans and PuertoRicans. Alternatively, some theorists suggest thatnewer immigrants are particularly strong and resilient

and therefore have lower levels of psychiatric disor-ders than their U.S.-born counterparts. However,research support for this position is limited.

Despite varying speculations regarding the natureof the relationship between acculturation and adjust-ment, it is important to avoid attempts to simplifyexplanations. This relationship should be viewed asrepresentative of complex interactions among histori-cal, social, cultural, group, and individual factors. Inaddition, multiple measures of adjustment and stressmay be required when examining the effects of accul-turative stress due to emic (culture-specific) ways ofthinking about and expressing distress.

—Pamela Balls Organista

See also Acculturation Measures; Acculturative Stress;Biculturalism

FURTHER READING

Berry, J. W. (1997). Immigration, acculturation and adaptation.Applied Psychology, 46, 5–68.

Chun, K. M., Balls Organista, P., & Marín, G. (Eds.). (2003).Acculturation: Advances in theory, measurement, andapplied research. Washington, DC: American Psycho-logical Association.

ACCULTURATION MEASURES

In light of the growing number of people of colorrepresented in the 2000 U.S. Census, research inpsychology is working to expand the field’s under-standing of the needs of ethnically and culturallydiverse populations. Besides documenting differencesin how people from diverse ethnic groups think, act,and believe, the most progressive research seeks notonly to determine where important distinctions lie butalso to demonstrate the meaning of group differences.Researchers have argued that the most meaningful dif-ference, both between and within ethnic groups, is thevalue that an individual places on his or her culture.Recently, the measurement of that value has come inthe form of acculturation measures. Designed to iden-tify attachment to one’s culture of origin, to a newculture, or to both, acculturation measures can beinvaluable tools for understanding group differences.

The need for acculturation measures was created inpart by the problems researchers had interpreting find-ings when people of color were included in study

Acculturation Measures———7


samples. When people of color were combined intoone group (i.e., people of color versus Caucasian sub-samples), researchers struggled to determine whatrole, if any, cultural differences played in the results.Furthermore, when people of color were separatedinto different groups according to ethnic identifica-tion, researchers also had difficulty determining therole of culture within and between groups. That is, itwas and is unclear what role culture plays in researchfindings because researchers did not have a methodfor controlling or testing the level of “culturalness”present in a given sample of people of color. Within-ethnic-group differences are often larger thanbetween-group differences, and researchers needed away to ensure that when sampling people of colorfrom one ethnic group, the group represented a homo-geneous representation of a specific level of culturalattachment. Acculturation measures were thought tobe one step toward untangling the effects of culture bycreating a method for assessing levels of culturalattachment, especially within ethnic groups.

Early models for acculturation measures suggestedthat acculturation was best conceptualized on a singlecontinuum. Advocates of this perspective believedthat acculturation is a process of moving from one’sculture of origin to the other end of the spectrum,whereby a person becomes a member of a new or hostculture. Some measures of acculturation in this sys-tem indicated only high or low involvement in one’shost culture (unicultural), and some represented a truecontinuum from attachment to the culture of origin tothe dominant culture (dual cultural). A central tenet ofthese approaches was that individuals cannot beequally immersed in two cultures at one time andlikely have to give up some aspect of one culture to bea part of a different culture. Examples of measuresfrom this approach include the African AmericanAcculturation Scale, the Asian Values Scale, and theAcculturation Measure for Chicano Adolescents.

During the 1980s, several researchers began devel-oping an extension to the previous notion that accultur-ation was best represented by a linear progression andinstead suggested that a unicultural or dual-culturalperspective ignored individuals who were bicultural.Biculturalism, in this sense, represents individuals whomaintain adherence to more than one culture at a time.Researchers proposed that acculturation is a bilinearprocess with one continuum representing a processwhereby individuals can experience either marginality(adherence to no culture) or involvement and either

uniculturalism or biculturalism. Examples of measuresrepresenting this approach include the AcculturationRating Scale for Mexican Americans and the Bicultur-alism Involvement Questionnaire.

The idea of acculturation was expanded even furtherin the 1980s and 1990s, when research began to addressa multilinear or typology approach to acculturative sta-tus. That is, researchers put forth the idea that individu-als could be classified according to their acculturationperspective along four basic constructs. Specifically,individuals could demonstrate integration, assimila-tion, separation, and marginalization. Individuals werethought to express attitudes of acculturation that com-bined levels of adherence to the host and indigenouscultures. Furthermore, the level of adherence could bemeasured and placed on a continuum.

Integration is thought to be expressed when aperson is bicultural, or active in his or her culture oforigin and in the dominant culture. Assimilation isthought to occur when a person is active in the domi-nant culture and has little interest in aspects of his orher native culture. Separation is manifested when aperson remains integrated into his or her culture oforigin and uninterested in learning about or participat-ing in the dominant culture. Finally, marginalizationoccurs when a person is inactive in both the culture oforigin and the dominant culture. Although these ideasare fairly new, efforts are under way to create measuresthat assess the four acculturation typologies. The maindifference between the latter perspective and the bicul-turalism model is that the multilinear model includesmeasurements of acculturation across different set-tings and cultures. From their earliest inception, accul-turation measures, whether unicultural, bicultural, ormulticultural, have generally been designed with theculture of origin in mind. That is, most measures arecreated to capture one’s attachment to the culture oforigin of a particular group (i.e., African Americans,Asian Americans). Despite efforts to this point, thefield is still in its infancy, with most measures of accul-turation requiring greater research and stronger psy-chometric findings before widespread use is possible.

AFRICAN AMERICANS

Targeting traditional African American culture, twomeasures of dual culturalism represent the available toolsfor measuring acculturation in the African American pop-ulation: the African American Acculturation Scale andthe Scale to Assess African American Acculturation.

8———Acculturation Measures


Both measures offer promise to the study of accultur-ation among African Americans; however, the psy-chometric properties of both measures are ratherunclear, and greater study of their validity and relia-bility, especially their stability over time, is needed.

HISPANIC AMERICANS

The choices for measuring acculturation in Hispanicpopulations are more varied than for the AfricanAmerican population and include measures of bothmonocultural and bicultural acculturation. Further-more, measures specific to the cultures of Cuban,Mexican, and Puerto Rican Americans are available.Several of the bicultural measures (e.g., BiculturalInvolvement Questionnaire, Cultural Lifestyle Inven-tory, Bicultural Scale for Puerto Rican Americans, andAcculturation Rating Scale for Mexican Americans)allow for measurement of attachment to the culture oforigin as well as the host culture, but they lack norma-tive data to enhance interpretation for their use. Thesemeasures represent adequate psychometrics and someevidence of construct validity.

NATIVE AMERICANS

The Navajo Family Acculturation Scale, the NavajoCommunity Acculturation Scale, and the RosebudPersonal Opinion Survey represent the best tools avail-able for measuring acculturation among NativeAmerican samples. Although there are more than 500recognized tribes in the United States, each with itsown unique culture, so far only the Rosebud PersonalOpinion Survey is designed to be a general measure forNative populations. More research is needed to estab-lish the psychometric properties of these measures.

ASIAN AMERICANS

Like the Native American measures, only threemeasures are commonly used with Asian Americanpopulations: the Acculturation Scale for ChineseAmericans, the Suinn-Lew Asian Self-IdentityAcculturation Scale, and the Asian Values Scale. Thelatter two measures are designed for use with all sub-groups of Asian Americans (e.g., Japanese, Korean)and appear to have adequate psychometric properties.

Only one measure, the Multicultural AcculturationScale, is designed for use with all cultural groups and

based on the bilinear acculturation model. The scoreson this measure give a general sense of attachmentto an ethnic group versus attachment to Americanvalues. This measure represents the first step towarddeveloping a cross-cultural measure of acculturation,but more research is needed to determine its psycho-metric properties.

CONCLUSION

Researchers recognize that people of color representmore than differences in ethnic groups and bring tobear their cultural influences on research findings.Measuring the role of culture is the direction of thefield, and to this end, several measures of acculturationare available for use with different cultural groups. Byincluding a measure of acculturation, researchers canbe assured that their findings are the result of the studyvariables and not necessarily within-group differencesamong the sample. For these measures to be of real use,however, more research is needed to establish the psy-chometric properties of acculturation measures.Moreover, new measures or updates of older versionsare needed to keep up with changes in acculturationtheory. Research that addresses the construct validityand long-term stability of acculturation measureswould advance the field and allow for more sophisti-cated research questions. For example, acculturationmeasures that address biculturalism and measure accul-turation status across settings are needed. Finally,acculturation measures generally measure behaviors(e.g., eating habits, social preferences) associated withattachment to a particular culture or cultures, and thismay not represent the true nature of the acculturationexperience. Focusing on behaviors only, researchersmay neglect the importance of an individual’s values,beliefs, and knowledge, all important parts of culturaladherence.

—Yo Jackson

FURTHER READING

Berry, J. W. (1980). Acculturation as varieties of adaptation. InA. M. Padilla (Ed.), Acculturation: Theory, models, andsome new findings (pp. 9–25). Boulder, CO: WestviewPress.

Berry, J. W. (1990). Psychology of acculturation: Understandingindividuals moving between cultures. In R. W. Brislin(Ed.), Applied cross-cultural psychology (pp. 232–253).Newbury Park, CA: Sage.

Acculturation Measures———9


Cuéllar, I., Arnold, B., & Maldonado, R. (1995). AcculturationRating Scale for Mexican Americans–II: A revision of theoriginal ARSMA scale. Hispanic Journal of BehavioralSciences, 17(3), 275–304.

Kim, B. S. K., & Abreu, J. M. (2005). Acculturation measure-ment. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, &C. M. Alexander (Eds.), Handbook of multicultural coun-seling. Thousand Oaks, CA: Sage.

Kim, B. S. K., Atkinson, D. R., & Yang, P. H. (1999). TheAsian Values Scale: Development, factor analysis, valida-tion, and reliability. Journal of Counseling Psychology,46, 342–352.

Landrine, H., & Klonoff, E. A. (1994). The African AmericanAcculturation Scale: Development, reliability, and validity.Journal of Black Psychology, 20, 104–127.

Olmedo, E. L., & Padilla, A. M. (1978). Empirical and con-struct validation of a measure of acculturation for MexicanAmericans. Journal of Social Psychology, 105, 179–187.

Szapocznik, J., Kurtines, W. M., & Fernandez, T. (1980).Bicultural involvement and adjustment in HispanicAmerican youths. International Journal of InterculturalRelations, 4, 353–365.

ACCULTURATION SCALES:ACCULTURATION, HABITS,AND INTERESTS MULTICULTURALSCALE FOR ADOLESCENTS

Acculturation—the interchange of cultural attitudesand behaviors—involves changes in styles of speech,social behaviors, attitudes, beliefs, customs, celebrationof holidays, and choices of foods and entertainment.Immigrants generally follow one of four general accul-turation patterns: (1) integration—combining aspectsof the new culture with aspects of the native culture;(2) assimilation—replacing the native cultural orienta-tion with the new cultural orientation; (3) separation—retaining the native cultural orientation while rejectingthe new cultural orientation; or (4) marginalization—becoming alienated from both cultures.

Measuring adolescents’ acculturation levels in large,population-based surveys is difficult. Most publishedacculturation scales for adults contain words or con-cepts that young adolescents cannot comprehend. Mostbrief acculturation scales assess only language usage,which is only one facet of the acculturation process.

The Acculturation, Habits, and Interests Multi-cultural Scale for Adolescents (AHIMSA) is a brief,multidimensional, multicultural acculturation measurefor use in large-scale, classroom-based, paper-and-pencil

surveys of early adolescents from varying culturalbackgrounds. The AHIMSA includes questions thatare relevant to adolescents, including their choice offriends, favorite music and television shows, favoriteholidays, foods eaten at home, and general ways ofthinking.

The items include the following: “I am most comfort-able being with people from . . . ,” “My best friends arefrom . . . ” “The people I fit in with best are from . . . ,”“My favorite music is from . . . ,” “My favorite TVshows are from . . . ,” “The holidays I celebrate arefrom . . . ,” “The food I eat at home is from . . . ,” and“The way I do things and the way I think about things arefrom . . .” The response options are “the United States,”“the country my family is from,” “both,” and “neither.”The AHIMSA generates four subscores: United StatesOrientation (assimilation), Other Country Orientation(separation), Both Countries Orientation (integration),and Neither Country Orientation (marginalization).Subscale scores are calculated by summing the numberof responses in each of the four categories. The score oneach subscale can range from 0 to 8. Researchers mightelect to use one or more of the four orientation scoresdepending on their research questions.

The AHIMSA was developed through multiplerounds of pilot testing and psychometric analysis. First,existing acculturation measures were examined to iden-tify questions that could be simplified or modified foradolescents. This resulted in an initial set of 13 items.These 13 items were shown to middle school studentsin focus groups to assess their interpretation of theitems. Items that were confusing were reworded. Theset of 13 modified items was administered to a pilotsample of sixth-grade students. Items with low variancewere eliminated from the scale. Item response-curveanalyses were used to select a final set of items that dif-ferentiated students at all levels of the scale. The finalset of items included eight questions.

In a study of 317 sixth-grade adolescents inSouthern California, the means on the United StatesOrientation, Other Country Orientation, Both Coun-tries Orientation, and Neither Country subscales were3.93, 0.50, 3.25, and 0.26, respectively. The UnitedStates Orientation, Other Country Orientation, andBoth Countries Orientation subscales were correlatedwith the subscales of a modified Acculturation RatingScale for Mexican Americans–II (ARSMA-II), English-language usage, and generation in the United States,providing evidence for the validity of those three sub-scales. The Neither Country Orientation subscale did

10———Acculturation Scales: Acculturation, Habits, and Interests Multicultural Scale for Adolescents


not appear to be a valid measure of marginalization, aconstruct that is difficult to operationalize and difficultfor adolescents to conceptualize.

Inclusion of the AHIMSA scale in surveys of ado-lescents provides a more complete understanding ofthe role of acculturation in adolescents’ behavioralchoices, which could lead to the creation of more cul-turally appropriate educational programs for adoles-cents in a multicultural society.

—Jennifer B. Unger

See also Acculturation

FURTHER READING

Unger, J. B., Gallaher, P., Shakib, S., Ritt-Olson, A., Palmer,P. H., & Johnson, C. A. (2002). The AHIMSA acculturationscale: A new measure of acculturation for adolescents in amulticultural society. Journal of Early Adolescence, 22,225–251.

ACCULTURATION SCALES:ACCULTURATION RATING SCALEFOR MEXICAN AMERICANS–II

The Acculturation Rating Scale for MexicanAmericans (ARSMA) is a seminal bilingual accultur-ation measure designed for use with both clinical andnonclinical Mexican American populations. Thedevelopment of the ARSMA was a timely responseto the booming Mexican American population.According to the 2000 U.S. Census, the Latino popu-lation is now the largest ethnic minority group in theUnited States, and 58.5% of this group is composedof Mexican Americans. Since its creation, the ARSMAhas served as the model for many acculturation mea-sures used with other ethnocultural groups.

The original ARSMA was a linear measure ofacculturation developed by Israel Cuéllar, Lorwen C.Harris, and Ricardo Jasso in 1980 to assess culturalpreferences and behavioral tendencies. In response tocriticism that their measure obliged respondents tochoose between two cultures and did not accuratelyreflect acculturation adaptation styles, Israel Cuéllar,Bill Arnold, and Roberto Maldonado produced arevised version in 1995. The ARSMA-II was designedto use an orthogonal, multidimensional approach toacculturation assessment by capturing varying levels

of biculturalism and allowing individuals to rate theirorientation to Mexican and U.S. mainstream cultureindependently. This was achieved by dividing theoriginal ARSMA items into two sections, one for eachcultural orientation. The ARSMA-II classifies respon-dents into one of four styles of acculturation: assimi-lation (highly identified with U.S. mainstream cultureonly), integration (highly identified with both cul-tures), separation (highly identified with Mexicanculture only), and marginalization (low levels of iden-tification with both cultures).

The ARSMA-II retains its original version’s behav-ioral focus but also includes an affective (positive/negative) affirmation of ethnic identity. Scale 1 of theARSMA-II contains two subscales: the AngloOrientation Subscale (13 items) and the MexicanOrientation Subscale (17 items). An optional Scale 2 (18items) was included to assess feelings of marginality anddifficulty accepting Anglo, Mexican, and MexicanAmerican ideas, beliefs, customs, and values. All itemsare scored on a five-point Likert scale ranging from1 (not at all) to 5 (extremely often/almost always). Over-all, the measure assesses three principal constructs:language, ethnic identity, and ethnic interaction or ethnicdistance. The ARSMA-II demonstrates good internalconsistency of subscales (alphas ranging from .68 to .91)and test-retest reliability (ranging from .72 to .96).Additionally, the validity of the ARSMA-II has beensupported by significant associations with the ARSMAand generational status.

The strong psychometrics of the ARSMA-II havemade it a very popular instrument, used in more than75 publications since 1980. The bilingual format, avail-ability of a software scoring program, ease and brevityof administration, variety of content areas assessed(moving away from relying exclusively on language),and success in differentiating between generationallevels are additional advantages. On the other hand,the ARSMA-II has been criticized for its limitedapplicability to other Latino ethnic groups, absence ofan assessment of cultural values (e.g., individualism,collectivism, familism), nonrepresentative sample (379college students), lack of norms for children, and prob-lems with classification (portions of samples that do notfall into categorical acculturation styles, insignificantdifferences between classifications).

A host of studies using the ARSMA and ARSMA-IIhave empirically linked Mexican American acculturationwith a variety of constructs, including ethnic identity,socioeconomic status, mental health, academic

Acculturation Scales: Acculturation Rating Scale for Mexican Americans–II———11


attainment, gang involvement, relationship satisfaction,health risk behaviors, eating disorders, suicidal ideation,depression, clinical elevations on personality tests, self-esteem, coping, and counseling expectations. Experts inthe field of acculturation underscore the need for longi-tudinal studies of the acculturation process to more accu-rately capture the developmental and dynamic nature ofacculturation. Many urge that revisions to acculturationscales should include direct measures of contextualmediators or moderators of acculturation (e.g., reason forimmigration, immigration policies, attitudes towardimmigrants, political environment).

—Rebecca E. Ford—Yarí Colón

—Bernadette Sánchez

See also Acculturation; Mexican Americans

FURTHER READING

Berry, J. W. (1980). Acculturation as varieties of adaptation.In A. M. Padilla (Ed.), Acculturation: Theory, models, andsome new findings (pp. 9–25). Boulder, CO: WestviewPress.

Cabassa, L. J. (2003). Measuring acculturation: Where we areand where we need to go. Hispanic Journal of BehavioralSciences, 25(2), 127–146.

Cuéllar, I., Arnold, B., & Maldonado, R. (1995). AcculturationRating Scale for Mexican Americans-II: A revision of theoriginal ARSMA scale. Hispanic Journal of BehavioralSciences, 17(3), 275–304.

ACCULTURATION SCALES:AFRICAN AMERICANACCULTURATION SCALE

Acculturation is defined as the extent to which anethnic minority individual participates in the valuesand beliefs of the dominant ethnic-majority culture.Acculturation can be thought of as a continuum fromtraditional at one extreme, to bicultural in the middle,to acculturated at the other extreme. Traditional indi-viduals retain almost exclusively the values andbeliefs of their culture of origin and do not participatein the majority culture. Bicultural individuals are flu-ent in both their culture of origin and that of themajority. Bicultural individuals can further be classi-fied as “blended,” having melded aspects of bothcultures, or “code-switchers,” those who alternatebetween the two cultures. Acculturated individuals

participate almost exclusively in the majority cultureand have rejected most aspects of their culture of origin.

In the United States, the concept of acculturation hasgenerally been applied to immigrant ethnic groups.However, as the developers of the African AmericanAcculturation Scale (AAAS), Hope Landrine andElizabeth Klonoff, have demonstrated, the conceptof acculturation can be meaningfully applied toAfrican Americans. Despite the long residenceof African Americans in the United States, individualAfrican Americans, like individuals in other ethnicminority groups, may choose to participate in themajority culture to a greater or lesser extent.

The AAAS is designed to tap some of the culturaldomains in which African Americans display relativelydistinctive beliefs and practices, such as religion,health, and child rearing. Scores on the scale have beenfound to be independent of demographic variables suchas education, income, and gender. Three versions of thescale have been published: The first version (AAAS),published in 1994, contained 72 items that weredivided into eight sections; a shorter version (AAAS-33), published in 1995, contained 33 items on 10empirically derived subscales; and a revised version(AAAS-R), published in 2000, contained 47 items oneight factors. The AAAS-R, like its predecessors, hasbeen shown to be psychometrically sound, with internalconsistency reliability of .93 and split-half reliability of.79. Discriminant validity of the AAAS-R was estab-lished by comparing African Americans with differinglevels of segregation; African Americans with otherethnic groups; and African American drinkers (whotend to be less traditional) with abstainers.

The AAAS has been used in studies in several areasof psychology, including health psychology, mentalhealth, and neuropsychology. In health psychology,scores on the AAAS have been linked to cigarettesmoking and hypertension. In general, the research sug-gests that an individual’s level of acculturation may berelated to (1) how much racism he or she experiences(more traditional people experience more racism),which is related to how much the person smokes (moreracism results in greater smoking), and (2) how stress-ful the racism is perceived as being (more traditionalpeople experience racism as more stressful), which isrelated to hypertension (more stressful racism results inhigher blood pressure levels).

In mental health research, AAAS scores have beenshown to predict depression, stress levels, and copingstyles. Additionally, the relationship between mental

12———Acculturation Scales: African American Acculturation Scale


health and coping styles may be different for accul-turated individuals than for traditional individuals. Inneuropsychology, the AAAS has been helpful in under-standing why African Americans, particularly elders,score significantly lower than European Americans ontests of cognitive ability. The AAAS has proven to be avaluable tool in elucidating the unique role that culturalfactors play in the experiences and behaviors of AfricanAmericans in the United States.

—Tamara D. Warner

See also Acculturation; Mexican Americans

FURTHER READING

Klonoff, E. A., & Landrine, H. (2000). Revising and improv-ing the African American Acculturation Scale. Journal ofBlack Psychology, 26(2), 235–261.

Landrine, H., & Klonoff, E. A. (1996). African Americanacculturation: Deconstructing race and reviving culture.Thousand Oaks, CA: Sage.

Manly, J. J., Byrd, D. A., Touradji, P., & Stern, Y. (2004).Acculturation, reading level, and neuropsychological testperformance among African American elders. AppliedNeuropsychology, 11(1), 37–46.

ACCULTURATION SCALES: ASIANAMERICAN MULTIDIMENSIONALACCULTURATION SCALE

The Asian American Multidimensional AcculturationScale (AAMAS) is a measure of acculturation based onorthogonal assessment of three different cultural dimen-sions, which comprise four specific acculturationdomains. Advancements in acculturation theory haveestablished the desirability of a bidimensional approachto the measurement of acculturation, one that takes intoaccount orientation to both the culture of origin and thehost culture, thereby challenging the zero-sum assump-tion of a unidimensional approach in which accultura-tion to one culture comes at the expense of the other.The AAMAS is based on a multidimensional approachthat includes orthogonal assessments of acculturation tothe Culture of Origin (AAMAS-CO) and to EuropeanAmerican culture (AAMAS-EA). The AAMAS furtherextends acculturation theory with the addition of a thirdcultural dimension, a pan-ethnic Asian American cul-tural dimension (AAMAS-AA), which is unique to theAAMAS. This dimension assesses the formation of a

shared Asian American identity and culture, which is ofincreasing significance for Asian Americans.

The items on the AAMAS were adapted from theSuinn-Lew Asian Self-Identity Acculturation Scale(SL-ASIA) and converted to a multidimensional formatby asking respondents to rate each item according tothree referent groups: (1) their Asian culture of origin,(2) other Asian American cultures, and (3) mainstreamEuropean American culture. The primary strengths ofthe AAMAS include its ability to provide a more com-plex assessment of Asian American acculturation alongcultural and domain-specific dimensions, as well as itsease of administration and use across different ethnici-ties. The primary weakness of the measure is that, likethe SL-ASIA, the AAMAS is primarily a measure ofbehavioral acculturation. The AAMAS is intended pri-marily as a research measure, and to date, the predom-inant application has been for this purpose.

ACCULTURATION DOMAINS

In addition to the three cultural dimensions,exploratory and confirmatory factor analyses supportfour specific acculturation domains: language, foodconsumption, cultural knowledge, and cultural iden-tity. Measures of internal consistency for each domainby cultural dimension range from .65 (food consump-tion in the AAMAS-CO) to .89 (cultural knowledge inthe AAMAS-CO).

RELIABILITY AND VALIDITY

Results of three separate studies provide strong evidenceof the instrument’s reliability and validity. Estimates ofinternal consistency for each cultural dimension rangedfrom .87 to .91 for the AAMAS-CO, from .78 to .83 forthe AAMAS-AA, and from .76 to .81 for the AAMAS-EA, and estimates of stability over time ranged from.75 to .89. Evidence of validity includes a significantnegative correlation between the AAMAS-CO and gen-erational status. Assessment of concurrent validity com-paring the AAMAS subscales with the Asian ValuesScale revealed expectedly modest correlations, whereasfor divergent validity, there was little to no relationshipwith the Rosenberg Self-Esteem Scale.

ADMINISTRATION AND SCORING

The 15 items on the AAMAS are worded so as tofacilitate administration across different ethnicities.

Acculturation Scales: Asian American Multidimensional Acculturation Scale———13


The instructions direct the respondents to rate eachitem according to their own Asian culture of origin,other Asian groups in the United States, and the main-stream host culture. The items are scored on a scaleranging from 1 (not very well) to 6 (very well). Onlyitem 15 is to be reverse scored before adding up theresponses for each cultural dimension for a totalscore, then dividing by 15 to obtain the scale score.Using this method, a separate score is obtained foreach cultural dimension.

—Ruth H. Gim Chung

See also Asian/Pacific Islander

FURTHER READING

Chung, R. H. G., Kim, B. S. K., & Abreu, J. M. (2004). AsianAmerican Multidimensional Acculturation Scale: Develop-ment, factor analysis, reliability and validity. CulturalDiversity and Ethnic Minority Psychology, 10, 66–80.

Suinn, R. M., Rickard-Figueroa, K., Lew, S., & Vigil, P.(1987). The Suinn-Lew Asian Self-Identity AcculturationScale: An initial report. Educational and PsychologicalMeasurement, 47, 401–407.

ACCULTURATION SCALES:BIDIMENSIONAL ACCULTURATIONSCALE FOR HISPANICS

The Bidimensional Acculturation Scale for Hispanics(BAS) was developed in 1996 to provide researcherswith a relatively short measure of acculturation thatcould address the conceptual and psychometric limita-tions of other acculturation scales. The BAS uses twodimensions to define acculturation, avoiding the faultyassumption that gains in learning a non-Hispanic cultureimply losses in the individual’s understanding of or pref-erence for Latino culture. As such, the BAS measuresrespondents’ behavioral characteristics in two culturaldomains: Hispanic and non-Hispanic. Furthermore,the BAS is useful in research with individuals fromall Latino backgrounds rather than with individualsfrom one subgroup (e.g., Cuban Americans, MexicanAmericans).

