Public health and social policies are often debated, designed, and adopted without implementation, sustainability, or equity in mind, which can generate profound uncertainty about how to equitably deliver them initially and over time. Although sustainability and equity considerations are sometimes considered in post-hoc policy analysis and evaluation, little is known about how to plan for and track planned and unplanned adaptations to policy implementation, as well as the ways that key sustainability factors and strategies can relate to the equitable delivery or relative effectiveness of policies on the ground and in community settings. The purpose of this dissertation was to explore the long-term sustainability and equity of tobacco control policies and programs in New York City to understand and contextualize their limited reach and impact on persistent smoking and tobacco-related health disparities in underserved Asian American communities. The specific aims were to: 1) conceptually specify an operational definition of policy sustainability and its key dimensions, including health equity, and to refine this using a mixed methods single case study of tobacco policies in New York City; 2) use the case study approach to describe the extent to which tobacco policies have been sustained and adapted in New York City; and 3) to use the case study to identify key multi-level factors that influence the long-term sustainability and equity of tobacco policies in New York City. Using a single, in-depth, convergent-parallel mixed methods case study design, data were collected, analyzed, and integrated across five key primary and secondary sources: 1) Policymaking documents – text of key tobacco bills and statutes, as well as transcripts from when they were first proposed, amended, debated, and adopted; 2) Local newspaper coverage – articles from a database of 29 major newspapers in New York State on the policies and their impacts on communities and businesses over time; 3) Key informant interviews – conducted with community members and community leaders at local health and advocacy organizations in New York City that primarily serve Asian American and immigrant communities (n = 21); 4) Direct observation periods – conducted within and around the health and advocacy organizations, as well as in majority Asian neighborhoods and Asian ethnic enclaves (n = 15); and 5) the New York City Community Health Survey (2012-2017) – conducted annually by the New York City Department of Health and Mental Hygiene. The integrated study findings point to the importance of understanding policy sustainability not as a static end goal, but rather as a dynamic set of processes and outcomes that impact health and health equity. Findings from this case study clustered across three key themes: 1) since the initial adoption of comprehensive local tobacco control measures in New York City in 2002, broad “one-size-fits-all” approaches to policy implementation and monitoring have been sustained, which have had and continue to have limited reach and impact within underserved Asian American and immigrant communities; 2) two delayed adaptation efforts were made by policymakers during the sustainability phase, one in 2012 and another in 2018, were intended to improve on prior uneven implementation to better reach Chinese-speaking communities, with the 2018 adaptation demonstrating significant improvements from the 2012 effort; and 3) community-based organizations have played a direct role in functioning not just as key stakeholders but also as key implementers to ensure that tobacco and other health policies are reaching communities that the designated or official implementers cannot reach. This suggests the need for further study of unofficial implementers in implementation science – those who have not been formally designated as the ones responsible for ensuring that implementation takes place, but are still delivering implementation strategies to ensure adoption, integration, and sustainment. Overall, this case study points to the potential for policy sustainability research to advance health equity by identifying factors and mechanisms that can be improved to maximize and sustain the equitable reach and impact of social and public health policies. By focusing on dynamic contextual factors and sustainability as a set of processes and outcomes, the findings from this case study raise critical questions about the criteria typically used to evaluate whether policy interventions are deemed evidence-based and effective by asking: 1) effective for whom?; 2) based on what evidence?; and 3) what happens as dynamic populations and contexts change over time? These questions highlight how the tobacco control success story was largely constructed around broad population-wide implementation and benefits, while overlooking underserved Asian American communities who continue to disproportionately bear the brunt of smoking and tobacco-related health disparities in New York City.

