Measuring culture: a critical review of acculturation and health in Asian immigrant populations

https://doi.org/10.1016/S0277-9536(02)00300-3Get rights and content

Abstract

The number of studies examining how acculturation affects the health of Asian immigrants has increased in recent years. The proliferation of studies reflects the growing size and heterogeneity of Asian immigrant populations in the United States, Canada, Australia, New Zealand, and the United Kingdom. This paper compares various approaches to acculturation within the health literature on Asian immigrants by reviewing the literature in three-health domains (1) mental health (2) physical health and (3) health services use. The review critically examines the conceptualizations and measures of acculturation in these three domains and presents major findings. We observe that measurement difficulties posed by the experiences of heterogeneous Asian groups compound theoretical and disciplinary disparities between acculturation instruments. The extent to which conceptual and methodological critiques of acculturation studies in Hispanic populations apply to studies of Asian populations is also discussed. The critical review thus provides insights into the diverse ways that the relationship between culture and health is measured in this complicated and growing literature.

Introduction

The tremendous growth in the numbers of Asian immigrants to English-speaking countries (United States, Canada, Australia, New Zealand, and the United Kingdom) has led to increased interest in their health and that of their descendents (Kuo & Porter, 1998). Also increasing is the ethnic, cultural, and socioeconomic heterogeneity of Asian immigrant populations. Many recent studies of migrant health have posited that acculturation—broadly defined as culture change—influences health outcomes. This research literature, however, has not embraced a common model of acculturation or a common explanation of why it would affect health. Here, we critically review the literature on the health of Asian immigrant populations that posits a role for acculturation. We focus on the conceptual models of acculturation that underlie the various methodological approaches taken, emphasizing the difficulties posed by certain measurement variables for comparisons across diverse Asian groups. In addition, we discuss the extent to which specific conceptual critiques of acculturation measurement in Hispanics apply to Asian populations. This paper begins with a brief overview of acculturation theory, followed by the review of methodologies and substantive findings and discussion of the conceptual issues they raise.

Section snippets

The study of acculturation

Originating in anthropology, the concept of acculturation has been adopted by other disciplines including sociology, epidemiology, and psychology. However, the theoretical and applied work concerning acculturation within these disciplines has developed in different directions and with different implications for how the relationship between acculturation and health is modeled and examined.

When anthropologists Redfield and others identified acculturation as an object of study in 1936, they

Method

Papers for the literature review were obtained through National Library of Medicine PubMed (Medline) searches using “acculturation” and “Asians” as either medical subject heading (MeSH) terms or title/abstract words. Similar searches for MeSH terms “immigration/emigration” and “Asians” produced relevant studies primarily of physical health outcomes in the context of culture change. Additional papers were identified from bibliographies of the above studies. Although our search results yielded

Measures and findings

We have grouped studies by type of measurement, i.e., scale or non-scale measures. Within each measurement type, we review relevant measures, compare major findings, and identify salient measurement problems. We refer the reader to the appendix for more detailed descriptions of individual studies. Table 1 shows the types of acculturation measurements used in the studies identified. Studies are grouped into three outcome areas: mental health/substance abuse, health services use, and physical

Discussion

Recent critiques of acculturation measurement in Hispanic populations have noted the failure to attend to contextual issues within the narrow “psychologizing” approach of much acculturation research (Adrados, 1993; Rogler et al., 1991). These critics point to the importance of considering socioeconomic context as well as migration histories within acculturation studies of particular ethnic groups. The latter recommendation stems from the increased diversity between and among ethnic groups that

Conclusion

The heterogeneity of Asian immigrant groups is paralleled by the acculturation measures used to study them. However, the diversity of specific measures and the disciplinary models upon which they are based make comparisons across ethnic groups and health domains extremely difficult. Acculturation measures in physical health studies generally conform to models derived from sociology and behavioral epidemiology while studies in mental health and health services use frequently borrow psychometric

Acknowledgements

This study was supported by the US National Institutes of Health (NIA RO1 AG17889-01). We would like to thank Edward Laumann and Namratha Kandula for helpful suggestions.

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