The BAS was developed by analyzing a largenumber of items addressing a variety of acculturativeareas (e.g., language use, preference for ethnic socialevents). A random sample of 254 adult Hispanics wasasked to report preferences and abilities in 30 areas in

which acculturation can have an impact on behavior.Exploratory principal components and factor analyseswere conducted on the original responses (separatelyfor language-related items and social behaviors) toidentify factors that accounted for large proportions ofthe variance. The final scale includes items that hadcorrelations greater than .45 with a given factor anddid not load heavily in more than one factor.

The BAS includes 24 items measuring linguisticusage, language proficiency, and electronic mediausage. Half of the items refer to English use orEnglish-language proficiency, and the other halfaddresses the same areas as they refer to Spanish useor proficiency. Each of the items is scored on a four-point Likert-type scale with anchors of “almost never”(scored as 1) and “almost always” (scored as 4) for theusage-related questions and “very well” (scored as 4)or “very poorly” (scored as 1) for the linguistic-proficiency items. The scale produces two accultura-tion indexes, one for each cultural domain, which areobtained by averaging responses to the 12 items rele-vant to each cultural domain (range of 1 to 4). Anaverage score close to 1 indicates a low level of cul-tural proficiency in a given cultural domain (e.g.,Latino), whereas an average score close to 4 indicatesa high level of cultural proficiency on that same cul-tural domain. An average score of 2.5 can be used todichotomize respondents into low or high levels ofadherence to the specific cultural domain.

The BAS has shown high levels of reliability andvalidity. In the original study, the scale showed analpha coefficient of .87 for the items in the Hispanicdomain and .94 for the items in the non-Hispanicdomain. Validity was established using a number ofapproaches, including correlations with respondents’generational status (r = .50 for the non-Hispanicdomain and –.42 for the Hispanic domain), length ofresidence in the United States (r = .46 for the non-Hispanic domain and –.28 for the Hispanic domain),age of arrival in the United States (r = –.60 for thenon-Hispanic domain and .41 for the Hispanicdomain), and respondents’ own assessments of theiracculturative status (r = .47 for the non-Hispanicdomain and –.38 for the Hispanic domain). In addition,the scale correlated highly (r = .79 for the non-Hispanicdomain and –.64 for the Hispanic domain) with theShort Acculturation Scale for Hispanics (SASH).

The BAS has been used with Latinos of all nationalbackgrounds and all generations, and the validationstudy was conducted with Mexican and Central

14———Acculturation Scales: Bidimensional Acculturation Scale for Hispanics


Americans. The items that make up the scale inEnglish and in Spanish and the scoring instructionsare available in the original publication. The scale hasbeen useful in providing a comprehensive understand-ing of Hispanic acculturation in areas as diverse asphysical health, mental health, drug and tobacco use,educational achievement, employment, and criminalbehavior.

—Gerardo Marín

See also Acculturation; Acculturation Scales: ShortAcculturation Scale for Hispanics

FURTHER READING

Marín, G., & Gamba, R. J. (1987). A new measure of accul-turation for Hispanics: The Bidimensional AcculturationScale for Hispanics (BAS). Hispanic Journal of BehavioralSciences, 18, 297–316.

ACCULTURATION SCALES: EASTASIAN ACCULTURATION MEASURE

The East Asian Acculturation Measure (EAAM) is a29-item self-report instrument designed to measurethe social interaction and communication styles (bothcompetency and ease and comfort in communicating)of East Asian (i.e., Chinese, Japanese, and Korean)immigrants in the United States.

MODELS OF ACCULTURATION

Researchers typically conceptualize the acculturationof Asian ethnic groups as a unidimensional constructthat ranges from low acculturation, indicating a pri-mary Asian identification, to high acculturation, indi-cating a Western identification, with an imputedmidpoint representing a bicultural identification. Thismodel has three key deficits: (1) Acculturation oftendoes not occur in a neat linear or unidimensional man-ner; (2) the distinction between acculturation and eth-nic identity is often obfuscated; and (3) identificationwith neither Asian nor Western cultures (i.e., margin-alization) is not assessed.

In contrast, the EAAM is based on a multidimen-sional model of acculturation and examines four modesof social interaction and communication: (1) with ethnicgroup peers (separation), (2) with members of the host

culture (assimilation), (3) with members of one’sethnic group and members of the host culture (inte-gration), and (4) with neither one’s own group peersnor members of the host culture (marginalization).The EAAM items do not assess ethnic identity (i.e.,identity associated with belonging to a certain ethnicgroup). Instead, ethnic identity among East Asian immi-grants may be assessed using the East Asian EthnicIdentity Scale.

NORMS, RELIABILITY, AND VALIDITY

The EAAM was originally studied with 150 EastAsian immigrants (75 men, 75 women) with a meanage of 28.7 (SD = 6.40). The internal consistency(alpha) coefficients were .76, .77, .74, and .85 forseparation, assimilation, integration, and marginaliza-tion, respectively. Significant negative correlationswere found between separation and assimilation andbetween integration and marginalization. Length ofstay in the United States was significantly and posi-tively associated with assimilation and integration butsignificantly and negatively associated with marginal-ization. Normative data for the EAAM are currentlybeing developed. Although the EAAM performedwell psychometrically on the initial sample, its psy-chometric properties need to be established with otherEast Asian and non-Asian samples, including thosewith varying socioeconomic and educational back-grounds and English-language proficiency.

CLINICAL PRACTICE AND RESEARCH

Although many acculturation measures provide proxymeasures of acculturation (e.g., generational status,English-language proficiency), the EAAM allowsresearchers to assess a pattern of attitudes and behav-iors relevant to socialization and communication invarious situations along multiple dimensions. Suchinformation may be of clinical as well as social impor-tance. The EAAM assimilation scale score significantlypredicts increased willingness to use psychologicalservices, whereas the EAAM marginalization scalescore significantly predicts guarded self-disclosure, apotentially important impediment to engagement intraditional psychotherapy. In terms of social function-ing, the EAAM integration scale score signifi-cantly predicts perceived egalitarian treatment fromAmericans, whereas the EAAM marginalization scalescore significantly predicts perceived ethnic-group

Acculturation Scales: East Asian Acculturation Measure———15


discrimination (i.e., “people from my ethnic group arediscriminated against”).

—Declan T. Barry

See also Asian Values Scale; Asian/Pacific Islander

FURTHER READING

Barry, D. T. (2001). Development of a new scale for measur-ing acculturation: The East Asian Acculturation Measure(EAAM). Journal of Immigrant Health, 3, 193–197.

Barry, D. T. (2002). An ethnic identity scale for East Asianimmigrants. Journal of Immigrant Health, 4, 87–94.

Barry, D. T., & Grilo, C. M. (2003). Cultural, self-esteem,and demographic correlates of perception of personal andgroup discrimination among East Asian immigrants.American Journal of Orthopsychiatry, 73(2), 223–229.

ACCULTURATION SCALES:SHORT ACCULTURATIONSCALE FOR HISPANICS

The Short Acculturation Scale for Hispanics (SASH)is one of the most frequently used acculturation scalesin research with Latinos. The SASH was developedin 1987 after lengthy analysis of the responses of363 Hispanics (e.g., Cubans, Mexican Americans,Puerto Ricans, and Central Americans) and 228Caucasians to questions dealing with ethnic contactpatterns, proficiency and preference of language use,preferred ethnicity in social relations, and characteris-tics of media use. Exploratory principal componentsfactor analyses were conducted on the originalresponses to identify factors that accounted for largeproportions of the variance. The final scale includesitems that had correlations greater than .60 on a givenfactor and did not load heavily in more than one factor.

The SASH includes 12 items measuring linguisticusage and preferences and the ethnicity of friends,social gatherings, and play partners for respondents’children. Each of the items is scored on a five-pointLikert-type scale with anchors of “only Spanish”(scored as 1) and “only English” (scored as 5) for thelanguage-related items and “all Latinos/Hispanics”(scored as 1) and “all Americans” (scored as 5) for theethnic-preference items. The acculturation index isobtained by averaging responses to the 12 items(range of 1 to 5). An average score close to 1 indicatesa low level of acculturation, whereas an average scoreclose to 5 indicates a high level of acculturation.

An average score of 2.99 can be used to dichotomizerespondents into low acculturation (i.e., those withaverage scores lower than 2.99) and highly accultur-ated respondents (i.e., those with average scoresgreater than 2.99). Further research has shown that,when needed, the scale can be shortened to the firstfive language-related items.

The SASH has shown high levels of reliability andvalidity. In the original study, the scale showed an alphacoefficient of .92 for all 12 items and .90 for the first fivelanguage-related items. Validity was established usinga number of approaches, including correlations withrespondents’ generational status (r = .65, p < .001),length of residence in the United States (r = .70, p <.001), age of arrival in the United States (r = –.69, p <.001), and respondents’ own assessment of their accul-turative status (r = .76, p < .001). In addition, the scalediscriminates between first- and second-generationHispanics.

The SASH has been used with Latinos of allnational backgrounds and all generations, as well aswith individuals of limited reading ability. The scalehas also been adapted for use with other ethnic andnational groups by changing the response categoriesto more accurately reflect the group being studied.The items that make up the scale in English andSpanish are available in the original publication. Aversion for children is also available.

A major limitation of the scale is that it measuresacculturation as a unidimensional phenomenon anchoredat one cultural pole by a Latino dimension and at the otherby a non-Hispanic dimension. Nevertheless, the SASHhas a long history of effectively identifying Latinoswith low or high levels of acculturation in different con-texts and under a variety of circumstances. The ShortAcculturation Scale for Hispanics is particularly usefulwhen a rapid measure of acculturation is needed becauseof time constraints or length of study. The scale is alsouseful when researchers need to dichotomize respondentsin terms of high or low levels of acculturation.

—Gerardo Marín

See also Acculturation; Acculturation Scales: BidimensionalAcculturation Scale for Hispanics

FURTHER READING

Barona, A., & Miller, J. A. (1994). Short Acculturation Scalefor Hispanic Youth (SASH-Y): A preliminary report.Hispanic Journal of Behavioral Sciences, 16, 155–162.

16———Acculturation Scales: Short Acculturation Scale for Hispanics


Marín, G., Sabogal, F., VanOss Marín, B., Otero-Sabogal, R.,& Pérez-Stable, E. J. (1987). Development of a ShortAcculturation Scale for Hispanics. Hispanic Journal ofBehavioral Sciences, 9, 183–205.

ACCULTURATION SCALES:SUINN-LEW ASIAN SELF-IDENTITYACCULTURATION SCALE

Developed to gauge acculturation in Asian Americans,the Suinn-Lew Asian Self-Identity AcculturationScale (SL-ASIA) assesses the cognitive, behavioral,and attitudinal aspects of acculturation. The SL-ASIAis the most widely used measure of acculturation inAsian American populations. The SL-ASIA is basedon a unilinear conceptualization of acculturation,which suggests that increased adherence to main-stream culture results in the reduction of adherence tothe person’s culture of origin.

The SL-ASIA is a paper-and-pencil self-reportscale that consists of 21 multiple-choice items, eachof which is rated on a five-point scale. Items assesslanguage, identity, friendship choice, behaviors, gen-eration and geographic history, and attitudes, and theyare worded so as to be relevant to various Asian sub-groups (e.g., Korean, Chinese, and Japanese). Scoresare obtained by summing the answers for all 21 itemsand dividing the sum of scores by 21 to derive thefinal acculturation score. Acculturation scores canrange from 1.00 (low acculturation) to 5.00 (highacculturation). An acculturation score of 3.00 repre-sents a bicultural experience. Higher acculturationscores infer a greater degree of Western identification.In addition to total score analysis, one item allows theparticipant to rate himself or herself as either “veryAsian,” “bicultural,” or “very anglicized.”

PSYCHOMETRIC PROPERTIES

There is much evidence to suggest that the SL-ASIAis capable of producing reliable scores (e.g., seePonterotto, Baluch, & Carielli, 1998). Scores on theSL-ASIA have generated internal consistency esti-mates ranging from .68 to .88 but typically fall in themid .80s. In addition, there is much evidence thatspeaks to the construct validity of the SL-ASIA. Forexample, relationships have been found between SL-ASIA scores and generational status, residency in the

United States, self-reported ethnic identity, attitudestoward counseling, willingness to see a counselor, andcounselor ratings. Suinn and colleagues found theSL-ASIA items to be influenced by five underlyingfactors: (1) reading, writing, and cultural preference;(2) ethnic interaction; (3) affinity for ethnic identityand pride; (4) generational identity; and (5) food pref-erence. This five-factor model of the SL-ASIA hasbeen validated in both exploratory and confirmatoryfactor analytic investigations. Miller and colleaguesalso found evidence suggesting the SL-ASIA mea-sures acculturation in an equivalent fashion for bothwomen and men. Together, these pieces of evidencesuggest the SL-ASIA produces reliable and validscores of acculturation for Asian Americans.

UTILITY OF THE SL-ASIA

Because the SL-ASIA is a relatively brief, clear-cutinstrument, it can be an effective piece of formal or infor-mal assessment in clinical practice. As an assessmenttool, the SL-ASIA supplies information about an indi-vidual’s ethnic interaction, ethnic identity, language use,and social networks. By obtaining a deeper cultural andethnic understanding of the individual, clinicians canbegin to understand the phenomenological experience ofthe Asian American individual. In addition, because ofthe wording of the SL-ASIA items, the measure can beused with a wide range of Asian American subgroups.

LIMITATIONS

When using the SL-ASIA, it is important to recog-nize that the majority of items assess the behavioraldimension of acculturation (e.g., language preference).Recently, multidimensional conceptualizations ofacculturation, which suggest that acculturation occurson multiple dimensions (e.g., values and behavior),have been postulated. Therefore, it is helpful to under-stand that the SL-ASIA may not address other dimen-sions of the acculturation process.

—Matthew J. Miller—Suzette L. Speight

See also Acculturation; Acculturation Measures

FURTHER READING

Miller, M. J., Abe-Kim, J., Li, J., & Bryant, F. B. (2006).A multisample confirmatory analysis examining the

Acculturation Scales: Suinn-Lew Asian Self-Identity Acculturation Scale———17


equivalence of the SL-ASIA across sex. Manuscriptsubmitted for publication.

Ponterotto, J. G., Baluch, S., & Carielli, D. (1998). The Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA):Critique and research recommendations. Measurement andEvaluation in Counseling and Development, 31, 109–124.

Suinn, R. M., Ahuna, C., & Khoo G. (1992). The Suinn-LewAsian Self-Identity Acculturation Scale: Concurrent andfactorial validation. Educational and PsychologicalMeasurement, 52, 1041–1046.

ACCULTURATIVE STRESS

Acculturation refers to a process of cultural change thatoccurs when two or more cultural groups come intocontact for an extended time, particularly when indi-viduals in minority groups move into a new cultureor host society. This is a complex, dynamic changeprocess whereby individuals continuously negotiateamong accepting, adapting to, or denying the charac-teristics of a majority culture, as well as retaining,changing, or rejecting certain components of their ownculture. Psychological acculturation involves an adap-tation or change in attitudes, behaviors, values, andidentity.

As people undergo the process of cultural change,they often encounter difficulties or challenges inadapting to a new set of cultural customs and behav-ioral rules in a nonnative society, where they may lackresources and support from their native culture.Acculturative stress is defined as stress related tomoving from one’s culture of origin to another cul-ture. Although the traditional view held that accul-turation inevitably brings tremendous stress, thecontemporary view attempts to understand accultura-tive stress through a lens of a stress-coping model.This model postulates that (1) acculturative stress mayoccur when the external and internal demands of theacculturation process exceed the individual’s copingability or resources, and (2) the level of acculturativestress depends on multiple factors, such as the modeof acculturation, nature of the acculturating group,characteristics of the host culture, and demographicvariables (e.g., age, gender).

For example, it has been found that among inter-national students in the United States, acculturativestress is associated with English fluency, satisfactionwith social support, social connectedness, the need forapproval, and maladaptive perfectionism. For African

American college students, acculturative stress isassociated with racial identity and racial socialization.For Latinos, acculturative stress is related to the effi-cacy of stress-coping resources, degree of accultura-tion, cohesion of the family, language use, and lengthof residence in the United States.

Not surprisingly, acculturative stress has beenlinked to academic performance and negative mentalhealth consequences. For example, acculturativestress has been positively associated with lower aca-demic performance, lower quality of life in general,excessive alcohol intake, body dissatisfaction andbulimia, identity confusion, anxiety, psychosomaticsymptoms, depression, and suicidal ideation. More-over, during the past five years, research related toacculturative stress has begun to identify variables thatmight mediate or moderate the relationship betweenacculturative stress and depression. For example, ithas been found that maladaptive perfectionism mod-erates the relationship between acculturative stressand depression in international students. Similarly,perceived social support from friends has been shownto have a buffering effect between acculturative stressand depression for Korean adolescents from immi-grant families in the United States. Likewise, familycloseness, hopefulness for the future, and financialresources have been found to provide a buffer againstthe negative effects of acculturative stress experi-enced by Mexican immigrants. Thus, the relationshipbetween acculturative stress and mental health in notnecessarily a simple linear relationship but can bebuffered by a range of personality variables, socialsupport, and financial resources.

—P. Paul Heppner—Hyun-joo Park

—Mei-fen Wei

See also Acculturation; Cultural Barriers

FURTHER READING

Berry, J. W. (1990). Psychology of acculturation: Under-standing individuals moving between cultures. In R. W.Brislin (Ed.), Applied cross-cultural psychology (pp. 232–253). Newbury Park, CA: Sage.

Rodriquez, N., Meyers, H. F., Mira, C. B., Flores, T., & Garcia-Hernandez, L. (2002). Development of the MultidimensionalAcculturative Stress Inventory for adults of Mexican origin.Psychological Assessment, 14, 451–461.

Williams, C. L., & Berry, J. W. (1991). Primary preventionof acculturative stress among refugees. American Psychol-ogist, 46, 632–641.

18———Acculturative Stress


AFFIRMATIVE ACTION

Few governmental policies have been as controversialas affirmative action. During the last several years,battles over affirmative action captured the public’sattention as two cases—Gratz v. Bollinger and Grutterv. Bollinger—were heard by the Supreme Court.Generally heralded as successes for affirmative action,the two Supreme Court decisions, handed down inJune 2003, have not stopped anti–affirmative efforts.

Part of the reason for the continued controversy isthat affirmative action is not well understood. Oftenmisrepresented as quotas or reverse discrimination,affirmative action is actually a system whose purposeis to detect and correct systematic institutionalizeddiscrimination. Affirmative action aims to ensure, notto undercut, true equality of opportunity for all eth-nicities and both genders.

WHAT IS AFFIRMATIVE ACTION?

The American Psychological Association definesaffirmative action as occurring when an organizationexpends energy to make sure that there is no discrim-ination in employment or education and to ensure thatequal opportunity exists. The United States receivedits first governmental mandate to initiate affirmativeaction by way of Executive Order 11246, issued byLyndon Johnson in 1965. The order required allgovernmental agencies, as well as organizations thatcontract with the federal government, to enact proac-tive measures to ensure that the diversity within theirorganizations matches the diversity in the pool ofqualified labor.

Ideally, hiring in the workplace and admissionsin educational organizations would result in diversitywithin businesses and schools equal to that in society.Yet research shows that this is not the case. Regardlessof the value of equal opportunity, it is clear that equalopportunity does not always exist in practice withinorganizations in the United States. Because of oldhabits of thought and behavior that create racialand gender insensitivity, as well as blatant and subtleracism and sexism, Caucasian men still enjoyunearned privileges in American society. They canfind and keep employment more easily than otherswho are similarly qualified. They obtain better mort-gage rates, car deals, housing, and health care thanothers.

Given the persistence of gender and racial discrim-ination, organizations have a choice: They can dealwith discrimination retroactively after a complaint ismade, or they can adopt an affirmative action policy tostave off complaints and to ensure that women andminorities are indeed receiving opportunities equal tothose of Caucasian men. Many organizations voluntar-ily opt for affirmative action to minimize the chances ofhaving to clean up a problem after the fact.

Affirmative action aims to assure true equality ofopportunity. Yet affirmative action can also be distin-guished from the ideal of equal opportunity. Affirma-tive action takes a proactive stance on ensuringfairness and diversity in employment and education.In other words, rather than assuming that equal oppor-tunity exists, affirmative action takes into account thatequal opportunity is flawed because of institutional-ized racism and sexism.

AFFIRMATIVE ACTION IN EMPLOYMENT

All federal organizations are required to comply withthe policy of affirmative action. Private organizationswith more than 50 employees that contract with thefederal government for amounts greater than $50,000are also required to act as affirmative action employ-ers. They are required, in other words, to develop andmaintain an affirmative action plan in the workplace.

At the core of any affirmative action plan for fed-eral contractors is a monitoring system. Organizationsmust make sure that the ratio of minorities and womento Caucasian men in their labor force is equal to thatof the qualified labor pool. Similarly, federal contrac-tors must monitor their promotions.

Sometimes the monitoring process reveals substan-tive differences—for example, that the proportion ofwomen in the organization’s labor force is lower thanthe proportion of qualified women in the availablelabor pool. When differences appear, correctiveactions must be identified and undertaken.

The Office of Federal Contract ComplianceProgram (OFCCP) is the governmental agency chargedwith oversight of businesses that have contracts withthe federal government. Although the majority ofprivate organizations self-monitor their own hiringstatistics, the OFCCP does run 3,000 to 5,000 compli-ance reviews on privately owned businesses per year.If an organization is found to be in noncompliance,the OFCCP helps the organization adhere to the rules.Organizations that are flagrant offenders of the rules

Affirmative Action———19


can be disbarred from holding federal contracts for aperiod of time.

AFFIRMATIVE ACTION IN EDUCATION

Affirmative action in education functions much as itdoes in employment. Typically, universities compilerecords from the admissions office that track the ethnic-ity and gender of applicants and students. The universityuses these records to compare the diversity of the appli-cant pool to that of the accepted students, as well asto track the retention of students to make sure that allethnicities and genders are being treated equally. If aproblem is detected, the university can examine why thediscrepancy exists and move to remedy the problem.

The state of California has a master plan for highereducation that guarantees admission to the Universityof California to the top 12.5% of high school gradu-ates. By monitoring the ethnicity and gender of the topstudents, the university noted that there were moreLatino students available for admission than werebeing admitted. The problem was found to be theresult of some specific factors. Latino high schoolstudents were less likely than others to be counseledby guidance staff to take the core class requirementsto gain admission. In addition, Latino students wereless able to take advantage of advanced placementcourses than Caucasian students. To address theseproblems, the university has exempted the top tier ofapplicants (those who graduated in the top 4%) fromthe course requirements, and it is in the process ofmaking advanced placement courses available online.These changes represent alternative paths to increas-ing diversity that aim to increase the eligibility ofunderrepresented students rather then giving prefer-ence to minority applicants.

In 1996, the voters of California passed Proposition209 by a very narrow majority. In addition, the Regentsof the University of California, under the proddingof Regent Ward Connerly, enacted two resolutions thatremoved the consideration of race, religion, sex, color,ethnicity, or country of origin as criteria for admissionto the university as well as faculty and staff hiring. Asa result of this policy change, the percentage of under-represented group members admitted to the universitydropped considerably in the following years. In 2001,the Regents unanimously voted to repeal the 1995 banon race-conscious admission; however, because of thepassage of Proposition 209, the ban is still in effect atthe state level.

In recent years, the University of Michigan hasbeen more in the public’s eye than the University ofCalifornia. In 1997, Jennifer Gratz and PatrickHamacher, two European American students, chal-lenged the race-sensitive admissions program of theundergraduate college at the University of Michigan.They had been rejected, whereas applicants of colorwith lower scores and grades had been accepted. Twomonths after the Gratz case was filed in federal court,Barbara Grutter, another rejected European Americanapplicant, brought suit against the University ofMichigan Law School. On June 23, 2003, theSupreme Court announced its decisions. It declaredthat race could not be used in formulaic approaches toadmissions, but the Court also recognized diversity inhigher education as a compelling state interest. Race-sensitive policies, the Court concluded, are not ipsofacto unconstitutional.

WHY DO WE NEED AFFIRMATIVE ACTION?

Affirmative action is only one method of correctinginjustices. More reactive means, such as bringing alawsuit, are sometimes thought to be more fair andeffective than affirmative action. There are three mainreasons why affirmative action may be a more effec-tive and less costly way of assuring fairness and sta-bility than the reactive (lawsuit) approach. First,copious research in the social sciences has shown that,many times, the victims of discrimination “haveblinders on,” refusing to acknowledge discriminationuntil the situation is dire. Second, even fair-mindedoutside observers who have not themselves beenthe victims of discrimination have a hard time detect-ing imbalances without the help of systematicallyarranged aggregate data. Most affirmative action plansprovide observers with aggregated data and thus allowthem to detect patterns of fairness or unfairness thatthey would otherwise miss. Third, lawsuits areextremely costly for individuals and for organizations.Proactive measures that allow organizations to moni-tor their situations and to correct minor problemsbefore they engender a lawsuit usually prove to beexcellent investments.

DOES AFFIRMATIVE ACTION WORK?

Affirmative action plans in education have beenshown to increase the presence and the success ofhitherto underrepresented minorities. Indeed, without

20———Affirmative Action


race-sensitive admissions plans, imperfections in theadmissions criteria would result in student bodiesmore Caucasian than at present. In our multiethnicsociety, the state has a compelling interest in achiev-ing diverse student bodies, according to the U.S.Supreme Court.

In industry, affirmative action has also proven to beeffective. Cost–benefit analyses have found that, inmaterial terms, companies that use affirmative actionbenefit not only from avoiding costly lawsuits but alsofrom the diversity in their workforce. Meanwhile, ethnicminority workers and Caucasian women benefit fromthe reduction in barriers that affirmative action brings.

Some opponents of affirmative action claim thatthe policy undermines the confidence of its intendedbeneficiaries. Certainly, people do not like to believethat they may have obtained positive outcomes as aresult of special privilege. Notwithstanding stereo-types to the contrary, only a handful of ethnic minor-ity individuals and Caucasian women mistakeaffirmative action for special privilege. Careful sur-veys show that the majority of direct beneficiaries seethe policy not as one that gives them special privilege,but rather as one that reduces the previously unques-tioned special privileges of Caucasian males.

In sum, affirmative action is a policy that attemptsto make the ideal of equal opportunity an actuality. Inemployment and education, it entails careful monitor-ing of information so that subtle patterns of discrimi-nation can be detected and imbalances can becorrected. Affirmative action promotes diversity.Rather than simply giving lip service to the values offairness, justice, and diversity, affirmative action helpsto ensure that these values are fulfilled in our society.