In this dissertation, I developed and validated the workplace racial microaggressions scale for Asians and Asian Americans, WRMS-AAA. This new scale measured the frequency of general and stereotype-based microaggressions that Asians experience in the workplace. General microaggressions are subtle forms of discrimination that could pertain to other minority groups, whereas stereotype-based microaggressions are subtle forms of discrimination that are based on stereotypes of Asians. In Phase 1, items were generated based on extant literature. These items were refined based on the feedback provided by subject matter experts who rated these items on relevancy, clarity, and provided other open-ended feedback. In phases 2 through 5, 351 participants completed a battery of measures including the WRMS-AAA and other measures to assess convergent, discriminant, and concurrent validity. These participants were then randomly split into two sample groups. In phase 2, an exploratory factor analysis using data from sample one (n = 180) revealed a four-factor structure for the WRMS-AAA. Two of these factors were general microaggressions, mistaken identity and not recognized, and the other two factors were stereotype-based microaggressions, ascription of math competency and submissiveness and lacking communication skills. In phase 3, using data from sample 2 (n=171) a confirmatory factor analysis provided further support for the four-factor structure. Both samples provided good internal consistency. In phase 4, the two samples were combined to examine the convergent and discriminant validity of the WRMS-AAA. The WRMS-AAA was highly related to the Workplace Incivility Scale (Cortina et al., 2013) and the Racial and Ethnic Microaggressions Scale (Nadal, 2011), providing support for convergent validity. There was little to no correlation between the WRMS-AAA and social desirability, and there was a weak positive correlation between the WRMS-AAA and neuroticism, providing support for discriminant validity. In phase 5, the WRMS-AAA was correlated with organizational outcomes. The WRMS-AAA was negatively correlated with organizational support, commitment, and job satisfaction. Additionally, the WRMS-AAA was positively correlated with intention to quit and burnout. These correlations provided evidence of concurrent validity, further establishing the validity of the WRMS-AAA. Subtle forms of discrimination are different from explicit discrimination, in that they can be elusive. The WRMS-AAA is one of the only known scales to measure the general and specific subtle forms of discrimination in the workplace. Results and implications of this research are discussed.

With unique historical, political, and social perceptions, the experiences of refugees, and later, their children, contribute to a more complex narrative of remembrance, citizenship, and belonging in the United States. Often framed as creating a disconnect between generations, intergenerational trauma may be addressed by surfacing different forms of affective and embodied remembrance. Recognizing the unique identities and subjectivities that the second-generation, Southeast Asian American (SEAA) population embodies (and the implications that those have for how the U.S. perceives and produces itself), this project engages narrative inquiry and participatory visual methodologies to explore how the children of Southeast Asian (SEA) refugees make meaning of their family histories and themselves through negotiating generational memories. This project shows that SEAA young people are actively engaging with the legacies of their families and communities as they move through the world. Through a series of individual interviews, participant creations, a whole group sharing circle, and a group co-created artifact, my analysis shows the ways that SEAA continually look inward and turn outward, seeking to understand, build, and re-member as they negotiate generational memories. As SEAA move toward continuity through a deep recognition and, ultimately, acceptance of rupture, they engage in healing practices. Drawing from the ways that a feminist refugee epistemology asserts the refugee as knower and centers their rich, complicated daily experiences and the ways that healing justice centers the transformation of institutions and relationships to facilitate individual and collective healing, this project offers continued opportunities to theorize the connections between historical understandings and how young people with legacies of displacement see themselves as actors in relation to those around them.

Though more recent Asian American representation in media has been lauded, the majority of portrayals have been considered to be stereotypical misrepresentations. Because negative media representations can have a detrimental impact on people's self-concepts and their views of others, it is important to understand how Asian Americans are representing their own identities online. In order to understand how Asian Americans are negotiating their own ethnic, racial, and national identities online, constant comparative analysis was employed to examine patterns and themes in the visual and textual communication of Asian American Instagram posts. Their cultural identities were communicated as a cultural blending, which included the use of Asian, American/Western, and Asian American cultural values, products, and behaviors. Together, these factors provided insight into the construction and communication of a multilayered identity, mirroring the process of the communication theory of identity. This study indicates that multicultural identity analysis can be applied to visual texts and Instagram can provide more fluid, authentic representations of identity despite its inability to account for internal multicultural identity conflict. Further, not only are values, products, and behaviors components of culture, but they are also facets of identity that can be portrayed visually.