—Kristina R. Schmukler

See also Equal Opportunity Employment; Institutional Racism

FURTHER READING

American Psychological Association. (1996). Affirmativeaction: Who benefits? Washington, DC: Author.

Bowen, W. G., & Bok, D. C. (1998). The shape of the river:Long-term consequences of considering race in collegeand university admissions. Princeton, NJ: PrincetonUniversity Press.

Crosby, F. J. (2004). Affirmative action is dead: Long live affir-mative action. New Haven, CT: Yale University Press.

Crosby, F. J., Iyer, A., Clayton, S., & Downing, R. (2003).Affirmative action: Psychological data and the policydebates. American Psychologist, 58, 93–115.

AFRICAN AMERICANSAND MENTAL HEALTH

PREVALENCE OF MENTAL ILLNESSAMONG AFRICAN AMERICANS

Mental disorders are highly prevalent across allpopulations, regardless of race or ethnicity. Within theUnited States, overall rates of mental disorders formost minority groups are largely similar to those forCaucasians. However, ethnic and racial minorities inthe United States face a social and economic environ-ment of inequality that includes greater exposure toracism and discrimination, violence, and poverty—allof which take a toll on mental health. In some surveys,African Americans have been found to have higherlevels of lifetime (or current) mental disorders thanCaucasians. However, when differences in age, gen-der, marital status, and socioeconomic status are takeninto account, the racial difference is eliminated.

In most major epidemiological surveys, the overallrates of mental illness for African Americans livingin a community appear to be similar to those of non-Hispanic Caucasians. However, differences do arisewhen assessing the prevalence of specific illnesses.For example, African Americans are less likely to suf-fer from major depression and more likely to sufferfrom phobias than Caucasians. Although somatizationis more common among African Americans thanamong Caucasians, rates of suicide for young men inboth ethnic groups are similar. Researchers have alsofound lower lifetime rates among African Americansfor several other major mental disorders, includingpanic disorder, social phobia, and generalized anxietydisorder. In contrast, African Americans have higherrates of posttraumatic stress disorder and substanceabuse than Afro-Caribbeans or Caucasian Americans.

The general conclusion regarding the lack of racialdifferences in rates of mental illness does not apply tovulnerable, high-need subgroups such as the homelessor the incarcerated, who have higher rates of mentalillness and are often not captured in community sur-veys. African Americans are overrepresented in thesehigh-need populations. Although they represent only12% of the U.S. population, African Americans makeup about 40% of the homeless. The ratio is similar forpeople who are incarcerated: Nearly half of all pris-oners in state and federal jails and almost 40% ofjuveniles in legal custody are African American. One

African Americans and Mental Health———21


explanation for African Americans’ higher rates ofcertain mental health problems is the stressful condi-tions created by racism, discrimination, and poverty.Whether racism and discrimination by themselvescan cause these disorders is not clear, but there doesappear to be a significant association between povertyand incidences of mental illness.

THE EFFECTS OF RACISMON MENTAL HEALTH

There is no question that racism exists in the UnitedStates and that African Americans have been the pri-mary recipients of negative stereotypes and discrimi-nation. There are numerous definitions of racismpresent in the research literature. For the purposes ofthis discussion, the term racism is used to refer to anybehavior or pattern of behavior that tends to systemat-ically deny access to opportunities or privileges tomembers of one racial group while perpetuatingaccess to opportunities and privileges to members ofanother racial group.

It has been argued that racism has a pervasive,adverse influence on the health and well-being ofracial and ethnic minority populations in the UnitedStates. There are three general ways that racism mayjeopardize the mental health of minorities: (1) Racialstereotypes and negative images may be internalized,denigrating individuals’ self-worth and adverselyaffecting their social and psychological functioning;(2) racism and discrimination by societal institutionshave resulted in minorities’ lower socioeconomicstatus and poorer living conditions, in which poverty,crime, and violence are persistent stressors that canaffect mental health; and (3) racism and discrimina-tion are stressful events that can directly lead topsychological distress and physiological changesaffecting mental health.

Racial attitudes toward African Americans haveshifted over time. During the early 1940s, surveyresearch found that most Caucasians supported poli-cies and practices that limited interracial contact inschools, neighborhoods, and marriages. By the 1990s,these attitudes had shifted, and a majority ofCaucasians endorsed such practices as integratedschools and interracial marriages. Although there havebeen changes in the attitudes of Caucasian Americanstoward African Americans, negative stereotypes ofAfrican Americans persist. In general, Caucasiansview African Americans more negatively than any

other ethnic minority group. As recently as 1990,29% of Caucasians viewed most African Americansas unintelligent, 44% believed that most are lazy,56% endorsed the view that most prefer to live onwelfare, and 51% indicated that most are prone to vio-lence. There seems to be broad support for egalitarianattitudes toward African Americans, but this coexistswith a desire to maintain at least some social distancefrom African Americans and a limited commitment topolicies to eradicate entrenched inequalities.

Racism exists on both an individual and an institu-tional level. Historically, beliefs about the inferiorityof African Americans were translated into policiesthat restricted their access to education, employment,health care, and residential opportunities. Theserestrictions led to disparities in essential resources,resulting in significant residential segregation andpoverty within African American communities.Today, institutional racism is evidenced by the factthat the median income for Caucasian Americanhouseholds is almost 1.7 times higher than that ofAfrican Americans. Nearly 40% of African Americanchildren under the age of 18 are growing up poor,compared with 11% of their Caucasian peers. Racismcan also be seen in less obvious differences, such asthe economic benefits of educational attainment. In1998, the U.S. Census Bureau noted that a householdwith an African American male college graduateearned 80 cents for every dollar earned by a compara-ble Caucasian household. The difference is even moremarked for African American households with afemale college graduate, whose median income is74% of that of comparable Caucasians.

These differences in socioeconomic status andeducational attainment have important consequencesfor mental health. Research has found that personsin the lowest categories of both income and educa-tion (who are disproportionately African Americans)are twice as likely as those at the highest levels(who are disproportionately Caucasian Americans)to meet the criteria for one of the major psychiatricdisorders.

Racism is also thought to adversely affect mentalhealth status through the subjective experience of dis-crimination. However, there are inconsistent resultsregarding the connection between racial discrimina-tion and psychological distress. Some studies havefound that exposure to racial discrimination is posi-tively related to physical risk factors such as elevatedlevels of blood pressure and elevated levels of

22———African Americans and Mental Health


psychological distress. Other studies have found theopposite or no racial differences in rates of psycho-logical distress in African Americans compared withCaucasians. Some have hypothesized that this patternmay reflect the presence of coping strategies withinthe African American population that may mitigatesome of the psychological consequences of exposureto racism. The link between perceived discriminationand mental health appears to be complex, and under-standing the variables that moderate this relationshipis a relatively new area of empirical research.

USE OF MENTAL HEALTH SERVICES

Disparities in access to and use of mental healthservices persist across racial and ethnic groups inthe United States. These disparities vary, however,depending on geographical location, socioeconomicstatus, and type of service. In general, racial andethnic minorities use fewer mental health services thando Caucasians with comparable distress and problemsand have less access to mental health services than donon-Hispanic Caucasians. Considering that the inci-dence of mental illness is similar across racial and eth-nic groups, minority individuals who require mentalhealth services carry a greater burden from unmetmental health needs. Studies have shown that AfricanAmericans are less likely than Caucasians to seek helpfrom therapists in private practice, mental health cen-ters, and physicians. Yet African Americans prove nodifferent from Caucasians in their use of public-sectortherapists, and they are more likely than Caucasians touse inpatient services and the emergency room formental health care. African Americans who haveundergone treatment for mental health problems arealso more likely than Caucasians to be confined tojails, prisons, and mental hospitals and more likely tobecome homeless at some point. These findings high-light the vulnerability of African Americans who arementally ill and their high degree of social fragility.

African Americans, both those in the general pop-ulation and those who have been diagnosed with amental illness, display more positive attitudes towardseeking mental health care than Caucasians, yet theyuse fewer services. It is interesting to note that priorto their actual use of services, African Americans’ atti-tudes toward seeking mental health services are com-parable to—and in some instances more favorablethan—those of Caucasians. Once they have used ser-vices, however, African Americans tend to hold more

negative attitudes about mental health services andreport being less likely to use them in the future thanare Caucasians with comparable needs and usage.

BARRIERS TO MENTAL HEALTH SERVICES

A number of variables have been suggested to explainthe racial disparity in the use of mental health ser-vices. Barriers to mental health care occur at threelevels: individual, environmental, and institutional.Individual barriers reflect factors that originate fromwithin the individual, such as culture-specific beliefsand knowledge about mental illness that may influ-ence help-seeking behavior.

Mistrust of mental health services is as a majorbarrier for ethnic minorities seeking treatment, andit is widely accepted as pervasive among AfricanAmericans. It arises from both historical persecutionand present-day struggles with racism and discrimina-tion. Mistrust also arises from documented abuses andperceived mistreatment, both in the past and morerecently, by medical and mental health professionals.It has been found that 12% of African Americans and15% of Latinos—compared with 1% of Caucasians—feel that a doctor or health provider judged themunfairly or treated them with disrespect because oftheir race or ethnic background.

Individuals who are more mistrustful of Caucasianproviders are less willing to seek mental health treat-ment and expect less satisfaction from such therapeu-tic encounters. Given the low numbers of ethnicminorities trained to deliver mental health services,many systems are unable to deliver racially matchedproviders. African American clients who must rely onracially different providers may face clinicians whoare culturally insensitive, and this experience maynegatively influence their attitudes toward mentalhealth services.

For some African Americans, limitations in under-standing the problem and in their awareness of possi-ble solutions, strategies, and resources are obstaclesto seeking mental health services. When experiencingproblems, many African Americans perceive that theyare having a normal response to a difficult life situa-tion and believe that they should keep trying to man-age their difficulties on their own. As their problemsincrease or reoccur and begin to interfere with theirability to function, African Americans are more likelyto rely on informal support from friends, family mem-bers, and clergy to try to deal with the situation rather



than seek formalized mental health services. It hasbeen noted that about 43% of African Americans relyexclusively on informal help, 44% use both informaland formal providers, and less than 5% turn exclusivelyto formal sources of help when they are experiencingpersonal difficulties. This approach to handling prob-lems seems to be supported by family members, sig-nificant others, and influential African Americancommunity members.

Certain cultural beliefs, such as the need to resolvefamily concerns within the family and the expectationthat African Americans should always demonstratestrength in the face of problems, inhibit individualsfrom seeking mental health services. There is a cul-tural expectation that life is difficult and that AfricanAmericans as a cultural group should be able to effec-tively cope with adversity. Another cultural factor thatmay influence the use of mental health services isone’s beliefs about the causes of mental illness.Individuals who identify causes that are consistentwith those espoused by mental health professionals(such as the importance of early experiences in fami-lies and the effect of trauma on development) aremore likely to seek mental health services than thosewho endorse more discrepant views. Ethnic minoritypopulations more strongly endorse folk beliefs—forexample, that imbalances in natural forces cause ill-ness or that supernatural, spiritual, or mystical forcescause illness. They also believe that a lack of modera-tion or willpower and weakness of character causeillness. It is unlikely that individuals who hold suchbeliefs about the causes of mental illness will seekformal approaches to mental health treatment.

Environmental barriers reflect factors that occurwithin the external environment and inhibit attemptsor increase the difficulty of efforts to seek help. Mentalillness and mental health treatment continue to beplagued by a stigma that adversely affects help-seekingbehavior. Stigma refers to a cluster of negative attitudesand beliefs that motivate the general public to fear,reject, avoid, and discriminate against people withmental illness. Stigma is widespread in the UnitedStates and other Western nations. Research conductedduring the 1980s found that African Americans heldmore negative views of mental illness than Caucasians.In more recent studies, however, it has been found thatAfrican Americans hold less stigmatized views of men-tal health services than in the past. But there continuesto be a belief that mental health services are only forthose who are seriously mentally ill.

Institutional barriers are factors related to theability of the individual seeking services to actuallyaccess mental health care. The surgeon general’sreport on culture, race, and ethnicity identified accessto care as a major issue involved in mental health ser-vice disparities among African Americans. The reportidentified numerous institutional barriers to mentalhealth services, including a lack of or inadequateinsurance coverage, disjointed services, and the loca-tion of culturally specific services. There are fewhigh-quality mental health services located in low-income communities, where the majority of AfricanAmericans reside. Twenty years ago, many more ser-vices were provided in these communities throughfederal and private funding. These services are nolonger available because of increasing budget cuts andshifts in priorities for government spending and pri-vate philanthropy. African Americans seeking mentalhealth services must often travel relatively long dis-tances to find available, affordable care. They oftenexperience problems with transportation, inflexiblejob schedules, and limited resource knowledge, all ofwhich serve as barriers to care.

The cost of mental health services has also beennoted as a significant barrier to seeking mental healthtreatment. African Americans, the majority of whomlive in poverty, frequently lack adequate insurance tocover mental health services. Hourly fees for treat-ment are perceived as excessive and are considered aluxury in the face of basic needs and ongoing finan-cial challenges. Even for African Americans whoreceive Medicaid benefits, bias is experienced becausemedication is often the recommended treatment. Moreoften than not, psychotherapy and counseling are notoffered as treatment options. With the further margin-alization of African Americans by managed care andother insurance companies, access to quality mentalhealth services has become more difficult and costly.Although there is considerable evidence that mentalhealth service needs are high within the AfricanAmerican community, the service shortfall that existsprecludes access, thereby exacerbating the emotionalstrain on African Americans as individuals and as acultural group.

Misdiagnosis is a further barrier to AfricanAmericans and other ethnic minorities receiving ade-quate mental health care. Minority patients are amongthose at greatest risk for nondetection of mental disor-ders in primary care. Missed or incorrect diagnosescarry severe consequences if individuals are given



inappropriate or possibly harmful treatments, leavingtheir underlying mental disorder untreated. Institu-tional racism was evident over a century ago in theform of separate and often inadequate mental healthservices for African Americans. It continues today inthe form of medical practices for diagnosis, treatment,prescription of medications, and referrals. There isample evidence that African Americans are overdiag-nosed for schizophrenia and underdiagnosed for bipo-lar disorder, depression, and anxiety as a result ofproviders’ stereotypical attitudes and beliefs. To date,there has been limited research on the extent of biasand stereotyping of African Americans among mentalhealth providers; therefore, the role that stereotypingplays in the racial disparities in mental health serviceutilization and effectiveness remains unclear.

CULTURE-SPECIFIC APPROACHESTO ASSESSMENT, DIAGNOSIS,AND INTERVENTION

African American psychologists recognize that tradi-tional psychology is limited in its understanding ofpeople of color and that much of the history of the fieldhas reflected bias and discriminatory attitudes andbeliefs about African American individuals, families,and communities. Today, many ethnic minorityresearchers and scholars are recommending that mentalhealth providers become more culturally sensitive in aneffort to enhance the effectiveness of their interventionefforts with African American clients. It has been sug-gested that providers should take a multifaceted thera-peutic approach, one that (1) identifies the therapist’sown attitudes and beliefs about the world based ondevelopmental and sociocultural influences; (2) exam-ines how the therapist’s background and worldviewmay differ from the client’s and may hinder the thera-peutic process; (3) strikes a balance between the thera-pist’s need to learn from the client about his or herexperiences and the use of community and interagencyresources to help understand the client’s background;and (4) stresses a therapeutic approach that incorpo-rates multicultural theories and practices.

Understanding African Americans from a multicul-tural perspective requires that mental health providersreally listen to clients and try to understand clients fromwithin their cultural context. Adopting this approach toworking with African American clients will helpproviders become more adaptable in their theoreticalorientation, flexible with their skills and strategies, and

sensitive to clients’ cultural idiosyncrasies. The devel-opment of a therapeutic or conceptual orientation is anongoing process, and mental health providers must bewilling to continue this developmental process wellbeyond their graduate school education. To be mosteffective in their work with African Americans, mentalhealth providers must accept that different worldviewscan coexist and adapt their skills and abilities so theyare applicable to other cultures.

An abundance of literature on African Americansand their culture is available to mental health providerswho are committed to enhancing their cultural sensitiv-ity and awareness of this ethnic minority group. It is notpossible to review this literature in detail, but a briefdiscussion of some of the newer theoretical approachesto working with African Americans can provide exam-ples of new trends in the field.

One new approach is the multicultural assessment-intervention process (MAIP) model. This modelrequires the mental health provider to employ a sys-tematic approach to assessment and intervention thatuses cultural information to inform service deliveryand improve the quality of services provided toAfrican Americans. Questions are addressed at vari-ous points in the assessment-intervention process toemphasize the relevance of assessment instruments,increase the reliability and accuracy of clinical diag-noses, and foster the use of more credible and benefi-cial intervention services. In the MAIP model, there isa recognition that cultural and racial differences areessential in the understanding of the self and impor-tant in the delivery of mental health services to ethnicminorities. It requires a willingness to address prob-lems on the basis of these differences during assess-ment, diagnosis, and treatment and a commitment onthe part of mental health providers to undergo thenecessary training to become culturally competent.

A second approach that seems to hold promise forenhancing access to mental health services calls forcollaboration between the field of psychology andthe African American church. The African Americanchurch in general and the clergy in particular havetraditionally played important roles in providing sup-portive resources to the African American community.Although there are a number of African-centeredmodels of psychotherapy in which spiritual develop-ment is understood as central to human development,few mental health providers have actively collaboratedwith the African American church. There are severalbarriers that impede collaborative efforts between



psychologists and the church: Few academic depart-ments require training for mental health providersin religious or spiritual issues, and mental healthproviders have limited understanding of the traditionsof the different denominations that make up theAfrican American church. To overcome these barriers,providers need to examine their own beliefs regardingreligion and spirituality and obtain additional trainingin religious or biblical counseling. Increasing the col-laboration between the African American church andmental health providers will make it possible to pro-vide culturally relevant mental health services tomany African Americans who currently do not usetraditional mental health delivery systems.

A third recommended treatment approach for work-ing with African Americans focuses on culturalstrengths within the African American community andfactors that promote resilience. Resilience refers to thenotion that some people are able to succeed in the faceof adversity. It involves factors and processes that inter-rupt the trajectory from risk to problem behavior orpsychopathy. A resilience perspective highlights thedevelopment of competencies, assets, and strengths inindividuals’ lives, and it includes the maintenance ofhealthy development despite the presence of a threat orrecovery from trauma. These psychosocial resourcesand resilience factors can insulate the individual fromsuch significant stressors as racism or provide copingmechanisms to reduce the negative effects of stress.

Well-established psychosocial resources, such assupportive social ties, perceptions of mastery or con-trol, and self-esteem, have been shown to serve as pro-tective factors for individuals coping with stress andadversity. In addition, research suggests that other cul-turally specific resources seem to enhance copingamong African Americans. These include religiousbeliefs and behavior, ethnic-group identity and con-sciousness, and racial socialization experiences. Theterm racial socialization refers to the process of com-municating behaviors and messages to children for thepurpose of enhancing their sense of racial or ethnicidentity, partially in preparation for racially hostileencounters. The association between African Americans’perceptions of racial discrimination and mental healthis moderated by experiences with racial socializationin families and by levels of self-esteem.

These newer approaches to understanding andpromoting mental health in African Americans holdpromise for the development of mental health servicesthat are culturally appropriate and effective. As they

become the accepted standard of care in the field,there is hope that existing racial disparities will besignificantly reduced or eliminated in the future.

CONCLUSIONS

The mental health needs of African Americans havebeen well documented in the psychological literature,and over the last decade, there has been a serious effortto incorporate race, ethnicity, and culture into ourunderstanding of mental health and mental illness.Although gains have been made in developing moreculturally sensitive treatment interventions, there con-tinues to be evidence of bias in the assessment anddiagnosis of mental disorders among AfricanAmericans. There are also multiple barriers that havea negative impact on African American clients’ accessto high-quality mental health services and effectiveutilization. There are a number of areas for futureresearch, such as the need to better understand the help-seeking attitudes and behaviors of African Americansin the utilization of mental health services and the rolethat stigma plays in this process. A final question thatwill need to be examined more thoroughly in the futurerelates to the effects of cumulative stress on the emer-gence and progression of mental health problemsexperienced by African Americans.

Focusing on cultural strengths and resilience isclearly an important direction for the future; however,we should not lose sight of the fact that promoting indi-vidual (or collective) resilience is not a substitute forsystemic, institutional change. There is compelling evi-dence that African Americans and other racial and eth-nic minorities experience a disproportionately highdisability burden from unmet mental health needs. Theracism, discrimination, and economic deprivation thatplague much of the African American communityrequire system-level change. Ultimately, reducing dis-parities in the mental health treatment of AfricanAmericans will require a societal commitment to socialjustice and equity.

—Elizabeth E. Sparks

See also African/Black Psychology; Africentric; Associationof Black Psychologists; Black Racial Identity Scale

FURTHER READING

Dana, R. H. (2002). Mental health services for AfricanAmericans: A cultural/racial perspective. Cultural Diversityand Ethnic Minority Psychology, 8(1), 3–18.



U.S. Department of Health and Human Services. (2001).Mental health: Culture, race, and ethnicity (Suppl. toMental health: A report of the surgeon general). Rockville,MD: Author.

Williams, D. R., & Williams-Morris, R. (2000). Racism andmental health: The African American experience. Ethnicityand Health, 5(3/4), 243–268.

AFRICAN/BLACK PSYCHOLOGY

African/Black psychology is a system of knowledgegrounded in the perspectives of African-descentpersons and designed to describe their personalities,attitudes, emotions, and behaviors. This system ofknowledge is based on an African cosmology and cor-responds to African conceptions of the social uni-verse. Essentially, it is a science of exploring the livesof African-descent persons from a perspective that iscentered on their experiences.

Although African psychologists acknowledge theexistence of an African/Black psychology derivedfrom the development of early African civilizations inEgypt and Ethiopia, formal study and articulation ofAfrican psychological concepts, theories, and modelshave only recently begun to take shape. This formaldevelopment is marked by three pivotal moments inhistory: (1) the work of Francis Cecil Sumner, (2) thefounding of the Association of Black Psychologists,and (3) Wade Nobles’s publication on the philosophi-cal basis of African psychology in 1986.

In 1992 and 1996, Chancellor Williams and DaudiAjani ya Azibo, respectively, discussed how thedestruction of Black African civilization, beginning asearly as 4500 BCE and continuing through the presentday, has arrested the development and ownership ofAfrican-centered conceptions of the human experi-ence. Historically, Eurocentric psychological explana-tions have been the primary mode of understandingthe behaviors of African/Black persons. In responseto this approach, Dr. Francis Cecil Sumner, the firstAfrican American to receive a PhD in psychology inthe United States (in 1920), began a program of inves-tigation to refute racist and pejorative theory andresearch that argued for African/Black inferiority.Sumner was named the “father of Black Americanpsychologists,” and his work is considered an initialresponse to Eurocentric psychology, which has beenused to validate the mistreatment of African-descentpersons.

In response to discontent with the AmericanPsychological Association, the Association of BlackPsychologists (ABP) was established in 1968 with anagenda to address issues of race, culture, and oppres-sion as they concern African/Black persons and topromote the refutation of cultural-deficit models andcomparative studies that portray African/Black per-sons as deviant. The ABP is credited with three con-tributions to the field of African/Black psychology.The first is the reemergence of African psychologybased on an African cosmology; second, the develop-ment of the Journal of Black Psychology; and finally,the Annual International ABP convention, at whichAfrican/Black psychologists throughout the diasporacollaborate and learn from one another while buildingan African/Black psychological community.

In 1972, Wade Nobles’s literary contribution,African Philosophy: Foundations for BlackPsychology, was the final development to clearly linkancient African philosophical thought to the psychol-ogy of African/Black people. Following the establish-ment of the ABP, three camps developed amongAfrican/Black psychologists: Eurocentric, Black, andAfrican. Eurocentric psychologists are of Africandescent and employ Eurocentric theory and researchin their work with African-descent persons. Black psy-chologists are described as reacting to White suprema-cist notions and racist formulations promoted byEurocentric psychological theory and research.Finally, African psychologists are described as beingproactive in the development of African/Black psy-chological research and theory, which is centered onthe experiences of African/Black people and con-nected to an African system of knowledge (i.e., cos-mology, ontology, axiology, worldview, ideology, andethos). Nobles’s essay was the first published work toarticulate the African philosophical basis of Africanpsychology—a seminal piece that initiated the propa-gation of proactive African/ Black psychologicalresearch orientation, theory, and practice.

AFRICAN/BLACK PSYCHOLOGICALDEVELOPMENTS

African/Black psychological research orientation, the-ory development, and practice are significantly guidedby the Afrocentric school of thought founded byMolefi Asante during the late 20th century. Asantecoined the term Africalogy—the Afrocentric study ofphenomena, events, ideas, and personalities related

African/Black Psychology———27


to Africa—to describe the generation of theory andpractice across all disciplines (including psychology)centered on Africa and African descendants. A reviewof developments in African/Black research orienta-tion, theory, and practice follows.

Research Orientation

There are four tenets of the Afrocentric methodby which Africalogists (i.e., researchers of Africa andAfrican-descent persons) are guided. First, researchersexamine themselves in the process of examining thesubject of study, thus maintaining a practice of intro-spection and retrospection throughout the course ofstudy. Second, the Afrocentric research methodrequires cultural and social immersion and discour-ages traditional scientific distance in the study ofAfrican and African-descent persons. Third, theAfrocentric method requires the researcher to havefamiliarity with the history, language, philosophy, andmyths of the people under study. Fourth, the Afrocen-tric method views research as a vehicle by which tohumanize research participants and, ultimately, theworld. Later theorists elaborated the Afrocentricresearch method, explicating and concretizing con-cepts offered by Asante’s initial work.

Theory

African/Black psychological theory has beendeveloped to explain the personalities, attitudes, emo-tions, and behaviors of African-descent persons froma perspective that is centered on their experiences.Personality and developmental psychological theorieshave experienced the most growth. Additionally, iden-tity theory has witnessed further growth and develop-ment. In her groundbreaking work, Dr. Frances CressWelsing (1970) presented the Cress theory of colorconfrontation and racism, which explains the hostiletreatment of African-descent persons by those ofEuropean descent. Other personality theories thatexplain African-descent persons have been offered byAfrican/Black psychologists such as Na’im Akbar,Daudi Ajani ya Azibo, and Linda Meyers.

Akbar’s early conceptualizations of African/Blackpsychology sought to redefine normalcy for African-descent persons by considering their logical reactionsto an oppressive social environment. He coined termssuch as misorientation and mentacide, which describeAfrican-descent persons’ psychological response to a

racially hostile and oppressive environment. Continu-ing this work, Azibo developed an African-centerednosology of Black personality disorders that system-atized 18 disorders of the African personality. Severalstudies have substantiated the integrity of Azibo’snosology. Like Akbar and Azibo, Linda Meyers pre-sented the framework of optimal psychology toexplain the manifestation of the African worldview inthe psychology of African/Black persons.

Developmental psychological theory has focusedon the redefinition of normative growth and develop-ment of African/Black children. The work of AmosWilson is noteworthy. Wilson’s work concentratedon the developmental psychology of African/Blackchildren and the development of culturally responsivechild-rearing and learning environments that wouldpromote their optimal development. In this vein,Neferkare Abena Stewart focused her work on theearly development of African/Black infants across theworld to generate developmental milestone norms(e.g., average age for sitting up, walking, talking, etc.)for these children.

Racial identity theory has also witnessed tremen-dous growth over the last 30 years. In 1970, WilliamCross introduced formidable work on “Nigrescence”(i.e., the Negro-to-Black conversion) that investigatedthe process by which African/Black persons developan integrated identity with regard to race. Cross’sinitial work influenced subsequent developments ingender and racial identity development theory.

Practice

The practice of African/Black psychology has onlyrecently been formally presented as a cohesive systemof treatment, although African-centered approaches totreatment in social services, educational, and mentalhealth settings have been employed for some time.In 1990, Frederick Phillips presented an Afrocentricapproach to psychotherapy. This approach is spiritu-ally based, focusing on achieving balance and align-ment within persons and systems. Basic principles ofAfrocentric therapy—harmony, balance, interconnect-edness, cultural awareness, and authenticity—areguided by the African worldview.

CONCLUSION

The field of African/Black psychology continues todevelop, reclaiming and elaborating on the African

28———African/Black Psychology


historical and cultural legacy. As growth in the fieldpersists, several developments are anticipated. Theexpansion of existing theories and the developmentof new theoretical conceptualizations and practicalapproaches are expected, as the existing theories andmodels are at least three decades old. Additionally,psychological studies grounded in Afrocentric theorythat demonstrate the effectiveness of African/Blackpsychological interventions and their generalizabilityamong African/Black persons in diverse settings andcontexts are needed. Finally, as a concerted efforttakes hold among African/Black psychologists tomeet the mental health needs of African-descent per-sons throughout the diaspora, the development, imple-mentation, and evaluation of theory and interventionsfor African-descent persons outside the United Stateswill most likely be expanded.

—Wendi S. Williams—Julie R. Ancis

See also Association of Black Psychologists

FURTHER READING

Azibo, D. A. (1996). African psychology in historical perspec-tive and related commentary. Trenton, NJ: Africa WorldPress.

Helms, J. E. (1990). Black and White racial identity: Theory,research, and practice. Westport, CT: Greenwood Press.

Nobles, W. (1986). African psychology: Toward its reclama-tion, reascension, and revitalization. Oakland, CA: BlackFamily Institute.

AFRICENTRIC

The term Africentric, and the more commonly usedterm Afrocentric, describe a worldview in whichAfrican people and culture are the central unit ofanalysis, with a focus on social and historical context.There are two critical aims in the framework ofAfricentric scholarship: (1) the reclamation and revi-sion of the history of African people, who share com-mon ancestral origins but are spread throughout theworld (this international population represents theAfrican diaspora) and (2) the resistance of Europeancultural hegemony and oppression.

The first aim is to transform scholarship. In partic-ular, Africentric scholars have studied the impactof Black African civilizations, such as the ancient

civilizations of the Nile Valley. This revisionist viewof world history and antiquity counters the dominantperspective of African people, which commences withEuropean conquest.

The second aim focuses on how individuals makemeaning of the world within an Africentric culturalcontext. Africentric scholars argue that because theWestern framework represents African people asdeviant from the European ideal, it is futile to attemptto understand the behaviors of African people withina Eurocentric framework.

AFRICENTRIC PSYCHOLOGY

Connectedness is a primary tenet of the Africentricworldview. Contrary to the Western or Eurocentric per-spective, which vales objectivity, the Africentric world-view recognizes the interconnectedness of the affective(feeling), cognitive (knowing), and behavioral (acting)domains. The African Self-Consciousness Scale is ameasure that encompasses dimensions related to anindividual’s awareness of a collective sense of relation-ship to African people and resistance to forces ofoppression. African self-consciousness is related to cul-tural and racial socialization among African Americans.

In the Africentric paradigm, the consequences ofoppression manifest in the psyche of African people andare evident in behavior. The Africentric psychologistviews cultural orientation as related to well-being. WhenAfrican people adopt a foreign or Eurocentric worldview,maladaptive behaviors and psychopathology result. Thus,an Africentric framework explains the often-cited dispar-ities between European Americans and AfricanAmericans in educational, health, or mental health out-comes as a consequence of oppression and detachmentfrom the cultural source. Africentric psychologists andeducators have designed culturally relevant interven-tions, such as youth rites of passage programs, to helpcounter the impact of racial oppression.

CHALLENGES TO AFRICENTRIC THEORY

One major challenge to Africentric theory is thatwithin this framework, race is constructed as an essen-tial characteristic. Africentric scholars have beencritiqued for focusing on racial classification asdeterministic rather than acknowledging the dynamicaspects of culture and the diversity of individualexpressions of ethnicity. Some scholars of Europeanclassicism have challenged the veracity of some of the

Africentric———29


claims made within the revised analysis of Africanpeople in ancient civilizations throughout the Africandiaspora. Other critiques address some Africentricscholarship that makes arguably sexist or homophobicassertions about interpersonal relationships in anauthentic African cultural context.

CONCLUSIONS

This entry offers a brief review of Africentric per-spectives on knowledge production, meaning making,and behavior. Although Africentric theory has gainedmore attention in recent years, this intellectual tradi-tion is evident historically throughout Black scholar-ship in the diaspora. Africentric theory in psychologyprovides a framework for understanding the context ofhuman behavior liberated from Western culturalbiases regarding mental health. An Africentric para-digm transforms the analysis of how cultural world-view affects micro- and macro-level outcomes.

—Zaje A. T. Harrell

See also African/Black Psychology; Association of BlackPsychologists; Culture

FURTHER READING

Ani, M. (1994). Yurugu: An African-centered critique ofEuropean cultural thought and behavior. Trenton, NJ:Africa World Press.

Asante, M. K. (1998). The Afrocentric idea. Philadelphia:Temple University Press.

Kambon, K. K. (1992). The African personality in America:An African-centered framework. Tallahassee, FL: NubianNational Publications.

ALASKA NATIVES

Mental health is important to an individual’s generalhealth, family relationships, and relationships withinthe community. A number of factors can contribute tomental health status, including biological, social, andpsychological phenomena. Mental illness can have asignificant negative impact on individuals, families,and communities. To effectively prevent or amelioratemental health–related problems, current research andpractice focus on these contributors to mental health.Specifically, the role of culture on mental health hasbecome an important area of interest for researchers

and mental health professionals. Although the AlaskaNative community constitutes a small percentageof the U.S. population, an incredible diversity existsamong its people. For example, differences amongAlaska Native peoples can be found in geographicallocation, language, customs, beliefs, religion, familystructures, and social structures. The degree of diver-sity among the Alaska Native peoples has importantimplications for psychological research and mentalhealth treatment.

GENERAL INFORMATION

Though there is no single definition of Alaska Native,this term is typically used to describe the indigenouspeople of what is now the state of Alaska. Specifi-cally, Alaska Natives are generally thought to includeEskimo, Indian, and Aleutian peoples. Nearly half ofall Alaska Natives are Eskimo, which includes theInupiat, Yup’ik, and Cup’ik peoples. About one-thirdof Alaska Natives are Indians, which encompassesthe Athabascan, Eyak, Tlingit, Tsimshian, and Haidapeoples. Finally, the Aleut people constitute approxi-mately 15% of Alaska Natives.

The Alaska Native population is geographically dis-persed throughout the state of Alaska, which is approx-imately one-fifth the size of the continental UnitedStates. In general, the majority of Alaska Natives resideoutside the larger Alaska cities in villages of 2,500people or fewer. Anchorage, the most populated cityin the state, is home to approximately 14,000 AlaskaNatives. Altogether, Alaska Native groups composeapproximately 16% of the state’s population. Not onlyare there geographical differences; linguistic and cul-tural differences can also be found among the AlaskaNative peoples. For example, Alaska Natives speak 20different languages, live in all major areas of Alaska,and vary in degrees of acculturation.

The Inupiaq live in the northern and northwesternregion of Alaska, where they still live a subsistencelifestyle. Two major dialects, which resemble thedialects of Canadian and Greenlandic Eskimos, arespoken by the Inupiaq. The Inupiaq believe in thereincarnation of both animal and human spirits. Thisbelief is often expressed in the ceremonial treatmentof animals that are killed during a hunt and the namingof children after deceased relatives.

Distinguishable by their different dialects, theYup’ik and Cup’ik are concentrated in southwesternAlaska. Also hunters and gatherers, the Yup’ik and

30———Alaska Natives


Cup’ik were once a mobile people following themigration of the game they hunted. Historically, socialhierarchies among the Yup’ik and Cup’ik were basedon gender, and men and women often lived in separatedwellings. Elders played an important role in thesocialization of younger members of the group andwere responsible for passing on cultural beliefsthrough storytelling.

Historically, the Athabascan people were concen-trated around river ways in the Alaskan interior (centralAlaska), where they would hunt, fish, and trap. Today,Athabascans live throughout the state of Alaska. Elevenlanguages are spoken by the Athabascan people.Although there are exceptions, the majority ofAthabascan clans follow a matrilineal social structure.In the past, this matrilineal system influenced huntingpractices, living arrangements, and the socializationof children. Among the many values the Athabascanpeople hold, sharing and respect for all living things areespecially important.

The Eyak, Tlingit, Tsimshian, and Haida peoplesinhabit the southeastern portion of Alaska, known asthe Alaska panhandle, and use a matrilineal system ofmoieties, phratries, and clans. A moiety includes twosubdivisions that can be broken down into severalclans. A phratry is similar to a moiety but has fourdivisions instead of two. Like moieties, phratriesinclude a specific number of clans. The matrilinealsocial system determines family name, inheritance,hunting practices, and living arrangements. The Eyakonce occupied the southeastern corner of south-central Alaska and included two moieties. Currently,the Eyak people are concentrated on the Copper RiverDelta in Alaska, where they continue to live a subsis-tence lifestyle. As with the Eyak, Tlingit subsistencecomes primarily from fishing but also includes thegathering of plants and hunting of game. Consideredone of the most complex cultures of the NorthAmerican Natives, Tlingit culture uses a social classifi-cation system that defines social norms and strata.Although one common language is shared by theTsimshian people, four separate dialects are spokendepending on geographical location. Currently, theTsimshian people are concentrated on Annette Islandoff the southeastern coast of Alaska. The Haida origi-nally lived among the Queen Charlotte Islands inCanada, eventually settling on Prince of Wales Islandoff the southeastern coast of Alaska. Unlike the Tlingitand Tsimshian peoples, the Haida speak a language thatis unrelated to the other Alaska Native languages.

Finally, the Aleut and Alutiiq peoples live insouthern and southwestern Alaska, including the chainof islands off the Alaskan coast known as the AleutianIslands. The Aleutian Islands are known for havingsome of the harshest weather in the world. The threemajor groups of the Aleut and Alutiiq peoples speaktwo different languages. The Aleut and Alutiiq alsoincorporate the Russian language into their everydayspeech. This reflects the early contact betweenRussian fur traders and the Aleut and Alutiiq peoples.Like many of the others Alaska Native groups, theAleut and Alutiiq peoples place a strong emphasis onkinship and sharing.

The Russian discovery of Alaska in 1741 broughtsignificant changes to the indigenous Alaska Nativepopulation. Russian fur traders concentrated huntingefforts on much of the Alaskan coast in search of seaotter pelts, often trading with the Alaska Natives. By1772, a permanent Russian settlement had been estab-lished in Unalaska. In 1795, Russian missionariesestablished the first Russian Orthodox Church onKodiak Island. Although not all Alaska Native groupswere negatively affected by the Russian fur trade, themistreatment of the Aleuts is well documented. In par-ticular, the Aleut people were enslaved and forced tohunt sea otters for the Russia fur traders. Eventually,interest in Alaska subsided when sea otters had beenhunted to near extinction. In 1867, the United Statespurchased Alaska from Russia for 7.2 million U.S.dollars.

Outside interest in Alaska was rekindled when goldwas discovered near Juneau in 1880 and again in theKlondike region in 1897. When vast quantities of goldwere found in the Nome region in 1898, the Alaskagold rush began. This brought the arrival of numerousnon-Natives to Alaska in a very short period of time.A booming commercial fishing and canning industry,in addition to a growing population of military per-sonnel, created a significant population increaseduring the early 1900s. By 1959, Alaska’s populationhad grown enough to qualify for statehood. With thediscovery of oil and natural gas reserves on Alaska’sNorth Slope, the influx of people to the state hascontinued to increase.

CUSTOMS AND BELIEFS

The cultural values and ways of life of the differentAlaska Native groups have been permanently affectedby the introduction of Western society. For example,

Alaska Natives———31


non-Native people brought diseases, racial discrimi-nation, and modern industry to Alaska. These thingshave, in some cases, led to a loss of the traditionalways of the Alaska Native peoples. However, tradi-tional beliefs still persist among Alaska Natives.Today, spirituality remains an important aspect ofAlaska Native culture, and the traditional belief thathumans, animals, and the earth share a relationshipis fundamental to the modern belief system of AlaskaNatives. With the introduction of organized religionto Alaska, some Alaska Natives have come to viewtheir spirituality concurrently through traditionalNative customs and non-Native religious perspectives(e.g., shamanism, Christianity).

In addition to beliefs about the relationshipbetween animals, humans, and the earth, AlaskaNative culture emphasizes harmony among an indi-vidual’s mind, body, and soul. This is consideredimportant to preserving overall health. Disharmonybetween mind, body, and soul, therefore, can result inmental and physical deterioration. In addition to itsholistic view of life, Alaska Native culture places anemphasis on helping within the Native community.This can be seen in the continuance of the subsistencelifestyle of many of the modern Alaska Native groups.Each individual has a role in the daily functioning ofthe community. For example, elders among the clanare considered an important source of wisdom andadvice among Alaska Native peoples.

Although not all Alaska Native cultures believe inshamanism, the idea that an individual can possess thepower to see and influence spirits does exist in someAlaska Native groups. Among these groups, a shamanis sometimes considered the spiritual leader of theclan. In other instances, the shaman is seen strictly asa healer or an individual who influences the luck ofthe community.

In the case of mental or physical illness, theshaman’s duties include determining the causes ofthe illness and deciding how to treat the underlyingcauses of that illness. For example, many physical ormental problems are considered to be the result of abroken taboo. A taboo is an inhibition or ban on spe-cific behaviors or even thoughts based on Native cus-toms and beliefs (e.g., not hunting the animal of yourclan name). Many taboos are related to preventing ill-ness or the promotion of a healthy lifestyle. A brokentaboo disrupts the harmony between mind, body, andspirit, not only for the individual but also for the com-munity as a whole. The shaman is responsible for

identifying which taboo has been broken and advisingthe individual or the members of the community onmethods for remedying the problem. This process typ-ically involves the shaman entering a trance-like stateto improve his or her ability to perceive supernaturalphenomena that are important to the healing process.The reason for the illness or problem is then identifiedin an attempt to prevent future problems for the indi-vidual and the community.

Alaska Natives believe that the underlying cause ofan illness can be either natural or supernatural; thesource of the problem determines the method of inter-vention. The healing ceremonies that follow involvereestablishing community harmony. For example,prayers, songs, and other activities are used to createan atmosphere that facilitates a healing environment.During these ceremonies, participants sometimeswear masks or ornate costumes, dance, play musicalinstruments, and use images depicting the spirits theyintend to attract.

HEALTH DISPARITIES

Because Alaska Natives and American Indians tendto be grouped together when it comes to health issues,it can be difficult to determine the specific mental andphysical health problems Alaska Natives face.However, some information does exist about the men-tal and physical health problems of Alaska Natives.Some of the leading causes of death among AlaskaNatives are cancer, unintentional injury,suicide, and homicide. Although cancer rates aredecreasing among the general population in theUnited States, cancer rates among Alaska Natives areincreasing. Compared with their non-Native counter-parts, Alaska Natives are less likely to survive oncethey are diagnosed with cancer. The most commontypes of cancer among Alaska Natives are colorectalcancer and lung cancer. The high rates of lung canceramong Alaska Natives may be related to the highsmoking rates among Alaska Native groups.Additionally, because tobacco sales to minors arecommon, Alaska Natives tend to start smoking at ayounger age.

Death as a result of unintentional injury amongAlaska Natives has been estimated to be almost fourtimes that of the general population in the UnitedStates. Additionally, unintentional injury is the leadingcause of death among Alaska Native children. Riskfactors related to unintentional injury include poverty,



substance abuse, poor housing, lack of access toadequate medical treatment, and geographic isolation.

Suicide rates among Alaska Natives have beenestimated to be twice the national average. Suiciderates are particularly high among Alaska Native malesin their late teens and early twenties who live innonurban areas of Alaska (i.e., villages). Though noone can say for sure, suicide is often the result of alack of treatment for depression and substance abuse.These risk factors appear to be more common amongthe Alaska Native population. Barriers related to theutilization of appropriate mental health services maybe a secondary contributor to suicide among AlaskaNatives who suffer from depression and addiction.Some estimates show that Alaska Natives are fourtimes more likely to die from homicide than their non-Native counterparts. In fact, nearly half of all deathsamong Alaska Natives are a result of suicide or homi-cide. Again, alcoholism is considered by many to playa significant role in the high homicide rates within theAlaska Native community.

Alaska Natives also have higher rates of incarcera-tion, homelessness, poverty, and alcohol and drugproblems. Statistics on homelessness and poverty canbe difficult to interpret because of the extreme varia-tion in living circumstances among Alaska Nativesgroups. Several theories exist to explain the highprevalence of alcohol abuse among Alaska Natives.Some believe that the altered state induced by alcoholconsumption was initially considered a valued spiri-tual experience among the Alaska Native peoples.Others postulate that the binge drinking of earlyRussian and American fur traders and trappers led toa skewed socialization of appropriate alcohol con-sumption. Finally, some believe that the problemsmany Alaska Natives face are the result of negativeevents experienced by their ancestors (e.g., racism,discrimination). These stressors are consequentlypassed down to each successive generation. Regardlessof the reason for the high rates of alcoholism amongAlaska Natives, most agree that this problem is asignificant one.

TREATMENT AND PREVENTION EFFORTS

Smoking Prevention

A number of prevention programs have been devel-oped to address the high rates of tobacco use amongAlaska Natives. For example, the Alaska Native Health

Board has developed tobacco-prevention programs toassist Alaska Native communities in reducing tobaccouse. These prevention programs focus on discourag-ing tobacco use and preventing tobacco-related ill-nesses that ultimately lead to death. These programsare also intended to target Alaska Native youth toprevent early tobacco use.

Suicide

The Department of Health and Social ServicesDivision of the Alcohol and Drug Abuse Community-Based Suicide Prevention Program provides supportfor Alaska Native communities to create preventionprograms aimed at reducing suicide. This resource isparticularly appealing because it allows communitiesto develop prevention programs to meet the specificneeds of the community. In addition to these services,a number of agencies and organizations proactivelyinitiate programs for the purpose of educating theAlaska Native community about suicide risk factors,preventing suicides, and providing a forum for dis-cussing concerns related to suicide.

For example, the Western Athabascan NaturalHelpers Program is a school-based program that tar-gets at-risk schools for suicide prevention. Addition-ally, the Zuni Life-Skills Development Curriculum,the Wind River Behavioral Health Program, theTohono O’odham Psychology Service, and the IndianSuicide Prevention Center are prevention programsdeveloped for American Indian populations. Althoughthese programs are not designed specifically forAlaska Natives, they may provide useful informationabout tailoring suicide-prevention programs toinclude Native customs and beliefs.

Unintentional Injury

The Alaska Injury Surveillance and PreventionProgram (ISAPP) currently provides resources forpreventing unintentional injuries among AlaskaNative peoples. These programs work to improveenvironmental surroundings (e.g., by installing childcar seats), encourage safety law compliance (e.g.,child car seat use), and provide safety-related educa-tion (e.g., proper use of child car seats). The ISAPPuses a community-level approach that focuses onestablishing specific programs that target the prob-lems a particular community is facing (e.g., carseat–related accidents).

Alaska Natives———33


Homicide

In addition to programs designed to prevent unin-tentional injury, resources exist for the purpose ofreducing and preventing intentional injury withinAlaska Native communities (i.e., homicide). Anexample of such an organization is the Alaska InjuryPrevention Center, which works to increase generalcommunity safety. The center works with Alaska lawenforcement and community agencies to reduce theincidence of homicide through education, public ser-vice announcements, and community-based programs.

Alcoholism

Although a number of substance abuse programsare available in Alaska, few incorporate Nativebeliefs into treatment protocol. However, recentefforts have been made by such organizations as theDepartment of Health and Human Services to pro-mote culturally sensitive treatment programs forAlaska Natives. Also, Internet resources have beenused by this organization to overcome barriers thatoften result from the geographic dispersion of Nativecommunities.

ALASKA NATIVE ORGANIZATIONS

In addition to prevention programs and organizations, anumber of groups exist to provide services to AlaskaNatives. For example, the Alaska Native Health Boardprovides a forum for discussing Alaska Native healthissues. The purpose of this organization is to promotethe overall well-being of the Alaska Native community.

The Alaska Native Knowledge Network is an orga-nization that compiles and exchanges informationrelated to Alaska Native culture. It was developed toprovide federal agencies, private organizations, edu-cators, and the public with insight into the AlaskaNative way of life. Additionally, this network providesAlaska Natives with a method for preserving informa-tion about their customs and beliefs. The AlaskaNative Knowledge Network also has resources foreducators who are developing curricula for AlaskaNative children and adolescents.

The Alaska Native Tribal Health Consortium is anorganization that is owned by the Alaska Native tribalgovernment and various Alaska Native health servicesorganizations. The consortium is part of the AlaskaTribal Health System, which provides medical and

mental health services to Alaska Natives. This systemof health service providers aims to improve the phys-ical and mental health of Alaska Natives.

The National Center for American Indian andAlaska Native Mental Health Research is a researchorganization affiliated with the University of Colorado’sDepartment of Psychiatry. This program is sponsoredby the National Institutes of Mental Health. Thecenter focuses its research efforts exclusively onAmerican Indian and Alaska Native peoples. Thisorganization was developed to improve understandingof psychological issues among American Indian andAlaska Native populations.

The Center for Alaska Native Health Research is aresearch organization that conducts research amongAlaska Native populations. Sponsored by grants fromthe National Institutes of Health and the NationalCenter for Research Resources to the University ofAlaska– Fairbanks, the center collects health-relatedinformation (e.g., nutritional information) amongAlaska Native people. Utilizing both scientific andcultural approaches to examining health issues, theCenter for Alaska Native Health Research looks toimprove the health of Alaska Natives.

MENTAL HEALTH SERVICE UTILIZATION

It is common knowledge that ethnic and racial minori-ties in general are less likely to use mental healthservices. Although the specific rates of mental healthservice utilization among Alaska Natives have notbeen carefully examined thus far, the use of theseresources appears to be particularly low in this popu-lation. Alaska Natives face barriers that are commonto other ethnic groups, but they also face obstaclesthat are unique to the cultural, social, and geographiccharacteristics of their way of life. Negative past expe-riences with non-Native peoples (i.e., racism, discrim-ination, segregation) may result in a general mistrustof mental health professionals. This, coupled with arelative lack of mental health professionals of AlaskaNative descent, may help explain the underutilizationof psychological services. Another barrier to the useof mental health services is cost. Fortunately, theIndian Health Service (IHS) is a federally fundedagency that provides affordable health care, includingmental health services, to Native populations.However, geographic isolation can make it difficult toaccess IHS-designated clinics that offer mental healthservices to Alaska Natives.



RECOMMENDATIONS FOR RESEARCH

There is still a great deal that is unknown about themental health issues faced by Alaska Native peoples.In general, future research efforts that focus on con-ducting culture-centered research among AlaskaNatives would help us better understand the psycho-logical needs of this population. The influence of cul-tural beliefs on psychological phenomena mayimprove our understanding of the suicide, uninten-tional injury, homicide, and alcoholism rates in thispopulation. Ethical research conducted among spe-cific Alaska Native groups that highlights differencesamong these groups could be improved. For example,when reporting treatment research methods anddesign in an Alaska Native sample, researchers shouldinclude information related to the specific groupassessed in the study (e.g., Tlingit, Aleut). This wouldimprove our understanding of the generalizability oftreatment results, which could, in turn, aid in thetranslation of research into effective treatments.

This is not to say that research has not been con-ducted among Alaska Native groups; however, addi-tional research is necessary. Specifically, furtherresearch should focus on the effects of non-Native ver-sus Native mental health professionals on theclient–therapist relationship, different utilization ratesof mental health services among specific Alaska Nativegroups, and the effectiveness of incorporating culturalvalues and beliefs into the treatment process. Researchthat answers these questions will enable mental healthprofessionals to more effectively address the mentalhealth needs of their Alaska Native clients.

RECOMMENDATIONS FOR PRACTICE

Assumptions should never be made about any indi-vidual based on his or her ethnicity or race. However,an understanding of specific cultural values andbeliefs can be an important factor in establishing aneffective therapeutic relationship. For example, someAlaska Native cultures display a reserved communi-cation style, which is sometimes viewed as unfriendlyby non-Natives. Additionally, in some Alaska Nativecultures, sharing information related to personal prob-lems or complaints is not encouraged by the Nativecommunity. In these circumstances, trust becomescrucial to the therapeutic relationship. A lack of trustin the context of cross-cultural mental health treat-ment and suspicion of mental health professionalsmay not be uncommon.

As in some American Native cultures, Alaska Nativesspeech may proceed at a slower rate than for otherpeople. Silence, pauses, and a lack of eye contact may becommon during conversations and should not be per-ceived as avoidance or disrespect. Additionally, exten-ding mental health treatment to include family members,respected elders from the community, or other commu-nity members may help to facilitate the treatmentprocess. Alaska Natives may have different perceptionsof disability and illness. For example, Alaska Nativessometimes believe that mental illness stems from a spir-itual rather than a psychological or biological cause.Inquiring about an individual’s perceptions of the con-tributors to mental health can help improve the develop-ment of an effective treatment plan. For example,including traditional Alaska Native treatments in addi-tion to more conventional psychological methods mayimprove treatment adherence. Improved adherence totreatment recommendations will therefore improve treat-ment outcomes. Again, the holistic view of health sharedby many Alaska Native peoples should be consideredwhen explaining and treating psychological issues.

In addition to client and patient factors, mentalhealth professionals should be aware of their ownbeliefs and cultural background. Because mentalhealth professionals are also products of their ownculture, they should be aware of attitudes and beliefsthat may influence their perceptions of AlaskaNatives. Consistently monitoring one’s own beliefsand preconceived notions about Alaska Native peo-ples can improve a mental health professional’s abil-ity to function effectively in cross-cultural situations.