This study examined the relationship between exposure to COVID-19 fake news, right-wing authoritarianism (RWA), sociodemographic factors (i.e., race, biological sex), and xenophobia along with anti-Asian sentiment during the pandemic. Participants included 133 female and male college students. Participants were randomly assigned to one of three conditions: (1) exposed to COVID-19 fake news, (2) exposed to real news related to COVID-19 news, and (3) no news exposure. All participants from three groups were then asked to complete a series of measures regarding their attitudes toward Asian Americans and xenophobia. Participants levels of RWA and sociodemographic variables of race and biological sex were also examined. There was no significant difference in participants' attitudes toward Asian Americans based on which experimental group they were in. Participant's level of RWA and xenophobia significantly predicted participants attitudes toward Asian Americans. Participants race marginally predicted levels of comfort and kinship with, as well as enthusiasm for Asian Americans. Implications and directions for future research are discussed.

As reflected in the surge of anti-Asian discrimination following the outbreak of COVID-19, Asian Americans continue to face subtle and overt forms of racism despite the misguided popular image as the “model minority.” Prior research has found that perceived discrimination experiences are associated with adverse mental health outcomes for Asian Americans. The current study extends the literature by exploring pathways that link perceptions of discrimination and psychological distress and protective factors that disrupt this link. The study tested a moderated mediation model that included internalized racism as a mediator and critical action and ethnic identity as moderators, utilizing the bootstrap-based PROCESS analysis (Hayes, 2013). Participants were 424 Asian American adults ranging in age from 18 to 73 that completed an online survey. Results indicated that internalized racism mediated the relation between perceptions of discrimination and psychological distress. Critical action, but not ethnic identity, significantly moderated the mediated effect of racial discrimination on psychological distress through internalized racism. Specifically, among Asian Americans that reported high levels of critical action, internalized racism did not the mediate the relation between perceived racial discrimination and psychological distress. Findings are discussed in terms of their implication for clinical practice, educational and community programming, and advocacy efforts for Asian Americans.

My dissertation is an ethnographic study of Asian-American users on the social network site, Xanga. Based on my analysis of online texts, responses to texts, and participants' discussions of their writing motivations, my research strongly suggests that examining digital writing through participants' complex and overlapping constructions of their community and public(s) can help the field reconsider digital writing as a site of Asian-American rhetoric and as a process of constructing and transforming racial identities and relations. In particular, I examine how community and public, as interconnected and shifting writing imaginaries on Xanga, afford Asian-American users on this site the opportunity to write, explore, and circulate their racial and ethnic identities for multiple purposes and various audiences. Race and ethnicity, as many scholars argue, are shifting and unstable concepts and experiences. Therefore, writing about race and ethnicity may be done best in environments that can accommodate complex and multiple acts of racial and ethnic formations. While my research demonstrates how participants "want to be heard" on their own terms, whom they imagine (or want to imagine) as listening/reading significantly informs their writing. That is, participants' conceptions of their writing goals and their audiences are multiple and simultaneous--these racial and ethnic writing acts are often inflected by intersecting issues of gender, sexuality, class, culture, and intergenerational tensions--and, hence, traditional writing genres that limit such goals, audiences, and complexity do not always reflect how writers conceive of their own racial and ethnic experiences and their writing in the world. This study, then, examines Xanga as a flexible writingecologythat affords Asian-American users opportunities to compose their continuously transforming and complex racial and ethnic identities across multiple niches of representational sites and, specifically, in public and community spaces.