—Michael M. Steele

See also Native Americans

FURTHER READING

Herring, R. D. (1999). Counseling with Native AmericanIndians and Alaska Natives: Strategies for helping profes-sionals. Thousand Oaks, CA: Sage.

U.S. Department of Health and Human Services. (1999).Mental health: A report of the surgeon general. RetrievedJanuary 28, 2006, from http://www.mentalhealth.org/cmhs/surgeongeneral/surgeongeneralrpt.asp

ALCOHOL/SUBSTANCEUSE AND ABUSE

Alcohol and illicit drug problems are not unique to themajority culture of the United States. They also exist

Alcohol/Substance Use and Abuse———35


throughout the many cultural groups that compose thenation’s ethnic minority population. Within the ethnicminority population, alcohol and illicit drug problemsspan age, gender, educational background, occupa-tion, and socioeconomic status. What follows is anoverview of alcohol and illicit drug use and misuse asit pertains to the ethnic minority population of theUnited States. This overview is divided into discus-sions of (1) the distinction between substance use andforms of substance misuse, (2) the role of culturalnorms and acculturation in substance use, (3) theprevalence of substance use and misuse among ethnicminority groups, (4) interventions for substance useand misuse in ethnic minority groups, and (5) theimpact of drug-control policies on ethnic minoritygroups. This overview does not address alcohol anddrug problems outside the United States, but it isimportant to note that substance problems are promi-nent in other nations and have a negative impact oncultural groups around the globe. Neither will thisoverview address nicotine and prescription drug prob-lems, both of which are also prominent domestic andinternational concerns.

DISTINGUISHING BETWEEN SUBSTANCE USEAND SUBSTANCE MISUSE

Understanding the nature of alcohol and illicit druguse and misuse among ethnic minority groups mustbegin by distinguishing among substance use, sub-stance misuse, substance abuse, and substance depen-dence (ordinarily referred to as addiction or chemicaldependence). Clarification of the terminology is impor-tant because patients, researchers, policymakers, lawenforcement, and the media often use these termsinterchangeably, and the definitions may be at oddswith those of the mental health and medical profes-sionals who are responsible for diagnosing and treat-ing alcohol and drug problems. For example, a manarrested for smoking marijuana at a concert may con-sider himself a substance user, but the criminal justicesystem may label him a substance abuser and him todrug treatment, where he may be diagnosed with a sub-stance dependence disorder (such as a cannabis depen-dence) by a psychologist.

A person engaging in substance use can bedescribed as using a substance without any identifiedproblem associated with such use. For example, ateenager may experiment with marijuana, experienceno adverse effects, and refrain from further use. The

term substance misuse is a general term that describespeople who suffer from either a substance abuse orsubstance dependence disorder.

Colloquially, the term substance abuse is used torefer to any degree of substance use, ranging fromone-time use of an illicit drug to severe addiction.Its definition among medical and mental health pro-fessionals, however, and its use here, refers to a sub-stance abuse disorder marked by habitual use of asubstance in a manner that is harmful to self or othersbut without strong signs of physical dependence orsignificant psychosocial negative consequences. Forexample, a man may drink heavily at bars on someweekends and then drive home in a state of intoxica-tion. His behavior is dangerous because he is placinghimself and others at risk of injury or death, but therole of alcohol in his life may not be so central as toreach the level of addiction.

Among medical and mental health professionals, asubstance dependence disorder describes an addictionto a substance, marked signs of tolerance and with-drawal, and a number of negative consequences asso-ciated with the substance use, but continued use of thesubstance despite these consequences. Terms such asalcoholic, junkie, and crackhead are colloquialismsused to describe people who suffer from abuse of ordependence on alcohol, heroin, and crack cocaine.

THE ROLE OF CULTURAL NORMS ANDACCULTURATION IN SUBSTANCE USE

Each culture has a set of norms regarding the sub-stance use of its members. Individuals within a givencultural group will vary in the extent to which theirpersonal attitudes and behavior toward substances areconsistent with these norms. Thus, the substance useof some individuals will closely follow their culturalnorms, whereas the substance use of others will be atodds with their cultural norms. Despite these individ-ual differences, cultural norms have been found tohave a profound and multifaceted impact on the sub-stance use of group members. They influence theparticular drugs that are deemed acceptable for use,how and when drugs are used, and even the kinds ofreactions that the drug produces in the user.

One facet of the relationship between culturalnorms and substance use concerns the delineationbetween substances that are acceptable and unaccept-able for use. The tolerance of some substances and theprohibition of others is a reflection of a cultural norm

36———Alcohol/Substance Use and Abuse


that varies from culture to culture. For example, in theUnited States, where drinking is a traditional part ofmany social customs and practices, alcohol use islegal for those above a certain age. In contrast, alco-hol use is illegal in many Middle Eastern cultures,where alcohol use is regarded as sinful.

A second facet of the relationship between culturalnorms and substance use concerns how a particularsubstance is used. A substance that is ingested in oneform in one culture may be ingested very differentlyby another culture. For example, in parts of SouthAmerica, indigenous cultures ingest cocaine by chew-ing coca leaves rather than by snorting or injectingpowder cocaine or smoking crack cocaine. In contrast,cocaine users in the United States snort or inject pow-der cocaine or smoke crack cocaine but do not chewcoca leaves.

A third facet of the relationship between culturalnorms and substance use concerns the delineationof appropriate versus inappropriate contexts for sub-stance use. The use of a substance may be tolerated inone context but prohibited in another. For example,members of the Native American church regard theuse of peyote in the context of worship as a sacra-mental act, one that allows the believer communionwith God. Peyote’s use during Native American wor-ship ceremonies has persisted for several centuries.However, the use of the drug outside the ceremonialcontext is not culturally proscribed.

Finally, cultural norms have a role in the kinds ofeffects a drug has on its user. For example, researchersinvestigating marijuana use in Jamaica during the1970s found that marijuana users reported strength,endurance, and quickness from their drug use. Thesefindings provide a sharp contrast to the amotivationalsyndrome marked by lowered drive, lack of ambition,and poor concentration that researchers have foundamong marijuana users in the United States.

Acculturation reflects the extent to which an indi-vidual has adapted to or acquired the beliefs of themajority culture. At first glance, the relationshipbetween acculturation and substance use might appearstraightforward. That is, the level of acculturationshould yield predictable patterns of substance use, sothat a minority group’s substance use should come toclosely resemble that of the majority culture as itsdegree of acculturation increases. This would inten-sify or lessen substance use depending on the culture’sunique sanctions and prohibitions regarding substanceuse. For example, immigrants from a culture that

sanctions a high degree of alcohol use will likelydecrease their alcohol use as they become more accul-turated to an adopted culture that has strong prohibi-tions on alcohol use.

Research on the relationship between acculturationand substance use has not been so straightforwardor consistent. In fact, the effects of acculturation onsubstance use have been found to vary by age, gender,and cultural group. For example, research has linkedincreased levels of acculturation with less drinkingamong middle-aged Mexican American men andmore drinking with other groups of Hispanic men.

THE PREVALENCE OF SUBSTANCE USE,ABUSE, AND DEPENDENCE AMONG ETHNICMINORITY GROUPS IN THE UNITED STATES

The measurement of substance use in the UnitedStates is constrained because of limitations in theresearch methodology. For example, researchers haveused disparate measuring strategies in alcohol anddrug use surveys. This inconsistency in measurementtechnique has led to difficulty comparing findingsacross studies. In addition, researchers attempting tomeasure alcohol and illicit drug use in the populationare always faced with people’s reluctance to admit tosubstance use. The measurement of substance abuseand substance dependence disorders is more complexthan simply measuring substance use because of theadded burden of assessing both the quantities of sub-stance use and the negative consequences associatedwith such use. Therefore, estimating the prevalence ofsubstance abuse and dependence disorders is impre-cise. The best research available provides only a roughestimate of the percentage of Americans who drink,use drugs, and suffer from substance abuse or depen-dence disorders.

Estimates of alcohol and illicit drug use amongethnic minority groups are even more subject to errorbecause of additional problems associated with ethnicminority research methodology. One such problem isthat most of the research on ethnic minority substanceuse employs umbrella labels for disparate culturalgroups. For example, labels such as Hispanic, Asian,and American Indian/Alaska Native are commonethnic minority categories in the research literature.These terms, though descriptively useful in manyways, mask an array of distinct cultural groups con-tained within these groups. The label Hispanicencompasses people with origins in Cuba, Puerto



Rico, Mexico, South America, and other CentralAmerican and Caribbean nations. The label Asianencompasses people with origins in China, Japan,Korea, Hawaii, and other Pacific Islands. The labelAmerican Indian/Alaska Native encompasses severalhundred tribal groups, people who live on reserva-tions, people who live off reservations, and peoplewith varying degrees of tribal exposure.

The use of these labels would not be a problem ifrates of substance use among the various culturalgroups within the label were equivalent. Unfortunately,it has become apparent that there are significant differ-ences among the various cultural groups containedwithin these umbrella labels. For example, rates ofalcohol use differ significantly among Native Americantribes. In addition, it has become apparent that sub-stance use rates differ among ethnic minority memberswho were born in the United States versus those whohave immigrated more recently. For example, rates ofabstinence from alcohol are significantly higher amongMexican American immigrant women than amongthird-generation Mexican American women.

ALCOHOL USE

The results of the most recent large-scale governmentsurvey on alcohol use, the 2002 National Survey onDrug Use and Health conducted by the SubstanceAbuse and Mental Health Services Administration,found that 51% of Americans over the age of 12reported current use of alcohol. Overall, the surveyfound differences in rates of alcohol use among thenation’s largest cultural groups. For example, 55% ofCaucasians reported consuming at least one drink inthe 30 days prior to the survey. Respondents reportingheritage from two or more races had the second-highest rate of past-month alcohol use at 49.9%, fol-lowed by 44.7% among American Indian/AlaskaNatives, 42.8% among Hispanics, 39.9% amongAfrican Americans, and 37.1% among Asians. The rateof past-month binge drinking (defined as consumingfive or more drinks in one sitting during the past 30days) was highest among American Indian/AlaskaNatives at 27.9%, followed by 25.2% among NativeHawaiians and other Pacific Islanders, 24.8% amongHispanics, 23.4% among Caucasians, 21% amongAfrican Americans, and 12.4% among Asians.

Rates of alcohol use can vary significantly withinthe cultural groups that make up the umbrella labelscommonly used in survey research. The extent of such

differences remains to be fully explored. However,research has thus far revealed differences amongHispanic cultural groups. For example, MexicanAmerican men report a higher rate of frequent heavydrinking than do Puerto Rican and Cuban Americanmen. Mexican American and Puerto Rican men aremore likely to report a period of heavy drinking dur-ing their lifetime than Cuban American men. CubanAmerican women report less alcohol use thanMexican American and Puerto Rican women. In asimilar vein, studies of drinking differences amongAsian cultural groups have identified more alcoholabstainers than alcohol users in Filipino American andKorean American samples and more alcohol usersthan abstainers in Japanese American and ChineseAmerican samples.

ILLICIT DRUG USE

The 2002 National Survey on Drug Use and Healthfound that 8.3% of the population 12 years and olderhad used an illicit drug during the month prior to thesurvey. Rates of drug use varied by cultural group.Respondents reporting heritage from two or moreraces had the highest rate of past-month drug use at11.4%. American Indian/Alaska Natives had thesecond-highest rate of past month drug use at 10.1%,followed by African Americans at 9.7%, Caucasiansat 8.5%, Hispanics at 7.2%, and Asian Americans at3.5%. There were significantly different rates of druguse among those who fell under the umbrella label ofHispanic. Puerto Ricans had the highest prevalencerate at 10%, followed by Mexican Americans at 7.3%,Cuban Americans at 6.5%, and people of Central andSouth American origin at 5%. There were also signif-icantly different rates of drug use among those whofell under the umbrella label of Asian. For example,past-month drug use among Korean Americans was7%, whereas the rate was 5% among JapaneseAmericans and 1% among Chinese Americans.

SUBSTANCE ABUSE AND DEPENDENCE

The 2002 National Survey on Drug Use and Healthestimated the prevalence rates of substance abuseand dependence disorders by asking respondentsquestions that reflect the criteria established by theAmerican Psychiatric Association for the diagnosis ofthese disorders. For example, questions pertaining tosubstance abuse disorders probed for problems with



the law, work, friends, family, or school as a resultof alcohol or illicit drug use. Questions pertainingto substance dependence disorders probed for phys-iological signs of tolerance and withdrawal andcontinued use of the substance despite the negativeconsequences associated with its use.

In the sample, 4.5% of the population reportedsymptoms consistent with a diagnosis of a substanceabuse disorder. The same percentage reported symp-toms consistent with a diagnosis of a substance depen-dence disorder. Alcohol was the most commonlyreported substance problem, followed by marijuana,cocaine, and prescription pain relievers. AmericanIndians and Alaska Natives had the highest rate ofabuse or dependence at 14.1%, followed by personsfrom two or more races at 13%, Hispanics at 10.4%,African Americans at 9.5%, Caucasians at 9.3%, andAsians at 4.2%.

The high rates of abuse and dependence amongAmerican Indians and Alaska Natives may explain thehigh rates of substance-related health and social prob-lems in this ethnic minority group. The death raterelated to alcohol misuse is higher among AmericanIndians and Alaska Natives than among the generalpopulation. For example, death from chronic liver dis-ease and cirrhosis (consequences of heavy drinking) isfour times more common among American Indians andAlaska Natives than in the rest of the U.S. population.Fatal alcohol-related motor vehicle accidents are threetimes more common. Alcohol-related suicide and homi-cide are also more common among American Indiansand Alaska Natives than in the general population.

Negative consequences associated with substanceabuse and dependence are overrepresented amongAfrican Americans and Hispanics. African Americanscompose 10% to 12% of the U.S. population, andHispanics compose about 10% of the population. Yetrecent estimates indicate that African Americans andHispanics make up 50% of new AIDS diagnoses(often a consequence of injection drug use). AfricanAmericans represent 51% of marijuana-related emer-gency room visits and 34% of cocaine-related emer-gency room visits. Overall, African Americans makeup 21% of drug-related emergency room visits.Hispanics represent 15% of methamphetamine-relatedemergency room visits and 11% of overall drug-related emergency room visits.

Cultural differences are also evident in drug-relateddeaths. Recent estimates place heroin and morphineas the most commonly implicated substances in

drug-related deaths among Caucasians and Hispanics(mentioned in 41% of cases involving Caucasian dece-dents and 47% of Hispanic decedents). In contrast,cocaine is the most commonly implicated substancein drug-related deaths among African Americans,mentioned in 64% of cases.

INTERVENTION

Interventions in the area of substance use and misusecan be broadly grouped into prevention programs,screening and assessment techniques, and treatmentprograms. Prevention programs are typically targetedtoward adolescents or other individuals at high risk forsubstance use and misuse. The aim of prevention pro-grams is to prevent or prolong the initiation of sub-stance use and to minimize the substance use of thosewho begin. Screening and assessment techniques areused to aid the identification and diagnosis of substanceabuse and dependence disorders. Treatment programsare targeted toward individuals who have already beenidentified as having a substance abuse or substancedependence disorder, typically a population that isolder than the audience of prevention programs. Theaim of treatment programs is usually abstinence fromsubstances; however, some programs seek moderationof substance use rather than abstinence. Traditionally,interventions have been provided to ethnic minoritygroup members without considering the compatibilityof the intervention with the values, beliefs, and prac-tices of the ethnic minority group. Over the past fewdecades, awareness has grown in the field of clinicalpsychology and other helping professions that an indi-vidual’s cultural values and beliefs about substancesinfluence his or her response to substance use and mis-use interventions.

This awareness has led to the modification of someexisting prevention programs and the creation of newprevention programs to increase their sensitivity to thecultural backgrounds of the ethnic minority groupsattending the programs. One example is Life SkillsTraining, a program developed to help adolescents suc-cessfully resist peer pressure to use alcohol, tobacco,and illicit drugs. Researchers modified the program toenhance its sensitivity to the cultural background ofAfrican American and Hispanic adolescents, and theyfound greater reduction in alcohol consumption amongthe Hispanic and African American adolescents whoattended the culturally sensitive version of the programcompared with those who attended the standard version.



Awareness of the relevance of cultural differenceshas also informed the practice of screening and assess-ment. Screening and assessment techniques in the fieldof addictions, and mental health in general, were oftendeveloped and standardized on Caucasian clients, withlittle regard for how the instrument or technique wouldperform with ethnic minority clients. Applying ascreening or assessment instrument developed on onecultural group to a different cultural group without firsttesting its adequacy is problematic. For example, if ascreening instrument inquires about a set of alcoholproblem warning signs that are uniquely manifested ina particular cultural group, the successful screening ofalcohol problems in a different cultural group will bequestionable.

Attempts to improve the multicultural utility ofscreening and assessment instruments have occurredthrough several avenues. One avenue is exemplifiedby the development of the Alcohol Use DisordersIdentification Test. This popular alcohol screeninginstrument was developed on clients from many cul-tures on several continents to ensure that the test itemswould be appropriate for different cultural groups.Other avenues to improve the multicultural utility ofscreening and assessment instruments have includedtranslating instruments into foreign languages and col-lecting normative data on ethnic minority populations.Improvements in the assessment process have also beenmade by training counselors to be sensitive to the eth-nic minority groups they serve and to assess an ethnicminority group member’s language preference, degreeof acculturation, and ethnic identity.

Awareness of the relevance of cultural differenceshas led to concerns about the adequacy of existingtreatment programs for ethnic minority clients. Thedominant modality of substance abuse treatment inthe United States has been the “Minnesota model”of treatment, which was developed from the principlesof Alcoholics Anonymous. Alternative forms of sub-stance abuse treatment based on cognitive-behavioraltherapy and motivational enhancement therapy havebecome popular as well. The utility of these treat-ments with ethnic minority clients has not been fullyevaluated. Attempts to improve treatment outcomesamong ethnic minority clients have led to the devel-opment of culturally sensitive and culturally specifictreatments. Culturally sensitive treatments modifyexisting treatment programs to make them more com-patible with the beliefs and values of the ethnic minor-ity clients being served. Culturally specific treatments

use traditional cultural healing practices that falloutside mainstream psychological practices. Forexample, traditional cultural folktales have been incor-porated into substance abuse treatment with Hispanicand Native Americans clients; peyote rituals and sweatlodges have been incorporated into treatment for NativeAmerican clients; and a public apology technique hasbeen developed for Asian American clients. However,the use of such treatments is the exception rather thanthe norm with ethnic minority clients.

DRUG CONTROL POLICY

Historically, U.S. drug control policy has been associ-ated with tension between majority group membersand ethnic minority group members. Restrictions onalcohol, cocaine, opiates, and marijuana have all beenlinked with prejudices toward ethnic minority groups.For example, fear and intolerance of a new and grow-ing immigrant group during the 19th century, theIrish, extended to their drinking habits and providedan impetus for the nation’s first temperance move-ment. As a result of this movement, a third ofAmerican states were under alcohol prohibition by theend of the 1850s. Cocaine was a legal drug in theUnited States during the 19th century, used for a vari-ety of recreational and medicinal purposes. Efforts toprohibit cocaine were prompted by claims that thedrug provided African American men with super-human strength and caused them to commit acts of vio-lence against Caucasians, including raping Caucasianwomen.

Opiate drugs such as opium, morphine, and heroinalso enjoyed widespread recreational and medicinaluse during the 19th century. Opium smoking in par-ticular was a common pastime of Chinese immigrants.Efforts to control opiates began as their addictivenature became more widely understood and wereprompted by fear and intolerance toward the Chinese.Not surprisingly, prohibitions on smoking opium wereenacted before prohibitions on morphine and heroin.Marijuana was used as a medicinal drug in the UnitedStates from the 19th century until the 1930s, andrecreational marijuana smoking was a common pas-time of Mexican immigrants. Similar to beliefs aboutAfrican Americans and cocaine was the belief thatmarijuana could lead Mexicans to acts of violence andother forms of crime. These claims aided the estab-lishment of legislation that ultimately led to the drug’sprohibition.



Some have argued that contemporary drug controlpolicy in the United States is discriminatory toward eth-nic minority group members because they are moreprone to the negative consequences of drug controlpolicies than Caucasians. Compared with Caucasians,African Americans are more likely to be arrested for adrug-related offense, their drug-related arrests are morelikely to result in conviction, they are more likely to beincarcerated after a drug-related conviction, and theyserve longer prison terms for drug-related offenses.

The majority of individuals incarcerated for federaldrug-related crimes are African American or Hispanic.Approximately 40% of incarcerated federal drugoffenders are Hispanic, 30% are African American, and25% are Caucasian. These numbers are well out ofproportion to the percentage of each cultural group inthe general population, and they are even more strik-ing when one considers that rates of drug use amongHispanics, African Americans, and Caucasians are rel-atively similar.

Perhaps the most controversial topic concerningcontemporary drug policy and ethnic minority groupsconcerns the federal mandatory minimum sentencingguidelines for crack and powder cocaine. The Anti–DrugAbuse Act of 1986 established vastly different manda-tory minimum penalties for powder versus crack cocaineviolations. For example, a first-time offender in posses-sion of 5 grams of crack cocaine faces a mandatory min-imum of five years’ incarceration; however, a first-timepowder cocaine offender would not face a five-yearminimum penalty unless he or she were in possessionof 500 grams of the drug. This discrepancy in the amountof crack versus powder cocaine required for a mandatoryminimum has been called the “100:1 penalty.” It hasbeen argued that this sentencing guideline is especiallydiscriminatory toward African Americans becauseapproximately 85% of individuals convicted of crackcocaine offenses are African American.

In summary, cultural differences are a relevantvariable in many aspects of psychoactive substanceuse. Cultural sanctions and prohibitions influenceprevalence rates of substance use and misuse andexplain differences in the rates of substance useamong ethnic minority groups. The responses of eth-nic minority group members to prevention and treat-ment programs is mediated by their cultural beliefsand values; positive and negative responses to pro-grams may be related to the extent the interventionprograms are congruent with culturally proscribedmeans of conceptualizing such problems. Finally,

culture influences drug control policy to the extent thatsuch policies reflect the formalization of the majorityculture’s views on legal and illicit substance use.

—Damon Mitchell—D. J. Angelone

See also Drug Abuse Prevention in Ethnic Minority Youth

FURTHER READING

Aponte, J. F., & Wohl, J. (Eds.). (2000). Psychological inter-vention and cultural diversity (2nd ed.). Boston: Allyn &Bacon.

Kazarian, S. S., & Evans, D. R. (Eds.). (1998). Culturalclinical psychology. New York: Oxford University Press.

Straussner, S. L., & Ekrenkranz, S. M. (Eds.). (2001).Ethnocultural factors in substance abuse treatment. NewYork: Guilford Press.

AMERICAN COUNSELINGASSOCIATION

In 1952, four independent associations convened ata joint convention to form the American Personneland Guidance Association. In 1983, this organizationchanged its name to the American Association ofCounseling and Development, and 10 years later short-ened its name to the American Counseling Association(ACA). Headquartered in Alexandria, Virginia, theACA sees its role as promoting public confidence inthe counseling profession. With members in the UnitedStates and 50 other countries, the ACA maintains a net-work of 56 branches and 18 divisions.

MISSION STATEMENT

The ACA’s brief mission statement underscores itscommitment to respecting human diversity: toenhance the quality of life in society by promoting thedevelopment of professional counselors, advancingthe counseling profession, and using the professionand practice of counseling to promote respect forhuman dignity and diversity.

CODE OF ETHICS

Consistent with its mission statement, The ACA’scode of ethics refers to the importance of respecting

American Counseling Association———41


human diversity in virtually every major section of thecode. Indeed, the preamble states that associationmembers recognize societal diversity and support theindividual’s rights and development.

Under the section of the code titled “The CounselingRelationship,” ACA members are expected to strive tounderstand the diverse cultural backgrounds of theclients with whom they work and to develop a clearunderstanding of how the counselor’s own cultural, eth-nic, and racial identity influences his or her values andbeliefs about the counseling process.

An emphasis on cultural competency extends toother areas of the ACA’s code of ethics. In the processof diagnosing their clients, for example, counselorsare expected to recognize cultural influences on thedefinition of clients’ problems and consider socioeco-nomic and cultural experiences before arriving atdiagnoses.

When it comes to testing, the ACA code warns thatcounselors should be cautious in administering testsamong culturally diverse populations, whose social-ized behavioral and cognitive patterns may fall out-side the range of the test’s applicability and validity.Furthermore, counselors are advised to observe cau-tion in interpreting the data of populations that differfrom the norm group on which the test was standard-ized and to remain forever cognizant of the possibleimpact of a range of factors (age, color, culture, etc.)on test administration and interpretation.

Counselor educators are also expected to introducematerial related to human diversity into all coursesand workshops that are designed to promote the devel-opment of professional counselors.

MULTICULTURAL COMPETENCIES

One of the 18 divisions of the ACA is the Associationfor Multicultural Counseling and Development(AMCD). Chartered in 1972, the AMCD was origi-nally called the Association of Non-White Concernsin Personnel and Guidance. The AMCD endeavorsto advance cultural, ethnic, and racial understandingto improve and maintain personal development.

In 1992, an article was simultaneously publishedin the Journal of Counseling and Development andthe AMCD’s Journal of Multicultural Counseling andDevelopment. The multicultural competencies that wereoutlined in that article have become part of the canonof the counseling literature. They are available fromthe ACA as three separate documents: “Cross-CulturalCompetencies and Objectives,” “Operationalization of

the Multicultural Counseling Competencies,” and“Dimensions of Personal Identity.”

—G. Scott Sparrow

See also Multicultural Counseling; Multicultural CounselingCompetencies

AMERICAN PSYCHOLOGICALASSOCIATION

The American Psychological Association (APA), head-quartered in Washington, D.C., is the largest scientificand professional organization representing psychologyin the United States and the world’s largest associationof psychologists. The APA’s membership includes morethan 150,000 researchers, educators, clinicians, consul-tants, and students. Through its divisions in 53 subfieldsof psychology and affiliations with 60 state, territorial,and Canadian provincial associations, the APA works toadvance psychology as a science, as a profession, andas a means of promoting health, education, and humanwelfare. The association’s annual convention, held in latesummer, is the world’s largest meeting of psychologists.

The APA members sit on association boards, com-mittees, and task forces and work with colleagues toshape policies for the association and to develop stan-dards regarding psychological research, practice,education, and the application of psychology andpsychological research to social issues.

The APA supports membership interests throughits central offices and four directorates—Practice,Science, Education, and Public Interest—as well asthrough its meetings, journals (the APA publishes46 journals), newsletters, books, e-products, continu-ing education programs, training, and accrediting activ-ities. Members also benefit from the APA’s federallegislative and regulatory advocacy and media rela-tions, as well as an ethics education program.

The Science Directorate is the focal point of theAPA’s efforts to enhance psychological science andexpand the recognition of its achievements. Thisdirectorate develops and manages programs servingAPA members involved in academe and research andconsolidates the APA’s science activities.

The Practice Directorate promotes the practiceof psychology and the availability and accessibilityof psychological services for health care consumersthrough its national public education campaign,advocacy and legislative efforts, and work with statepsychological associations.

42———American Psychological Association


The Public Interest Directorate promotes thescience and practice of psychology by contributing tothe improvement of the public’s health and well-being. It works to inform social policies based on psy-chology’s unique expertise in human behavior.

The Education Directorate works to advance theeducation and training of psychologists, the teachingof psychology, and the application of psychology toeducation and teaching.

Other functions of the association include theResearch Office, the Office of Public Affairs, and the pub-lication Monitor on Psychology. The primary mission ofthe Research Office is to collect, analyze, and disseminateinformation relevant to psychology’s labor force and edu-cational system. The Office of Public Affairs provides alink between the news media and the expertise of APAmembers. The Monitor on Psychology, the APA’s officialmonthly magazine, informs readers of the latest advancesin the field and the activities of the APA.

The APA is a nonprofit corporation chartered inWashington, D.C. In accordance with its bylaws andthe association rules, the APA is governed by a councilof representatives with elected representatives from itsdivisions and affiliated psychological associations. TheAPA’s central office is guided by a board of directorsand administered by a chief executive officer.

—Diane Willis

See also Committee/Office on Ethnic Minority Affairs,American Psychological Association; Council of NationalPsychological Associations for the Advancement of EthnicMinority Interests

FURTHER READING

American Psychological Association. (2003). Making APA workfor you: A guide for members. Washington, DC: Author.

AMERICANS WITHDISABILITIES ACT

The Americans With Disabilities Act (ADA) of 1990 isa civil rights act protecting persons with disabilitiesfrom discrimination. The ADA follows earlier civilrights legislation that provided similar protectionsagainst discrimination on the basis of race, gender, age,and national origin. The ADA is especially significantfor ethnic and racial minorities with disabilities, whoseexperience has been described as a “double whammy”of having to cope with reactions to both race anddisability.

The goal of the ADA is equal rights for personswith disabilities and their full inclusion and participa-tion in society. The ADA brings a civil rights approachto persons with disabilities and moves away fromseeing persons with disabilities as beneficiaries ofcharity.

The ADA specifically addresses employment dis-crimination, discriminatory access to local and stategovernments, public accommodations, access toestablishments such as restaurants and supermarkets,and telecommunications availability (primarily forpersons who are deaf and hard of hearing).

PRECURSORS OF THE ADA

The Architectural Barriers Act of 1968, which wasconcerned with access to federal and federally financedbuildings for persons with disabilities, and Sections 501,503, and 504 of the Rehabilitation Act Amendments of1973, which mandated programmatic access of personswith disabilities to organizations receiving federalfunds, were precursors of the ADA. The Education forAll Handicapped Children Act of 1975 entitled childrenwith disabilities to a free, appropriate education andreinforced inclusiveness by the U.S. government. Theneed for specific legislation protecting persons with dis-abilities from discrimination was bolstered by a reporttitled “Toward Independence,” issued by the NationalCouncil on Disability in 1986.

The ADA’s passage into law is significant because itinvolved many people working together to bring aboutchange. The final passage of the ADA occurred becausepeople with many different kinds of disabilities—frompeople who were blind to those with developmentaldisabilities, along with families and advocates—worked together in ways that were unprecedented inAmerican disability history.

DISABILITY DEFINED

The ADA defines persons with disabilities as personswho have a physical or mental impairment that sub-stantially limits one or more of their major life activi-ties; who have a record of such impairment; or whoare regarded as having such an impairment.

The ADA says that persons with disabilities maynot be discriminated against in employment on thebasis of their disability; however, they must be quali-fied for the job, with the requisite work, experience,education, and other requirements of the position, andmust, with or without reasonable accommodation, be

Americans With Disabilities Act———43


able to perform the essential functions of the position.At the same time, there is an inherent obligation ofemployers to remove barriers and to provide “reason-able accommodation.”

The ADA also extends the antidiscriminationmandate to local and state governments and to organi-zations in the public arena, such as banks, supermar-kets, retailers, and restaurants. Government andbusinesses must remove barriers that are “readilyachievable” and are not an “undue hardship” for them.

—Paul Leung

See also Disabilities; Racism and Discrimination

FURTHER READING

Americans With Disabilities Act of 1990, 42 U.S.C.A. § 12101et seq. Retrieved January 19, 2006, from http://www.usdoj.gov/crt/ada/pubs/ada.txt

Bruyere, S. M., & O’Keeffe, J. O. (1994). Implications ofthe Americans With Disabilities Act for psychology.Washington, DC: American Psychological Association.

Shapiro, J. P. (1993). No pity. New York: Random House.

ANTI-SEMITISM

Anti-Semitism refers to hostility toward Jews as a reli-gious, ethnic, or racial group that is manifested on anindividual, institutional, or societal level. This defini-tion highlights one of the major difficulties of defininganti-Semitism accurately—that is, Jews often confoundestablished notions of ethnic, racial, and religious iden-tity. Unfortunately, many people see Judaism only as areligion, and others see Jews as Caucasian; the latterdesignation is particularly problematic for Jews ofcolor. These categorizations are overly simplistic anddo not fully describe the diversity of Jews. For example,there are Jewish ethnic differences (i.e., Ashkenazim,Sephardim, and Mizrachim) and different Jewishmovements (i.e., Orthodox, Hasidic, Reform, Conser-vative, Reconstructionist, and Renewal). Hence, anti-Semitism is more than simple religious bias. It isimportant to note that many scholars no longer hyphen-ate the term anti-Semitism in order to cease the co-opting of this word for anything other than what it trulymeans: Jew hatred.

Anti-Semitism has been documented for more than2,000 years and comes in many forms, includingoppression, discrimination, segregation, pogroms, and

genocide. Scholars have outlined seven categoriesof anti-Semitism: (1) religious (e.g., Jews’ “refusal” toembrace Jesus); (2) social (e.g., limiting Jews’ occu-pational choices); (3) political (e.g., blaming Jews forcommunism); (4) economic (e.g., the myth that allJews are rich); (5) psychological (e.g., the majorityculture’s desire to assimilate Jews is projected ontoJews so that they are seen as wanting to take over theworld); (6) sexual (e.g., Jewish women are stereo-typed as being both teases and prudes simultane-ously); and (7) racial (e.g., Jews are seen asbiologically inferior).

Other examples of anti-Semitism include question-ing the Jewish identity of nonreligious Jews, violenceagainst Jews at the individual and community levels,denying the occurrence of the Holocaust, and bashingthe state of Israel.

Why does anti-Semitism persist? Three factorsappear to be responsible. The first and foremost isChristian anti-Semitism. With the creation and main-tenance of Christian state power, the deicide myth(i.e., the erroneous belief that the Jews killed Jesus),the blood libel myth (i.e., the belief that Jews killedChristian children for religious ceremonies), andthe New Testament’s depiction of Judaism (e.g.,Christianity superseding the Hebrew covenant withGod) became institutionalized. This made anti-Semitism a state- and church-sanctioned activity, last-ing for hundreds of years. In the United States, this ledto the creation of an invisible yet powerful anti-Semitic system that provides unearned privileges toChristians in a process parallel to the way racismbenefits Caucasians. This Christian dominance is justbeginning to be deconstructed.

Second, Jews historically served as a middle classwhom those in power used as an intermediarybetween the oppressed and the oppressors. As a state-less people, Jews were permitted to enter countries inexchange for serving those in power; simultaneously,a continuous low-level, unofficial campaign of anti-Jewish propaganda was kept alive among theoppressed majority. In times of threatened revoltamong the oppressed, violent, official anti-Jewishpropaganda emerged. Pogroms, massacres, and expul-sions were organized to turn the resentments of theoppressed majority, prepared to revolt against theoppressors, toward the Jews as scapegoats. This strat-egy has been used throughout the last 2,000 years,and scholars contend that Jews are difficult to catego-rize because this intermediary status has made them

44———Anti-Semitism


simultaneously part of both the dominant and subor-dinate groups.

The third factor is the invisibility of Jewish identity.The long history of oppression experienced by Jews,culminating in the Shoah (Holocaust), caused manyJews to hide or shed their Jewish identity in a desperateattempt to assimilate. Though many Caucasian Jewsused their privileged skin color to “pass,” the costswere severe (e.g., losing their Jewish culture). The suc-cess of Jewish American assimilation allowed anti-Semitism to persist because Jews became Caucasianand because their invisibility legitimized the denial ofanti-Semitism.

—Lewis Z. Schlosser

See also Racism and Discrimination

FURTHER READING

Feldman, S. M. (1997). Please don’t wish me a merryChristmas: A critical history of the separation of churchand state. New York: New York University Press.

Langman, P. F. (1999). Jewish issues in multiculturalism: Ahandbook for educators and clinicians. Northvale, NJ:Jason Aronson.

Schlosser, L. Z. (2003). Christian privilege: Breaking a sacredtaboo. Journal of Multicultural Counseling and Develop-ment, 31, 44–51.

ANXIETY DISORDERSIN ETHNIC MINORITIES

Of the major diagnostic groups of mental disorders,anxiety disorders have one of the highest—if not thehighest—reported prevalence rates in the UnitedStates. Anxiety is the most common mental disorderamong women and the second most common amongmen. This entry provides a brief overview of the cur-rent literature on anxiety disorders in racial and ethnicminority groups, particularly among the four principalracial and ethnic minority groups in the United States:African Americans, Asian Americans, HispanicAmericans, and American Indians/Alaska Natives.Although these descriptors are necessary for ease ofreading, it is critical to bear in mind the diversity withineach category. Racial and ethnic groups are multifac-eted rather than unidimensional, with many culturesexisting within each group. Furthermore, these distinc-tions are based on U.S. national boundaries, and

so they are somewhat arbitrary and do not entirelyportray the cross-national status of some indigenousHispanic and Native American groups. Given thescope of this entry, information concerning the assess-ment and treatment of anxiety disorders in ethnicminority groups is not included. Rather, attention isfocused on known, unique aspects of anxiety dis-orders in ethnic minorities, as well as specific culture-bound disorders.

UNIQUE SYMPTOM EXPRESSIONAMONG RACIAL AND ETHNIC GROUPS

The important role of culture in anxiety has been high-lighted by developments in emotion theory. What consti-tutes anxiety varies by culture, and cultural variablesmay affect the way an individual describes his or hersymptoms. For example, it may be more acceptable incertain cultures to express psychological distress throughphysical symptoms, such as a headache, as opposed to“feeling depressed.” For further information on the som-atization versus psychologization of descriptors for anx-iety and depression, including idioms of distress, readersare referred to Laurence Kirmayer’s review of differ-ences in anxiety symptomatology by culture.

Thoughts, feelings, and bodily experiences arenot necessarily seen as separate in many cultures.Therefore, in certain cultures, even serious anxietysymptomatology may not be brought to the attentionof a health care professional. Additionally, the culturalexpressions used to describe anxiety may overlap withtraditional descriptors of affective, somatoform, anddissociative disorders, further complicating the clini-cal presentation. As a result, anxiety disorders inethnic minorities may be misdiagnosed, perhaps moreoften than in the general population.

There are many examples of differences in thesymptom expression of anxiety across cultures. InHispanic cultures, for example, anxiety may presentitself as ataques de nervios, a condition that involvesattacks of anger, screaming, and other symptoms thatmay not be seen as panic or anxiety from other per-spectives. Steven Friedman noted that, for men in someSouth Asian cultures, anxiety may be communicatedas losing semen in urine. Qualitative ethnographicresearch has suggested that culture may affect the expe-rience and presentation of anxiety among AfricanAmericans in a unique way, as described by SuzanneHeurtin-Roberts and collaborators. For example,African Americans may express anxiety through

Anxiety Disorders in Ethnic Minorities———45


expressions such as “high-pertension,” “high blood,”“nerves,” and “falling out” rather than traditional psy-chological nomenclature, and they may report somaticsymptoms related to problems with their blood. In theirreview of ethnographic research, Heurtin-Roberts andcolleagues concluded that many African Americansdescribe anxiety primarily through somatic terms.

RISK FACTORS

Risk factors for developing anxiety include discrimi-nation and racism experienced both by the individualand vicariously through a legacy of historical trauma.Additional factors (noted by Gayle Iwamasa andShilpa Pai) that may influence the development ofanxiety and other psychological disorders are racialidentity, ethnic identity, and acculturation level. Thesethree culturally related aspects are unique to eachindividual; therefore, they may act as protective fac-tors or as risk factors in the development and possiblecontinuation of anxiety. Many ethnic minorities in theUnited States face increased social stressors whencompared with the Caucasian majority. For example,minorities are more likely to live in substandard hous-ing, be unemployed, and have no health insurance.For all ethnic minority groups, racism and poverty arerisk factors for psychopathology.

EPIDEMIOLOGY AND PREVALENCE

Although relatively few cross-cultural studies haveexamined the epidemiology of anxiety disorders,those conducted thus far have reported similar rates ofanxiety disorders across the world. Prevalence ratesof anxiety disorders across racial and ethnic groupswithin the United States, however, are inconsistent.The Epidemiologic Catchment Area (ECA) studies,conducted by the National Institute of Mental Healthfrom 1980 to 1985, determined the lifetime preva-lence of specific phobias and agoraphobia to be higherin African Americans than in Caucasians and HispanicAmericans at every level of education. Research hasalso indicated that rates of phobias, panic disorder,and sleep paralysis are higher in African Americansthan in the general population.

However, in a subsequent examination of anxietydisorder prevalence, the National Comorbidity Surveyof 1989, no racial differences were found in the preva-lence of any anxiety disorders. Furthermore, CharlotteBrown and collaborators found no differences in anxiety

disorder prevalence, symptoms, or impairment betweenAfrican American and Caucasian patients in a primarymedical setting. Taken together, the disagreement inprevalence rate findings for anxiety disorders acrossracial and ethnic groups is not surprising, consideringthe wide range of anxiety symptomatology. Therefore,future epidemiological research on anxiety within ethnicminorities is needed.

UNIQUE MANIFESTATIONSOF ANXIETY DISORDERS AMONGRACIAL AND ETHNIC GROUPS

Variations in the expression and experience of anxietysymptoms exist across ethnic and racial minoritygroups. One important caveat to consider is the hetero-geneity inherent within ethnic groups. For this reason,an idiographic approach is essential to understandinganxiety disorders. Aside from the culture-bound syn-dromes, there is an unfortunate dearth of informationon unique manifestations of the major anxiety disordersamong ethnic and racial minority groups. Currently, theAfrican American experience of anxiety has the mostliterature, particularly on panic disorder, although theamount of research is still largely inadequate.

African Americans

Information regarding the epidemiology of anxietydisorders in African Americans currently is availablefor panic disorder and obsessive-compulsive disorder.

Panic Disorder

Although research is limited, studies have sug-gested several factors that may influence the presenta-tion of panic disorder (PD) among African Americansand differentiate it from PD among Caucasians, par-ticularly hypertension and isolated sleep paralysis.Isolated sleep paralysis (ISP) is a condition thatoccurs while one is falling asleep or awakening; theperson cannot move and may experience hypnagogicor hypnopompic hallucinations, tachycardia, hyper-ventilation, and fear. Different from a nocturnal panicattack, ISP has been described by the phrase “thewitch is riding you.” In a study of Caucasian andAfrican American anxiety patients from clinical andcommunity samples, African Americans with PD hadby far the greatest incidence of recurrent ISP (59.6%),leading Steven Friedman and colleagues to conclude

46———Anxiety Disorders in Ethnic Minorities


that recurrent ISP may be a feature of PD that isunique to African Americans.

In an analysis of ECA data by Ewald Horwath andcollaborators, African Americans and Caucasians hadsimilar clinical features of panic disorder, althoughAfrican Americans reported more tingling in theextremities and “hot and cold flashes” during panicattacks. African Americans with panic disorderdescribed greater tingling and numbing of the extremi-ties during panic attacks, as well as stronger fears ofdying or going crazy, in studies by Steven Friedman andCheryl Paradis and by Lisa Smith and collaborators.

Finally, in work by these same investigators,greater rates of comorbid posttraumatic stress anddepression were noted among African Americans thanamong Caucasian panic disorder patients. Thesestudies also revealed that the two groups employeddifferent coping strategies; specifically, AfricanAmericans displayed less self-blame and used strate-gies involving religion, spirituality, and gratitude forone’s good fortunes more than Caucasians.

Obsessive-Compulsive Disorder

The inclusion of African Americans in clinicalresearch on obsessive-compulsive disorder (OCD) hasbeen vastly inadequate despite the suggestion in theECA data that the prevalence of OCD may be slightlyhigher in African Americans than in Caucasians.Current research has found little to distinguish theAfrican American experience of OCD from that ofother racial and ethnic groups. In a naturalistic treat-ment outcome study of African American, CaribbeanAmerican, and Caucasian OCD patients, StevenFriedman and colleagues found no differences in thetype of OCD symptoms displayed, symptom severity,or treatment outcome across the three ethnic groups.Furthermore, no differences in religious symptoma-tology were found. Interestingly, although symptomseverity was equivalent between Caucasians andAfrican Americans, African Americans were lesslikely to report obsessive-compulsive symptoms ini-tially and often revealed them only after the establish-ment of rapport. This hesitancy to disclose one’ssymptoms or distress may speak to the greater levelsof shame found in African American compared withCaucasian OCD sufferers, as reported by ElaineWilliams, Dianne Chambless, and Gail Steketee.

In case studies of African American women withOCD, Elaine Williams and colleagues described an

unusually high amount of shame and a sense of beingalone in the presentation of the disorder comparedwith Caucasian patients. Additional clinical issues forAfrican American women with OCD included fears ofgoing crazy (i.e., fear that their obsessions and compul-sions indicated that they had “lost their mind”) and,typical of OCD cases, obsessions that were influencedby their cultural belief systems. Specifically, one obses-sion involved a fear of being cast under a spell if theclient touched a spot previously touched by another,which she explained could “put the root” on her. Theauthors noted the normalcy of a belief in root magic insome cultural groups, including those with Caribbeanbackgrounds. As noted by Peter Guarnaccia, cliniciansshould be cautioned against misdiagnosing patients’concerns about “root work,” harmful magic, or super-natural forces as indicative of psychosis rather thananxiety.

Asian Americans

The Asian American population comprises anumber of ethnic groups, including Asian Indians,Cambodians, Chinese, Filipinos, Japanese, Koreans,and Vietnamese, among others. Like other racial andethnic groups, the extensive heterogeneity within thispopulation proscribes broad assumptions concerningthe cultural expressions of anxiety that are unique toAsian Americans. Research has indicated, however, ahigher prevalence of certain anxiety disorders withinsubpopulations of Asian Americans. In particular,refugees of Southeast Asia are at increased risk forposttraumatic stress disorder (PTSD). This finding isconsistent with the experience of brutal environmentalstrains such as habitation in refugee camps, combat,and torture. In addition, Asian American collegestudents reported higher levels of social anxiety rela-tive to Caucasians.

According to Derald Sue and David Sue, AsianAmericans often express emotional and psychologicalstress through physical complaints, which are moreculturally accepted. This tendency to communicateanxiety through somatic complaints was echoed byDosheen Toarmino and Chi-Ah Chun in their guide-lines for counseling Korean Americans; specifically,they noted that complaints about appetite, sleep dis-turbances, fatigue, headache, and restlessness oftenare expressed rather than descriptors such as “anxi-ety” or “depression.” Sue and Sue noted that thisemphasis on somatic complaints may result from a



belief that emotional distress is caused by physicalailments and that it will cease upon proper medicaltreatment for the physical problem.

Hispanic Americans

In recent years, the Hispanic population in theUnited States has seen rapid growth and diversifica-tion, including individuals from Mexico, Puerto Rico,Cuba, and other Central and South American coun-tries. Like other minority groups, Hispanic Americansoften underutilize mental health care services for avariety of reasons, such as poor financial circum-stances or preferences for family support. Althoughthere is an unfortunate paucity of information con-cerning the experience of the major anxiety disordersamong Hispanic Americans, information is availableon unique idioms of distress that may be used todescribe anxiety (e.g., ataques de nervios) and culture-bound syndromes (e.g., nervios). Peter Guarnacciaand others have suggested that culturally relatedanxiety disorders among Hispanic Americans, such asataques de nervios, may be a culturally shaped responseto extreme stress because they often elicit family orother social support and usually occur at family con-flicts, funerals, or accidents.

One culture-bound syndrome among HispanicAmericans, susto, may be an expression of PTSD oracute stress disorder. Resulting from a distressing orfrightening event, susto may involve complaints ofsadness, troubled eating or sleeping, and reduced esti-mation of self-worth, as well as various physical ail-ments, such as stomachaches. Certain symptoms ofsusto, such as disturbing dreams, are consistent with thePTSD criterion related to the reexperiencing of a trau-matic event. Although susto may also indicate depres-sive or somatoform disorders, its resemblance to PTSDand acute stress disorder merit its consideration as ananxiety disorder.

American Indians and Alaska Natives

Although psychological disorders such as depres-sion and substance abuse are believed to be morecommon among American Indians and Alaska Natives,problems with anxiety are increasingly being recog-nized among these groups. There are also culturallyspecific anxieties and anxiety disorders that appearto uniquely affect Native Americans. As indigenous

peoples of North America, American Indians andAlaska Natives have endured hundreds of years ofonslaught by other dominating cultural groups. Thecultural stressors involved in this forced acculturationare numerous and include the loss of ancestral landsand forcible relocation to inhospitable or culturallyforeign areas, systematic attempts to eliminate reli-gion and language, imposed outside governance,treaty violations, mandated education in boardingschools, exposure to non-Native diseases and prac-tices with disastrous health consequences, and evengenocide.

Given these historical and contemporary stressors,it is not surprising that many American Indians andAlaska Natives experience culturally specific anxi-eties. Such anxieties, spanning social involvementwith Native Americans and cultural knowledge, eco-nomic issues, and social involvement with the major-ity culture, have been identified by Daniel McNeil andcolleagues using the Native American CulturalInvolvement and Detachment Anxiety Questionnaire.Consistent with this idea of unique historically andenvironmentally based influences on the anxiety ofAmerican Indians and Alaska Natives, J. DouglasMcDonald, Thomas Jackson, and Arthur McDonaldhave suggested that Native American college studentswho leave home to pursue their education may expe-rience greater generalized anxiety than both their non-Native counterparts and reservation-based NativeAmerican students who stay near home at a reserva-tion-based college. In addition to such culturally spe-cific anxieties, other disorders that are culturallybound (e.g., kayak angst) or culturally related (e.g.,intergenerational PTSD) may affect the indigenouspeoples of North America.

CULTURALLY SPECIFICANXIETY DISORDERS

The following disorders, listed alphabetically, areunique to various cultural groups. Many of them aredescribed in greater detail in other entries in thisvolume. This list is not exhaustive. Furthermore,although culturally specific disorders with a stronganxiety component are included, the majority of thesyndromes described here do not map exactly onto thediagnostic categories of the Diagnostic and StatisticalManual of Mental Disorders, 4th edition (DSM-IV-TR). Presentations may resemble adjustment,



depressive, dissociative, somatic, or psychotic disorders.Many, but not all, of the disorders described here areincluded in the glossary of culture-bound disorders inthe DSM-IV-TR.

Ataque de Nervios (Hispanic Americans)

Ataque de nervios (attack of nerves) is describedin the DSM-IV-TR as an expression most closelyrelated to panic attacks and commonly recognizedamong Latin American and Latin Mediterraneangroups. Common symptoms include shaking, palpita-tions, numbness, and a sense of heat rising to the head.Peter Guarnaccia noted “screaming uncontrollably”as the most common symptom reported, followed by“attacks of crying.”

Brain Fag (African Americans)

Brain fag is a phrase indicating fatigue or exhaus-tion from intense thinking in many cultures. Difficultythinking and concentrating is a common symptom,and somatic complaints have also been reported.Brain fag syndrome is most prevalent in rural areas; itmay be a form of anxiety or depression disparate fromtraditional North American psychological terms.

Dhat (Asian Americans)

Syndromes with presentations similar to dhatinclude jiryan in India, sukra prameha in Sri Lanka,and shen-k’uei in China. Inherent in these cultures isan ancient belief that a man’s vital energy resides inhis semen. Dhat refers to feelings of extreme anxietyrelated to a supposed discharge of semen, usuallythought to be passed through the urine, and an accom-panying whitish discoloration of the urine. Numeroussomatic symptoms often accompany the complaint ofsemen loss; weakness and exhaustion are commonlyassociated with dhat.

Frigophobia (Asian Americans)

Frigophobia, also known as pa-leng and wei hanzheng, is a condition characterized by a severe fear ofcold and winds, which are believed to cause fatigue,impotence, or death. Frigophobia, a disorder that is well-known in Chinese mental health practice, often involvessomatic complaints (e.g., headaches, numbness) and

avoidance behaviors related to cold (e.g., compulsivewearing of heavy clothing, even in warm temperatures).

Intergenerational PosttraumaticStress Disorder (Many Racialand Ethnic Minority Groups)

Posttraumatic stress disorder is an anxiety disorderthat has unique considerations for ethnic minoritymembers because of potential cumulative traumaand the possible transmission of traumatic events toindividuals of subsequent generations. For example,work by Sandra Choney and colleagues has sug-gested that intergenerational PTSD may occur inNative Americans in response to historical trauma.Robert Robin and collaborators described the impactof community trauma on the psychological health ofAmerican Indian individuals, a consideration that isconsistent with the collectivist, extended-family ori-entation and oral traditions within American Indianand Alaska Native cultures. Therefore, the develop-ment and presentation of PTSD in Native Americanindividuals may involve additional clinical considera-tions. Similar ethnocultural historical effects may berisk factors for PTSD for a variety of racial and ethnicgroups. For a comprehensive reference concerningPTSD among African Americans, American Indians,Asian Americans, and Hispanic Americans, the workof Anthony Marsella and colleagues is recommended.

Hwa-byung (Asian Americans)

Hwa-byung, or wool-hwa-byung, refers to “angersyndrome” in Korean folk culture. Presenting symp-toms include panic, fear of imminent death, fatigue,and insomnia, as well as somatic symptoms of indi-gestion, anorexia, general aches, and feeling a lump inthe front of the abdomen.

Kayak Angst (Native Americans)

Kayak angst, a condition that has been historicallyidentified among the Inuit of Greenland, bears a strik-ing resemblance to panic disorder. Kayak angst hasbeen described as a discrete condition of severe anxi-ety that overcomes seal hunters while fishing inone-man boats. A loss of direction, helpless feelings,and psychophysiological responsivity are characteris-tic. An intense fear of drowning that decreases by



returning to land or by the presence of other huntershas also been reported. Kayak angst shares many fea-tures of panic disorder, including unexpected onsetand subsequent avoidance behavior (e.g., avoidingfuture hunting opportunities).

Koro (Asian Americans)

Koro, a diagnosis included in the Chinese Classifi-cation of Mental Disorders, is a syndrome known inSoutheast Asia. Koro manifests as extreme anxietythat one’s genitals will retract into the body, perhapsresulting in death, or that one’s genitals have beenstolen. Reports of koro have ranged from single casesto epidemics. Koro also is similar to shen-k’uei, oranxiety relating to a perceived loss of semen.

Nervios (Hispanic Americans)

Nervios is a frequently described expression ofdistress among Hispanic Americans. Nervios rangesfrom a small subset of symptoms to presentationsresembling full disorders, and it includes broad cate-gories of somatic symptoms, difficulty functioning, andemotional distress. Headaches, stomach problems,sleep disturbances, feelings of nervousness, dizziness,tearfulness, trembling, and tingling sensations are com-monly reported symptoms.

Taijin-Kyofu-Sho (Japanese Americans)

Taijin-kyofu-sho, or taijin kyofusho, is often seen asa Japanese form of social phobia. Rather than intensefear of embarrassment or negative evaluation, as in theWestern conceptualization of social anxiety disorder,this syndrome is characterized by anxiety resultingfrom a fear of offending others through one’s body,appearance, odor, or movements.

CONCLUSIONS

Anxiety disorders are some of the most common psy-chological difficulties. As the population of the UnitedStates becomes increasingly more diverse, there is needfor a greater understanding of anxiety disorders withinethnic and racial minority groups. Because one’sexpression and manifestation of anxiety may varydepending on one’s cultural background, it is importantfor clinicians to understand each patient’s conceptual-ization of his or her symptoms. In this vein, the ways in

which anxiety is communicated by ethnic and racialminority clients may vary according to the culturalacceptability of psychological descriptors of distress andthe ways in which emotional states are described withinthe client’s culture. An understanding of this culturalcomplexity is a step toward removing semantic and otherbarriers to valid assessment and treatment.

Despite the high prevalence of anxiety disorders inthe population, limited epidemiological data are avail-able for racial and ethnic minorities. Therefore, moresystematic research is needed to identify idioms of dis-tress and anxiety symptomatology that may characterizethe experience of anxiety for different cultural groups.Recognition of the significant overlap of anxiety disor-ders with other clinical syndromes—particularly affec-tive, somatoform, and dissociative disorders—is critical.Finally, guidelines for clinicians in regard to anxiety andits relationship to culture are required to move toward anunderstanding of anxiety across ethnic and racial groups.

—Rebecca K. Widoe—Renata K. Martins—Daniel W. McNeil

See also Cross-Cultural Psychology; Culture-Bound Syn-dromes: Ataque de Nervios; Culture-Bound Syndromes:Brain Fag; Culture-Bound Syndromes: Dhat; Culture-BoundSyndromes: Hwa-byung; Culture-Bound Syndromes: Koro;Culture-Bound Syndromes: Nervios; Culture-BoundSyndromes:TaijinKyofusho;PosttraumaticStress Disorder

FURTHER READING

Brown, C. B., Shear, M. K., Schulberg, H. C., & Madonia, M. J.(1999). Anxiety disorders among African-American andWhite primary medical care patients. Psychiatric Services,50, 407–409.

Choney, S. K., Berryhill-Paapke, E., & Robbins, R. R. (1995).The acculturation of American Indians: Developing frame-works for research and practice. In J. G. Ponterotto, J. M.Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbookof multicultural counseling (pp. 73–92). Thousand Oaks,CA: Sage.

Friedman, S. (Ed.). (1994). Anxiety disorders in AfricanAmericans. New York: Springer.

Friedman, S. (Ed.). (1997). Cultural issues in the treatment ofanxiety. New York: Guilford Press.

Friedman, S., & Paradis, C. (2002). Panic disorder in African-Americans: Symptomatology and isolated sleep paralysis.Culture, Medicine and Psychiatry, 26, 179–198.

Friedman, S., Smith, L. C., Halpern, B., Levine, C., Paradis,C., Viswanathan, R., Trappler, B., & Ackerman, R. (2003).Obsessive-compulsive disorder in a multi-ethnic urban



outpatient clinic: Initial presentation and treatmentoutcome with exposure and ritual prevention. BehaviorTherapy, 34, 397–410.

Guarnaccia, P. J. (1997). A cross-cultural perspective on anxi-ety disorders. In S. Friedman (Ed.), Cultural issues in thetreatment of anxiety (pp. 3–20). New York: Guilford Press.

Guarnaccia, P. J., Rubio-Stipec, M., & Canino, G. J. (1989).Ataques de nervios in the Puerto Rican DiagnosticInterview Schedule: The impact of cultural categorieson psychiatric epidemiology. Culture, Medicine andPsychiatry, 13, 275–295.

Heurtin-Roberts, S., Snowden, L., & Miller, L. (1997).Expressions of anxiety in African Americans: Ethnographyand the Epidemiological Catchment Area studies. Culture,Medicine and Psychiatry, 21, 337–363.

Horwath, E., Johnson, J., & Hornig, C. D. (1993).Epidemiology of panic disorder in African-Americans.American Journal of Psychiatry, 150, 465–468.

Iwamasa, G. Y., & Pai, S. M. (2003). Anxiety disorders amongethnic minority groups. In G. Bernal, J. E. Trimble, A. K.Burlew, & F. T. L. Leong (Eds.), Handbook of racial andethnic minority psychology (pp. 429–447). Thousand Oaks,CA: Sage.

Kirmayer, L. J. (2001). Cultural variations in the clinical pre-sentation of depression and anxiety: Implications for diag-nosis and treatment. Journal of Clinical Psychiatry,62(Suppl. 13), 22–28.

Marsella, A. J., Friedman, M. J., Gerrity, E. T., & Scurfield, R. M.(Eds.). (1996). Ethnocultural aspects of posttraumaticstress disorder. Washington, DC: American PsychologicalAssociation.

McDonald, J. D., Jackson, T. L., & McDonald, A. L. (1991).Perceived anxiety differences among reservation and non-reservation Native American and majority culture students.Journal of Indigenous Studies, 2, 71–79.

McNeil, D. W., Porter, C. A., Zvolensky, M. J., Chaney, J. M.,& Kee, M. (2000). Assessment of culturally related anxietyin American Indians and Alaska Natives. BehaviorTherapy, 31, 301–325.

Robin, R. W., Chester, B., & Goldman, D. (1996). Cumulativetrauma and PTSD in American Indian communities. InA. J. Marsella, M. J. Friedman, E. T. Gerrity, & R. M.Scurfield (Eds.), Ethnocultural aspects of posttraumaticstress disorder (pp. 239–253). Washington, DC: AmericanPsychological Association.

Smith, L. C., Friedman, S., & Nevid, J. (1999). Clinical andsociocultural differences inAfricanAmerican and EuropeanAmerican patients with panic disorder and agoraphobia.Journal of Nervous and Mental Disease, 187, 549–560.

Sue, D. W., & Sue, D. (2003). Counseling the culturallydiverse: Theory and practice (4th ed.). New York: Wiley.

Toarmino, D., & Chun, C. A. (1997). The issues and strategiesin counseling for Korean Americans. In C. C. Lee (Ed.),Multicultural issues in counseling: New approaches todiversity (pp. 368–394). Alexandria, VA: AmericanCounseling Association.

Williams, K. E., Chambless, D. L., & Steketee, G. (1998).Behavioral treatment of obsessive-compulsive disorder inAfrican Americans: Clinical issues. Journal of BehaviorTherapy and Experimental Psychiatry, 29, 163–170.

ASIAN AMERICANPSYCHOLOGICAL ASSOCIATION

The Asian American Psychological Association(AAPA) was founded in 1972 as a group effort spear-headed by a small but dedicated and influential hand-ful of Asian American psychologists such as DeraldSue, Stanley Sue, Roger Lum, Marion Tin Loy, ReikoTrue, and Tina Yong Yee. What began as informalmeetings to stay connected and offer an exchange ofinformation and support among this select group inthe San Francisco Bay Area has become a major eth-nic minority psychological association with more than400 members. The growth of the AAPA as an influen-tial force within psychology reflects the growingneeds and demands of the Asian American population,which is currently the fastest growing ethnic minoritygroup in the United States.

Since its inception in the 1970s, the AAPA hasgrown and struggled to overcome many barriers tobecome a highly visible organization with manyobjectives, the focus of which are the mental and psy-chosocial health issues of Asian Americans. Some ofthese goals include advocating for Asian Americansand promoting Asian American psychology in theform of research, policies, and practices. Other keyobjectives of the organization include the training andeducation of Asian American mental health profes-sionals. Important AAPA initiatives have includedlobbying the U.S. Census Bureau to recognize andinclude Asian American subgroups in census data,presenting state-of-the-art information on AsianAmericans to various presidential commissions andsurgeon general’s reports, and promoting AsianAmerican perspectives within organized psychology.

Many journals, books, and newsletters focus onAsian American psychology and advocacy of servicedelivery to this population. From Stanley Sue’s pioneer-ing Mental Health of Asian Americans to the landmarkHandbook of Asian American Psychology, each of theseworks have helped to lay the groundwork for develop-ment of the field of Asian American psychology.

Asian American Psychological Association———51


The AAPA operates through an elected executivecommittee that serves a two-year term and consists of aboard of directors, which includes a president, vice pres-ident, past president, membership and financial affairsofficer, secretary/historian, and four board members. Asthe AAPA began to form an established identity, it beganto publish an official newsletter, the Asian AmericanPsychologist, which eventually evolved into a journal.Currently, the AAPA has returned to the newsletter for-mat, which is published on a regular basis, three timesannually. It consists of topics revolving around AAPAnews, events, advertisements, accomplishments, andissues pertaining to Asian American psychology.

The AAPA holds a national annual convention theday before the American Psychological Associationconvention. The national convention features programsrelatedtoAsianAmericanpsychology, training,research,policies, and education. The convention is designed tooptimize interactions between the presenters and theparticipants so that levels of intimacy, learning, men-toring, and comradeship are established. The AAPAalso maintains a Web site (www.aapaonline.org) and anactive Listserv for discussion. The current executivecommittee of the AAPA has initiated a Digital HistoryProject for the association, and soon, digital copies ofthe historical record will be available on its Web site.

The future of the AAPA seems clear: to continue itsefforts to promote the well-being of Asian Americansthrough training, research, and service and to serve asthe primary professional organization for AsianAmerican psychologists.

—Frederick T. L. Leong—Arpana Gupta

See also Asian/Pacific Islanders

FURTHER READING

Leong, F. T. L. (1995). History of Asian American psychology(Asian American Psychological Association MonographSeries, Vol. 1). Phoenix, AZ: Asian American Psycho-logical Association.

Leong, F. T. L., Inman, A., Elares, A., Yang, L., Kinoshita, L.,& Fu, M (Eds.). (2006). Handbook of Asian AmericanPsychology (2nd ed.).

ASIAN/PACIFIC ISLANDERS

Estimates suggest that, at the present time, just over60% of the global population resides on the continent

of Asia; however, this is an underestimate of theglobal population of Asian and Pacific Islanders (API)because numerous API reside outside Asia. In theUnited States alone, Asian and Pacific IslanderAmericans (APIA) represent one of the fastest-growingminority populations. Nonetheless, they remainoverwhelmingly underrepresented in psychologicalresearch.

ASIAN AND PACIFIC ISLANDERAMERICANS IN THE UNITED STATES

The Chinese were among the first API immigrantsto the United States. The increasing rate of Chineseimmigration, initially fueled by the gold rush, wasrapidly stifled with the passage of the ChineseExclusion Act of 1882. As the number of immigrantsfrom other API nations (e.g., Japan, Korea, and India)began to steadily increase, a number of parallel leg-islative acts were passed during the early 1900s torestrict their immigration as well. As a result, APIimmigration slowed to a trickle until the enactment ofthe 1965 Immigration Act, which eased restrictionon immigration from API nations, catalyzing a resur-gence of API immigration. Although the majority ofAPIA arrived after 1965, there are substantial num-bers of APIA refugees and American-born APIA.

Current data suggest that there are more than12.5 million APIA residing in the United States, rep-resenting nearly 4.5% of the nation’s population. Themajority of APIA have taken residence in the westernUnited States (51%), and the remainder are spreadthroughout the South and Northeast (19% each), aswell as the Midwest (12%). It is estimated that thereare approximately 43 different ethnicities representedby API in the United States, displaying a tremendousdiversity in terms of language, culture, religion, levelof education, and socioeconomic status.

ISSUES IN THE RESEARCH CONCERNINGASIAN AND PACIFIC ISLANDER AMERICANS

Although significant advances have been made withinthe last 20 years in regard to ethnic minority research,research within the field of psychology using APIAparticipants remains sparse, and the literature that doesexist is often inconclusive. There have been numerousattempts to illuminate the reasons for the paucity ofresearch, as well as the inconsistencies within the exist-ing literature, involving this group of people.

52———Asian/Pacific Islanders


Some researchers argue that the discriminatory andexclusionary tactics aimed at APIA tend to be greaterthan those directed at other ethnic minority groups.These biases are believed to stem from the fact thatAPI decided to immigrate to the United States, unlikeother minorities, who had little choice. Thus, the sen-timent suggests that APIA do not deserve to be stud-ied until other groups have been given their dueattention. Although some may consider this a ratherextreme point of view, it should not be too quickly dis-missed, regarded as an extremist position, or viewedas an impossibility. It is quite possible that at somelevel, these erroneous beliefs have the power to influ-ence or even tarnish one’s view of various ethnicgroups, hence reducing interest in the conduction ofresearch on those groups.

Additionally, many researchers have suggested thatcommon (mis)perceptions of APIA as professionallyand financially successful may lead to a lack of interestin research on this population. Such perceptions maycontribute to a mistaken belief that these enhancedfinancial resources are accompanied by superior psy-chological resources, thus better equipping these indi-viduals to combat the stresses typically associated withimmigration and acculturation. Such unsubstantiatedthinking may lead to the unfounded belief that APIA,because of their financial success, simply do not sufferfrom psychological distress, or if they do, they are inpossession of superior coping resources that allow themto better deal with distress. Thus, their status as “worth-while” and “important” subjects for research is furthermade subordinate.

One reason the research on APIA is so inconclu-sive may stem from the astonishing diversity of thepeople suggested for inclusion in this broadly definedgroup. The APIA represent one of the most diverseethnic groups in the United States. However, the termAsian is ill defined and often leads to mis-understanding and ambiguity.

The definition of APIA currently used by the U.S.Census Bureau, though comprehensive, is not withoutits own complexities. Although it identifies severalsubcontinents and provides examples of the identifiedgroups therein, its seeming “broad stroke” groupingof these minorities creates room for perceptions ofcultural homogeneity among the distinct groups.

Within recent decades, social etiquette and politi-cal correctness have encouraged the discontinuationof the use of the term Oriental. Previously, this termwas used primarily to describe individuals of East

Asian descent, for example, those of Cambodian,Chinese, Japanese, Philippine, or Vietnamese back-ground. However, when the term Oriental wasdeemed no longer appropriate for use in reference toindividuals, it was replaced by the much broader andmore nebulous term Asian. Thus, all the people of thevast Asian continent were grouped together under oneumbrella term. No attention was given or attemptmade to distinguish the vastly heterogeneous peoplesof this immense continent. There are undoubtedlynumerous significant differences among the cultures,customs, and fundamental beliefs of individuals orig-inating from the different regions of Asia and thePacific Islands, yet they are often treated as one group.Thus, the preponderance of research using “Asian”participants lacks a truly representative sample ofAPIA participants. Omissions in the literature becomeapparent as the Chinese and Japanese appear to be thepredominantly addressed cultures.

This leads back to the question of defining the APIpopulation, both globally and within the United States.The importance of differentiating various API popula-tions, such as South Asians from East Asians fromPacific Islanders, appears to stem naturally from thebasic principles of scientific methodology and repre-sentative sampling. Psychological research has longbeen criticized for its overwhelming lack of samplingdiversity and representativeness. The majority of ourcurrent psychological principles and theories are biasedby research conducted primarily on middle-aged,Caucasian males or undergraduate psychology students.Such concerns have been echoed by a number ofresearchers within the psychological community.

The field of psychology, in its relentless pursuitof internal validity, has neglected the importance ofexternal validity. It appears that this neglect has servedas a fault in a good deal of the current literature. Thebalance between external and internal validity is adifficult matter for virtually all psychological research.Additionally, the lack of operational definitions toidentify various groups has proven to be a disconcert-ing conundrum. At what point do we consider apeople “a group” necessitating differentiation and sep-aration as its own population? Many suggest that such aquestion opens up a never-ending Pandora’s box. Infact, it appears that there is no definitive point atwhich a particular group of people is identified as aunique people, “deserving” of distinction and individ-uation from other groups. Such distinctions are poten-tially quite subjective, but they must be arrived at,

Asian/Pacific Islanders———53


operationally defined, and employed by the communityof researchers in a way that is relevant to the researchquestion under investigation and that allows theresearch to be more consistent and comparable acrossstudies.

PSYCHOLOGICAL DISTRESS

Psychological distress is an expansive term thatencompasses factors such as depression, anxiety, andother conditions. As our world continues to grow intoa more unified and global community, constructs suchas depression and anxiety require reevaluation andrevision. Such constructs, as they currently exist, havebeen defined within a context of limited cultural andcontextual variability. Cross-cultural variations in themanifestation of symptomatology associated withpsychological disorders may render our current diag-nostic and classificatory systems inadequate and inac-curate as we begin to consider such constructs in across-cultural context.

Numerous authors have commented on the role ofculture in psychological illness, stressing the concernsof culturally specific perceptions of illness and theconsequential responses. Thus, it may be posited thatcultural context affects the ways in which biologicalchanges within the body as well as psychological phe-nomena are manifested. An individual’s manifestationof psychological distress is thus undoubtedly affectedby his or her given culture’s expectations, taboos, andbeliefs regarding etiology.

It has been suggested that cultural influence onsymptom manifestation affects the account of illnessprovided to the clinician. In other words, a constructsuch as depression may exist cross-culturally, yet itsmanifestations may vary in accordance with culturalvariations and differences. Such disparity in the man-ifestations of psychological symptomatology maylead to difficulty in precise diagnoses. This may fur-ther result in the prescription of inappropriate, unsuit-able, and thus ineffective treatments.

PSYCHOLOGICAL DISTRESS INASIAN AND PACIFIC ISLANDERAMERICAN POPULATIONS

A great deal of research has been conducted on dis-tress manifestation in APIA populations; however, thefindings have been equivocal. Some studies indicatea lower manifestation of depressive symptoms than in

Caucasian Americans, whereas others studies indicateno such trend. A few of these studies have gone so faras to hypothesize that many of the symptoms associ-ated with depression—as it is currently conceptual-ized by the majority of the Western world—are rareand perhaps even nonexistent for individuals withbackgrounds that are not rooted in Western societies.A number of factors may be implicated in the dis-parate findings within the literature. Given the arrayof distinct cultures that fall under the APIA umbrella,the confounding of classification may lead to erro-neous results. Also, the measures used in the collec-tion of data may not be appropriately normed orstandardized for use within the various populations,effectively making the results uninterpretable orinvalid. The age range of the participants may alsoplay a role as an additional confound, as there is rea-sonable evidence suggesting that an individual’s agemay vary symptom presentation and manifestation.

Although it is important to bear in mind that theseconfounds have been obstacles to research on minori-ties in general, there are other factors that one mustconsider when attempting to integrate the contrastingresearch findings concerning APIA in particular.

From the lay perspective, many APIA are oftenreferred to and viewed as the “model minority,” based onperceptions and stereotypes of APIA as educationally,professionally, and financially successful. Therefore, onemight then be tempted to explain research findings withhypotheses that are influenced by these stereotypicalbeliefs. For example, one might suggest that studiesreporting elevated levels of symptomatology stem fromthe use of inappropriate assessment devices that have ledto inaccurate and unsubstantiated elevations, or thatobserved elevations are the result of variations in culture.Another example is that studies suggesting lower levelsof depression may be viewed as indicating a lack ofdepressive symptomatology in APIA populations andthus greater psychological adjustment and superior cop-ing faculties. These hypotheses, which are potentiallyinfluenced by stereotypical beliefs regarding this popula-tion, are made to be consistent with popular belief.

FACTORS THAT SUGGESTINCREASED PSYCHOLOGICALDISTRESS IN ASIAN AND PACIFICISLANDER AMERICAN POPULATIONS

In contrast to the mixed results of the APIA studies ondepression, consistent results have been observed



when one considers the concept of psychologicaldistress from a much broader, and consequently moreill-defined, perspective. There are many indicationsthat Asian Americans experience as much, if notmore, emotional difficulty and psychological distressas Caucasians. The level of stress is attributed toincreased experience of psychological stressors thatare directly related to acculturative stress or to diffi-culties associated with the process of immigration.For example, immigrants are often faced with a vari-ety of changes related to climate, the nature of theirresidence, and the characteristics of the community inwhich they reside. They also face changes in diet, per-haps because of the unavailability of foods and ingre-dients to which they are accustomed, and dangersassociated with exposure to new and different dis-eases, which their immune systems may not be usedto. Social changes also abound: Immigrants are oftenfaced with the trauma of separation from family andfriends, which is compounded by the lack of a socialsupport system in their new environment. Finally—though quite significantly—changes associated withthe general attitudes, values, and religious beliefs ofthe culture in which immigrants now find themselvesmay contribute to acculturative stress as well.

Immigrants face these challenges on a daily basis.They are continually inundated with aspects of theirnew culture, and although this process places pressureon both the immigrant and the host culture, the immi-grant bears the brunt of the pressure to accommodate.Given these challenges and in light of the ingrainedroles and values immigrants often arrive with, accul-turation is often experienced as a difficult and at timesa painful process. Some studies have proposed corre-lates associated with APIA immigrants’ experienceof acculturative stress. Some general trends in thisresearch suggest that women exhibit greater accultur-ative stress than men and that immigrants who havechosen to migrate and plan to remain permanentlyexpress more positive attitudes about their new hostculture and exhibit better overall mental health.

Furthermore, it has been suggested that APIA areseen as lacking a distinct position among the peopleand immigrants in the United States; they are oftenviewed simply as the “other” group, not quite fittingwithin other U.S. minorities. Many people of otherethnicities who have immigrated have a historical rolethat, to some extent, defines their place as an immi-grant group. European Americans may be conceptual-ized as the conquerors from a historical perspective.

African Americans are perceived as being anoppressed people, having been brought to this conti-nent under the chains of slavery, against their will.Latino Americans are viewed as the original inhabi-tants of this land or as a colonized people. Among thislandscape of immigrants, APIA may be perceived aslacking a distinctive role in relation to other peoplewho are here. This may adversely affect APIA ethnicidentity formation during the process of acculturation,leading to even greater experience of psychologicaldistress.

MANIFESTATION OFPSYCHOLOGICAL DISTRESS

One significant issue when studying ethnic minoritiesis that studies may use measures that do not focus onrelevant manifestations of psychological distress in agiven minority population. For example, a measure thatassesses the social and emotional components ofdepression would be insensitive and inappropriate if aparticular ethnic group manifests depression in a moresomatic manner. Thus, attempting to assess depressionwith an inappropriate or insensitive device may lead tooverlooked diagnoses. Conversely, the use of an inap-propriate assessment device may lead to superfluousdiagnosis or an overestimation of the severity of a dis-order. For example, consistent elevations were found inMinnesota Multiphasic Personality Inventory scores onScale 2 (Depression) and Scale 8 (Schizophrenia) in asample of Hong Kong students. Such observationscould lead one to believe that individuals from thispopulation suffer from elevated levels of depression- andschizophrenia-related symptomatology. Furthermore,what is considered to be withdrawn behavior—andthus viewed as disturbed behavior among CaucasianAmericans—may be the norm for Hong Kong Chinese.Similar problems with profile elevations have beenobserved in a variety of other ethnic minority groups.

It is difficult to make a global statement about themental well-being of the APIA population because ofthe heterogeneity of the group. Although somatizationhas been indicated in groups such as South and EastAsians, there is little evidence to suggest a similartrend within the Pacific Islander groups. Additionaldistinctions may be noted in the culture-specific dis-orders through which psychological distress is mani-fested. The Japanese, for example, conceptualize adisorder called taijin kyofusho as a multityped syn-drome that encompasses some aspects of the Western

Asian/Pacific Islanders———55


personality, delusional, body dysmorphic, and anxietydisorders. The Korean hwa-byung, which may begrossly identified as a mixture of anxiety and depres-sion, has distinct features (e.g., pain in the epigas-trium) that are not found in depressive manifestationsof other cultures. And koro and dhat, anxiety expressedthrough concern for genital function, are distinctlyAsian Indian–bound disorders. This variance in symp-tom presentation, as well as the uniqueness of culture-bound disorders, creates an obstacle to generalizationacross the different groups.

Regarding the construct or theoretical identifica-tion of depression, it is quite possible that the mannerin which it is conceptualized in the Western world isnot culturally relevant to this population. Thus, it ispossible that the construct of depression may be con-ceptualized and manifested in an entirely differentmanner. If this is the case, the instruments we cur-rently use to assess that construct may not be validwith this population.

One consistent finding that lends support to thisnotion is the utilization of somatization as a meansof expressing psychological distress among APIA.Somatization, or the physical manifestation of psycho-logical stress, often includes the presentation of fatigue,dizziness, angina, and other body sensations. Thoughadvances have been made in the battle against the neg-ative stigmatization of mental illness and mental healthconcerns, these prejudices remain firmly seated withinour society, as well as within many of the world’s cul-tures. In this respect, API cultures are in no way exemptfrom these biases against mental illness. In fact, it maybe argued that intolerance of mental illness is exagger-ated in the eastern cultures of the API. These culturesadhere to a more collectivistic tradition rather than theindividualistic tradition observed in Western cultures.As a result, the expression of emotion and mental ill-ness is discouraged in these societies in an effort tomaintain a given social status and to “save face” in theircommunity. Thus, it is often more readily acceptable todisplay psychological distress through somatic mani-festations, as has often been observed among individu-als of API ancestry.

A number of researchers have suggested that APIAhave different help-seeking preferences that resultfrom this alternative expression of symptom manifes-tation. Studies suggest that APIA rarely present emo-tional or interpersonal problems on occasions whenthey do seek out professional treatment. Rather, theytend to focus on concerns regarding their occupation,somatic complaints, and educational concerns. In the

United States, Asian and Pacific Islander populationsexhibit lower rates of both inpatient stays and employ-ment of psychiatric services than any other culturalgroup.

One reason for the disparate rates may lie in theperception of the mind–body relationship. Westerncultures tend to take a dualistic approach to the mind–body relationship, whereas Eastern cultures take amore holistic stance. This means that, although thoseof Western thought can make a distinction betweensomatic and psychological ailments, such a distinctioncan only be made with great difficulty and high inaccu-racy for those of a holistic perspective. The implicationof such variance has bearing on the language used insymptom description, as well as the cause attributed totheir manifestation. Linguistic barriers, too, have beencited as a source of diagnostic problems, particularly incases in which translation is used. Because translationis unable to coherently employ word-for-word equiva-lence between two languages, terms that are particularto a culture may fall by the wayside, effectively con-founding the message’s meaning. Perceptions of pain,for example, may be presented differently by those ofthe Asian culture, with psychological distress expressedas somatized pain. When faced with ambiguous symp-tom presentation, general practitioners and psychia-trists may be unable to classify the disorder. Researchon the topic appears to support this conjecture and indi-cates that the Western construct of depression allowsfor only a subsyndrome in many evaluations of Asianindividuals. This underdiagnosis and nontreatmenteffectively reinforces the tendency to seek aid fromnontraditional medicine.

Another fact that might account for the low treatmentrates is the perceived need for psychiatric assistance.Beyond the treatment efforts exerted for somaticsymptoms, specific cultural views on the cause of thedisorder often spur individuals to seek treatment fromnatural healers and other nontraditional medical per-sonnel. Supernatural causes such as magic curses orthe Djinn have been cited as reasons why such ser-vices have been employed.

When psychiatric disorders are diagnosed, thecultural barriers affecting the utilization of psychi-atric services may also retard treatment progress. Thepatient’s perception of his or her ailment and its causehas a great impact on the efforts of the psychologist.Because a good patient–clinician alliance is an inte-gral part of any treatment, addressing culturally spe-cific concerns (e.g., reporting style, spiritual beliefs,etc.), behavioral norms (e.g., direct eye contact), and



therapeutic approaches has a great influence on thetherapeutic outcome.

CONCLUSION

As the population of the United States grows andincreases and its makeup becomes more diverse, greaterunderstanding of cultural differences is a matter ofincreasing precedence. Though the body of literature onthe APIA is increasing, the rate at which progress isbeing made is insufficient. Methodological and categor-ical issues impede the progress of research, and they arefurther complicated by erroneous “model minority” per-ceptions that often surround these groups. What may beabstracted from the literature is that the APIA are as vul-nerable to psychological distress as any other culture. Infact, the process of acculturation may exacerbate thisvulnerability through elevated stress levels. The mani-festation of distress as a psychological disorder interactswith cultural background, affecting syndrome detectionand inaccurately depicting these groups. If psychologyis to disabuse itself of such misconceptualizations, mis-perceptions, miscalculations, and mistreatments, cultur-ally specific manifestations and diagnostic criteria needto be addressed in the diagnosis, treatment, and researchof individuals within these groups.

—Reece O. Rahman—Ilya Yaroslavsky

See also Asian Values Scale; Chinese Americans; FilipinoAmericans; Japanese Americans; Korean Americans;Model Minority Myth

FURTHER READING

Cheung, F. (1985). Cross-cultural consideration for the trans-lation and adaptation of the Chinese MMPI in Hong Kong.In J. N. Butcher & C. D. Spielberger (Eds.), Advances inpersonality assessment (Vol. 4, pp. 95–130). Hillsdale, NJ:Lawrence Erlbaum.

Doerfler, L. A., Felner, R. A., Rowlinson, R. T., Raley, P. A., &Evans, E. (1988). Depression in children and adolescents:A comparative analysis of the utility and construct validityof two assessment measures. Journal of Consulting andClinical Psychology, 56, 769–772.

Durvasula, R. S., & Mylvaganam, G. A. (1994). Mental healthof Asian Indians: Relevant issues and community implica-tions. Journal of Community Psychology, 22, 97–108.

Furnham, A., & Malik, R. (1994). Cross-cultural beliefs about“depression.” International Journal of Social Psychiatry,40, 106–123.

Huang, L. N. (1994). An integrative approach to clinicalassessment and intervention with Asian American adoles-cents. Journal of Clinical Child Psychology, 23, 21–31.

Ibrahim, F., Ohnishi, H., & Sandhu, D. S. (1997). AsianAmerican identity development: A culture-specific modelfor South Asian Americans. Journal of MulticulturalCounseling and Development, 25, 34–50.

Kaplan, G.A., Hong, G. K., &Weinhold, C. (1984). Epidemiologyof depressive symptomatology in adolescents. Journal of theAmerican Academy of Child Psychiatry, 23, 91–98.

Kim, W., & Rew, L. (1994). Ethnic identity, role integration,quality of life, and depression in Korean-American women.Archives of Psychiatric Nursing, 6, 348–356.

Krishnan,A., & Berry, J. W. (1992). Acculturative stress and accul-turation attitudes among Indian immigrants to the UnitedStates. Psychology and Developing Societies, 4(2), 187–212.

Lee, S. M. (1998). Asian Americans: Diverse and growing.Population Bulletin, 53(2), 2–40.

Rahman, R. O., & Akamatsu, T. J. (2000, November). Depres-sive symptomatology in Asian Indians. Poster presentationat the Association for the Advancement of BehaviorTherapy Annual Convention, New Orleans, LA.

Reeves, T., & Bennett, C. (2003). The Asian and PacificIslander population in the United States: March 2002.Current population reports (Series P20, No. 540).Washington, DC: U.S. Census Bureau.

Sue, S. (1999). Science, ethnicity, and bias: Where have wegone wrong? American Psychologist, 54, 1070–1077.

United Nations Population Division. (2003). World populationprospects: The 2002 revision (highlights). New York:United Nations.

U.S. Census Bureau. (2001). The Asian and Pacific Islanderpopulation in the United States: March 2000 (update)(PPL-146). Washington, DC: U.S. Census Bureau.

Zane, N. W. S., Sue, S., Hu, L., & Kwon, J. (1991). Asian-American assertion: A social learning analysis of culturaldifferences. Journal of Counseling Psychology, 38, 1–8.

ASSOCIATION OFBLACK PSYCHOLOGISTS

The Association of Black Psychologists (ABP) wasfounded in 1968 in San Francisco, California, by 28psychologists of African descent. This was the firstnational organization to be established by and for psy-chologists of African descent. Its establishment wasbased on the unique history of African descent, espe-cially enslavement and its social, economic, andpsychological effects on people of African descentworldwide. These founding members called for spe-cialized training and expertise in addressing the psycho-logical well-being of the African community locally,nationally, and internationally.

The founding members also desired to develop anapproach to psychology consistent with the experience

Association of Black Psychologists———57


of people of African descent. They envisioned that thenewly formed organization would promote andadvance the profession of African psychology, influ-ence and affect social change, and develop programswhereby psychologists of African descent could helpto solve the problems of people of African descent andother ethnic and racial groups.

FOUNDING MEMBERS

The 28 founding members of the ABP were JosephAwkard, Aubrey Escoffery, Florence Farley, WileyBolden, Jane Fort, George Franklin, Alvis Caliman,Avlin Goings, Robert Green, Norman Chambers,Robert Guthrie, William Harvey, Harold Dent, LeslieHicks, Thomas Hilliard, Anna Jackson, Walter Jacobs,Adelbert Jenkins, Reginald Jones, Melvin King,Lonnie Mitchell, Wade Nobles, David Terrell, DalmasTaylor, Charles Thomas, Ernestine Thomas, RobertWilliams, and Joseph White.

Members of this group represented a myriad ofpsychological disciplines, professions, and locationsacross the United States.

FIRST ACTIONS—RESPONSES

The formative group of founding members submittedseven petitions of concerns proposing that theAmerican Psychological Association (1) officiallyendorse the Kerner Commission’s Report of CivilDisorders; (2) develop or implement policies relatedto the African American community; (3) bring itsresources to finding solutions to the problems of racismand poverty; (4) establish a committee to study themisuse of standardized psychological instruments; (5)reevaluate the adequacy of certified training programsin clinical and counseling training programs in termsof their relevance to social problems; (6) recommendto each psychology department steps to be taken toincrease the number of African American students intheir graduate program; and (7) implement and evaluatethe progress of the foregoing recommendations inconsultation with representatives from the ABP. Therequests were received and reviewed by the AmericanPsychological Association, but they were not fulfilled.

CURRENT ASSOCIATION GOALS

By examining approaches to research that had tradi-tionally represented people of African descent as

deviant, including but not limited to the inferiority,deficiency, or disadvantaged models, the goals of theassociation became not only to enhance the psycho-logical well-being of people of African descent butalso to promote constructive understanding throughpositive approaches to research. These research goalsexpanded to include the development of psychologi-cal concepts and standards consistent with African orAfrican American culture, the development of supportsystems for psychology students, and the promotionof values that support well-being. Association mem-bers were also encouraged to foster relationships withlocal, state, national, and international policymakersto better influence the mental health and communityneeds of the African-descent community. Severalannual awards are granted each year, including anaward to support student research and an award forservice, scholarship, and community service.

ORGANIZATIONAL STRUCTURE

The organization elects a president to a two-year term.The board of directors consists of a past president,president, and president-elect, along with a secretary,treasurer, four regional representatives, presidingelder, and parliamentarian.

COMMITTEE STRUCTURE

Committees are structured into three main clusters:advancing knowledge, community, and organizationalmaintenance. Located within the advancing knowl-edge cluster are professional development, theCommittee to Advance African Psychology, theAfrican Psychology Institute, Black Mental HealthMonth, and the Leadership Institute. The communitycluster supports social action, testing and education,legislative education, health, and the African AmericanFamily Preservation and Revitalization committee.The final cluster comprises membership, the Committeeon International Relations, chapter development, stu-dent affairs, and information technology. Additionally,there are seven standing committees: Ethics, Rules,National Convention, Personnel, Fiscal Affairs, Publi-cations, and Reparations.

PUBLICATIONS

The Association of Black Psychologists hasthree regular publications: PSYCHDiscourse; ABPsi

58———Association of Black Psychologists


NewsJournal, a monthly or bimonthly newsletter; andthe Journal of Black Psychology, a professional quar-terly journal of qualitative and quantitative research.

—Harvette Armonda Grey

See also African/Black Psychology; African Americans

FURTHER READING

Azibo, D. (2003). African-centered psychology: Culture-focusing for multicultural competence. Durham, NC:Carolina Academic Press.

Williams, B. (1997). Coming together: The founding of theAssociation of Black Psychologists. Unpublished doctoraldissertation, St. Louis University.

Williams, R. (1974). A history of the Association of BlackPsychologists: Early formation and development. Journalof Black Psychology, 1, 9–24.

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

Attention-deficit/hyperactivity disorder (ADHD) is oneof the most frequently diagnosed disorders amongchildren and adolescents. It is a lifelong condition thatis estimated to affect 3% to 5% of school-age children.The disorder is characterized by core symptoms thatinclude age-inappropriate levels of concentration,attention, distractibility, and impulsive behavior. Forexample, affected children seem unable to sit still,always appear to be daydreaming, or cannot focus ontasks long enough to finish. Children may exhibit arange of characteristics and varying levels of severity.Behaviors associated with ADHD are classified intothree subtypes: predominantly inattentive, predomi-nantly hyperactive-impulsive, and combined. BecauseADHD often affects functioning in multiple settings,such as home, school, and peer relations, it may have anegative, long-term impact on academic and vocationalperformance and on social-emotional development.

A number of controversies surround ADHD:whether it exists as a distinct disorder, whether it canbe accurately identified, and what the most effectivetreatments are. For people of color, there are also con-cerns about stigma associated with diagnostic labels,the rate at which ethnic groups are identified withADHD, and access to appropriate treatment. Extantresearch focuses primarily on Caucasian, male, andmiddle-class populations, with limited consideration

of gender, race, ethnicity, culture, and socioeconomicstatus.

CAUSES AND MAJOR CHARACTERISTICS

Comprehensive considerations of race, ethnicity,gender, and culture have generally been overlooked inthe understanding of ADHD. Among individuals withADHD, the core symptoms, such as distractibility orinattentiveness, are biologically influenced. There isno single known cause of ADHD. It occurs more fre-quently in individuals who have a family history ofthe disorder and more frequently in children who areexposed to prenatal insult, obstetrical complications,or high levels of lead. The disorder was once viewedas a neurological condition primarily involving atten-tion, but it is now understood as a neurological condi-tion primarily involving self-control and behavioralinhibition. Cultural environment is important becauseit determines how well or how poorly an individualfunctions, and it influences how behavior will beunderstood and treated. Parenting styles and educa-tional methods do not cause ADHD, but they oftenplay a role in effective treatment.

Studies examining the prevalence of ADHD or theproportion of individuals with ADHD in specific eth-nic groups have reported conflicting results. The useof different assessment instruments and methods ofdiagnosis may account for the conflicting findings asmuch as any true differences in the rate of ADHDamong ethnic groups. For example, rates of ADHDbased on teacher ratings of children’s behavior indi-cate higher rates among African American andHispanic American children compared with EuropeanAmerican and Asian American children. However, theobserver’s judgment about the quality of the child’sbehavior has been shown to be influenced by ethnic-ity, socioeconomic status, and student and teacherexpectations.

Attention-deficit/hyperactivity disorder is a life-long condition that is identified more often in boys.It is estimated that boys are three times more likely tobe affected than girls, although ADHD may not be aseasily recognized in girls. Boys are more likely todemonstrate disruptive and impulsive behavior thatgets the attention of parents and teachers. Girls aremore likely to demonstrate inattentiveness, depres-sion, and academic problems that may be overlooked.Consequently, girls are more likely to be identifiedlater than boys and less likely to receive treatment.

Attention-Deficit/Hyperactivity Disorder——59


Until recently, ADHD was most often diagnosedduring childhood. It is now known that ADHD continuesinto adulthood, although symptoms can change fromchildhood to adulthood. Hyperactivity, aggressiveness,impulsive behavior, and distractibility are more commonamong children. In older adolescents and adults, inatten-tiveness, impatience, and restlessness are more commonwith lessened hyperactivity, partly because of copingstrategies that are learned with life experience.

Attention-deficit/hyperactivity disorder frequentlycoexists with other disorders, including disruptivebehavioral disorders, specific learning disabilities,anxiety, depression, and tic disorders. A large propor-tion of adults with ADHD may also experiencedepression, anxiety, and major mood disorders. WhenADHD goes untreated, substance abuse occurs innearly half the people affected.

ASSESSMENT

Criteria for a diagnosis of ADHD includes the onset orbeginning of symptoms before age seven, the presenceof at least six inattentive or six hyperactive symptomsfor at least six months, and significantly lowered per-formance in two or more areas of the child’s life (e.g.,difficulty at home and at school). Children may be mis-takenly identified with ADHD because many of the keycharacteristics are typical for children of certain ages,and a diagnosis may be made based on poor informa-tion after a brief assessment. In addition, culture influ-ences the expectations and behavioral norms of family,schools, and communities. What is acceptable andadaptive behavior from one cultural or ethnic group toanother varies. People from different cultural and eth-nic groups may also have different beliefs and attitudesabout illness, helping professions, and trust in largeinstitutions, as well as preferred community supportsand healers.

There is no single psychological, educational, ormedical test for ADHD. To accurately identify ADHD,a multisource (information obtained from multipleindividuals) and multimethod (information obtainedusing many methods) process is necessary. Informationfrom the child, parents, teachers, and others familiarwith the child in different settings helps to assess thechild’s behavior compared with other children of thesame developmental stage and cultural context.

Methods used in assessment may include interviews,behavior rating scales, and psychological testing. Theuse of rating scales and psychological tests is limited

by how well the scales and tests have been designedfor use with racial and ethnic groups and by possiblerater or examiner bias. Rating scales that focus onspecific core symptoms are helpful in identifying thechild’s behavior in different settings. Rating scalesthat focus on a wide range of behavior, attitudes, andfeelings are helpful in making an accurate diagnosisand determining whether there are other coexistingproblems. As a group, African American children areoften rated with more ADHD behaviors and with moresevere symptoms, which may be the result of bias oractual behavioral differences from other groups.Although psychological and educational tests arehelpful in identifying academic and learning disabili-ties, their appropriate use with ethnic and racialgroups requires an understanding of possible bias intest construction and interpretation.

TREATMENT

There are three basic types of treatment for ADHD:medication, behavioral intervention, and combined ormultimodal intervention. Medications such as Ritalinare considered by medical professionals to be themost effective treatment for the core symptoms ofADHD. The use of medication is controversial becauseof concerns about the abuse and misuse of these drugsand because little is known about their long-termeffect (i.e., longer than 14 months) on development.Possible racial and ethnic differences in how thesemedications are processed by the body have not beenconclusively demonstrated.

Behavioral or psychosocial interventions includeparent education, social skills training, structured posi-tive reinforcement for appropriate behavior in schooland at home, and counseling for organizational andsocialization strategies. These treatments are moreeffective than medication in improving academic,vocational, and social functioning, but they are not aseffective as medication in reducing the core ADHDsymptoms. Ethnic groups may prefer psychosocialinterventions over medication. Ethnicity and socioeco-nomic status may influence the motivation for varioustreatments.

Multimodal approaches combine medication andbehavioral treatments to address ADHD symptomsand academic and social problems. Combinedapproaches work best when family, teachers, andother professionals coordinate their efforts to ensureconsistency from one setting to another.

60———Attention-Deficit/Hyperactivity Disorder


Although ADHD is not specifically designatedunder the Individuals With Disabilities Education Act,some children and adolescents may be eligible forspecial education services depending on the severityof their symptoms and the presence of specific learn-ing disabilities. Many families of color are suspiciousof in-school services because of stigma and becauseof the disproportionate representation of AfricanAmerican and Hispanic youth, especially males, inspecial education. Youth and adults may be eligiblefor school and workplace accommodations underSection 504 of the Rehabilitation Act and under theAmericans With Disabilities Act.

—Cheryl C. Munday

FURTHER READING

Barkley, R. (1998). Attention deficit hyperactivity disorder: Ahandbook for diagnosis and treatment (2nd ed.). New York:Guilford Press.

Gingerich, K. J., Turnock, P., Litfin, J. K., & Rosen, L. A.(1998). Diversity and attention deficit hyperactivity disor-der. Journal of Clinical Psychology, 54(4), 415–426.

LaRosse, M. (2004, November). Ideas for accommodatingindividuals with ADD/ADHD in postsecondary trainingand college. Retrieved from the Job AccommodationNetwork Web site: http://www.jan.wvu.edu

Livingston, R. (1999). Cultural issues in diagnosis and treat-ment of ADHD. Journal of the American Academy of Childand Adolescent Psychiatry, 38(12), 1591–1594.

U.S. Department of Education, Office of Special Educationand Rehabilitative Services, Office of Special EducationPrograms. (2003). Identifying and treating attention deficithyperactivity disorder: A resource for home and school.Washington, DC: Author.

Weiss, G., & Hechtman, L. (1993). Hyperactive childrengrown up: ADHD in children, adolescents, and adults.New York: Guilford Press.

ATTRIBUTION

Attributions involve making causal explanations forevents or outcomes, particularly the behaviors that ledto those events or outcomes. These explanations maybe made by the individuals who experienced theevents directly (self-attributions), or explanations maybe given for why events or outcomes happened toother individuals (social attributions).

Individuals tend to take personal credit for suc-cessful outcomes by making attributions that reflect

characteristics that are internal and stable to them(e.g., positive personality characteristics), whereasthey tend to deflect blame for failure outcomes bymaking attributions that reflect external elements ofthe situation or context (e.g., the task was too hard).These self-serving attributions are important becausethey have been linked to psychological and physicalhealth indexes such as self-esteem and immune func-tioning. Moreover, these self-serving attributions,though prevalent in all cultural groups, are typicallystronger in Western (versus Eastern) cultures.

In explaining outcomes that happen to others, morepronounced cultural differences are found, particu-larly for failure outcomes. Individuals from Westerncultures tend to make dispositional attributions toexplain the unsuccessful outcomes of others (e.g.,“She didn’t get the job because she is not smartenough”), whereas individuals from Eastern culturestend to make attributions that reflect situational con-straints or pressures (e.g., “She was late for the meet-ing because she was caring for an ailing parent”).These social attributions are important because theycan lead to stereotyping and discrimination when indi-viduals, particularly those from Western cultures,make attributions within a multicultural society.

SELF-ATTRIBUTIONS

Self-attributions can be classified according to threedimensions: internality, stability, and globality. Inter-nality is present when an outcome is an attribute ofthe self (e.g., ability, effort) rather than outside the self(e.g., difficulty of task, other people). Stability ispresent when an outcome is consistently present (e.g.,an immutable personality trait) rather than temporary(e.g., effort). Globality is present when an outcomeis cross-situational (i.e., occurs on many situations)rather than situation specific (i.e., occurs only in thetarget situation). Attributing negative or failure out-comes to internal, stable, and global causes (e.g.,one’s own personality) is referred to as a depressive orpessimistic attributional style.

Because the underlying attributions suggest thecause will be present in a multitude of situations inthe future, individuals will experience feelings ofhelplessness, lowered self-esteem, and expectationsthat future failures are likely to reoccur. In contrast,attributing negative outcomes to internal, unstable,and specific causes (e.g., lack of effort) suggests thatone’s behavior can be altered to eliminate or reduce

Attribution———61


the negative outcome (e.g., if one just works harder).Conversely, attributing positive outcomes to internal,stable, and global causes (e.g., one’s own personality)is referred to as an optimistic or stress-buffering attri-butional style. This attributional style (also referred toas having “positive illusions”) is generally associatedwith heightened self-esteem and expectations thatsuccessful outcomes are likely to reoccur in the future.

Cross-cultural differences in attributional stylesare explained by a cultural emphasis on individualismversus collectivism. Because individuals in Westerncultures focus on the person as the source of negativeand positive outcomes, one would expect these individ-uals to make more dispositional than situational attri-butions for their own behavior. Because individuals inEastern cultures focus on the individual as rooted in thesocial environment, one would expect these individualsto make more situational than dispositional attributionsfor their own behavior. Research has shown that a self-serving attributional bias is relatively universal, thoughit is weaker in Eastern cultures.

There is a tendency, however, for some minoritygroup members within the United States to experienceattributional ambiguity for outcomes. This occurs whena minority group member is unsure whether an out-come is the result of his or her own personal character-istics or group membership. For successful outcomes,such as being hired for a job, individuals might wonderwhether they were hired because of their perceivedabilities (e.g., an internal, stable attribution) or becauseof perceived affirmative action policies (e.g., an exter-nal attribution). For unsuccessful outcomes, such as notbeing hired for a job, individuals might wonder whetherthey were not hired because they were unqualified (i.e.,they did not have the abilities for the job) or because“they are African American.” Thus, no clear self-servingattributions are made.

SOCIAL ATTRIBUTIONS

Similar cultural theories of individualism and collec-tivism can be used to explain cultural differences inthe attributions that individuals make about the behav-ior of others. Differences in social attributions arelargely a function of where individuals focus theirattention. Individuals from Western cultures have atendency to emphasize the traits and abilities of othersat the expense of situational characteristics (e.g., howhard a task was) when making attributions for behav-ior, particularly for negative outcomes. Individuals

from Eastern cultures have a tendency to emphasizeattributions as tempered by situational or contextualinfluences, such as the social-role obligations andsocial pressures that an individual is experiencing.Cultural differences in attributional thinking do notappear because there is an absence of dispositionalthinking in Eastern cultures. However, Eastern cul-tures view dispositions as more malleable, and theyare more sensitive to the fact that individuals behavedifferently under different circumstances.

Attributions that individuals make about the behav-ior of members from other groups (specifically,different cultural groups) are important because theycan foster stereotypes and lead to discrimination.Attributions made by an individual (referred to as thejudge) from a specific cultural group (referred to asthe in-group) about the negative outcomes experi-enced by members (referred to as the target) of adifferent cultural group (referred to as the out-group)typically reflect negative personality characteristicsand engender feelings of anger. For example, aCaucasian juror may attribute the criminal behavior ofan African American defendant to the aggressivenature of the target individual. Conversely, attribu-tions made for the behavior of a fellow in-group mem-ber are more likely to be situationally based andengender feelings of sympathy. For example, aCaucasian juror is more likely to attribute the criminalbehavior (e.g., robbery) of a Caucasian defendantto extenuating circumstances, such as financial need.The implications of these attributions can be profoundin the courtroom and beyond. The assignment of per-sonality attributions for behavior is more stronglyassociated with judgments of guilt and retaliatorybehaviors than the assignment of situationally basedattributions for behavior.

Attributions provide an expectation about behavior.Behaviors leading to negative outcomes that are consis-tent with existing stereotypes are attributed to internal,stable, and global causes (e.g., negative personalitytraits). Behaviors leading to positive outcomes that arenot consistent with existing stereotypes are attributedto external, unstable, and situation-specific causes(e.g., luck) or to internal, unstable, and situation-specificcauses (e.g., “they [African Americans] happened towork hard in this one instance”). It has been found,for example, that the perceived successes of AfricanAmericans (and women, for that matter) are attributedmore to luck and task ease than the perceived successesof Caucasians (particularly men).

62———Attribution


A model of the effect of stereotypes on socialjudgments can be proposed to explain these socialattributions. A target individual’s behavior is firstcompared with a salient group stereotype that thejudge (or the individual perceiving the behavior) has.Next, the target behavior is determined to be eitherconsistent or inconsistent with the prevailing groupstereotype. An observed behavior that is consistentwith the group stereotype will lead to attributions thatare ability or personality based. A behavior that isinconsistent with the group stereotype will lead toattributions that largely reflect luck or task ease.

For example, assume that a Caucasian high schoolstudent (the judge) has just learned that a fellowHispanic classmate (the target) has been admitted toHarvard University (the target behavior or outcome).Further, assume that the Caucasian student holdsthe stereotype that Hispanics are lazy. Because theHispanic student’s target behavior is inconsistent withthe Caucasian student’s group stereotype, the latterwill largely attribute the behavior to causes such asluck or affirmative action. However, if this Caucasian

student holds the stereotype that Hispanics are hard-working, the same target behavior will be viewed asconsistent with the stereotype and attributed to theability of the target Hispanic. Thus, the attributionsthat individuals have—and ultimately, the discrimina-tory behaviors that individuals may engage in as aconsequence of these attributions—begin with stereo-types. Nowhere is this more prominent than int thestereotypes that individuals hold about differentcultural groups.

—Scott C. Roesch—Allison A. Vaughn

FURTHER READING

Choi, I., Nisbett, R. E., & Norenzayan, A. (1999). Causal attri-bution across cultures: Variation and universality.Psychological Bulletin, 125, 47–63.

Mezulis, A. H., Abramson, L. Y., Hyde, J. S., & Hankin, B. L.(2004). Is there a universal positivity bias in attributions?A meta-analytic review of individual, developmental, andcultural differences in the self-serving attributional bias.Psychological Bulletin, 130, 711–747.

Attribution———63


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