A focus on racial and ethnic minority youth is crucial considering the projections of growth for these populations in the United States. The Journal of American Academy of Child/Adolescent Psychiatry, Journal of Clinical Child and Adolescent Psychology, and Child and Adolescent Psychiatric Clinics of North America were coded for level of focus on minority youth group focus, article topic, and journal trends over time. Latinxs represented 3.2% of published articles (versus 17.8% of the U. S. population), African Americans 3.0% (versus 13.3%), Asian Americans 0.1% (versus 5.9%) and Native Americans 0.9% (versus 1.3%). The top research topics for all minority groups are discussed.

Type 2 diabetes mellitus (T2DM) disproportionality affects under-represented groups, specifically Asian Americans. Asian Americans are less likely to receive proper diabetes mellitus screening compared to other racial and ethnic groups, potentially due to improper screening guidelines by clinicians, and Asian Americans being unaware of their increased risk for diabetes mellitus. There are differences in the etiology of T2DM in Asian Americans compared to White Americans. Due to the increasing rates of T2DM among Asian Americans, new approaches in the screening of T2DM should be tailored based on race and ethnicity. The aging process is frequently associated with decreased muscle mass and increased adipose tissue, which can contribute to insulin resistance and lead to elevated hemoglobin A1c (HbA1c) percentages. Although sex has not been classified as an independent risk factor for T2DM, it is important to consider sex-specific conditions in the context of the disease. Body mass index (BMI) alone is insufficient to properly evaluate adiposity in Asian-American adults due to Asian Americans having a lower BMI with a higher body fat percentage. Waist circumference, waist-to-height ratio (WHtR), and visceral adiposity index (VAI) may be better for screening Asian Americans for T2DM. Multiple modifiable risk factors, such as sedentary behavior, and dietary intake (specifically dietary magnesium intake) can increase the risk for T2DM. Lack of physical activity can result in insulin resistance and impaired glucose metabolism as a result of muscle disuse and decreased lean body mass. Half of the Asian-American population is not consuming the recommended amounts of magnesium from foods, drinks, and dietary supplements. There is an inverse relationship between increased dietary magnesium intake and the risk of T2DM. In addition, the main language spoken in the household may influence lifestyle and risk of T2DM. The overarching goal of the present study was to establish which independent variables (age, sex, BMI, waist circumference, WHtR, VAI, sedentary behavior time, dietary magnesium intake, self-reported healthy diet status, and language) were the strongest predictors of HbA1c percentage (a measure of blood glucose control) in Asian-American adults using the National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2020. The present study also evaluated the relationship among multiple predictors of HbA1c percentage, including age, sex, body composition, sedentary behavior time, dietary magnesium intake, self-reported healthy diet status, and language among Asian-American adults, 18 years of age and older, using the NHANES data from 2011 to 2020. / Doctor of Philosophy / Asian Americans have been disproportionately affected by type 2 diabetes mellitus (T2DM). Compared to other racial and ethnic groups, Asian Americans are less likely to receive proper diabetes mellitus screening. This may be due to inadequate screening guidelines and lack of awareness about their increased risk for diabetes mellitus. The cause of T2DM in Asian Americans differs from that in White Americans, which calls for tailored screening approaches based on race and ethnicity. The aging process is frequently associated with decreased muscle mass and increased adipose tissue, which can contribute to insulin resistance and lead to elevated hemoglobin A1c (HbA1c) percentages. Although sex has not been classified as an independent risk factor for T2DM, it is important to consider sex-specific conditions in the context of the disease. Body mass index (BMI) alone is not enough to accurately assess body fat in Asian-American adults, because they tend to have a lower BMI, but higher body fat percentage. Waist circumference, waist-to-height ratio (WHtR), and visceral adiposity index (VAI) might be more suitable for screening Asian Americans for T2DM. Several modifiable risk factors, such as a sedentary lifestyle and dietary intake (specifically, dietary magnesium intake), can increase the risk of T2DM. Lack of physical activity can lead to insulin resistance and impaired glucose metabolism due to muscle disuse and reduced lean body mass. Half of the Asian-American population does not consume the recommended amounts of magnesium from food, drinks, and dietary supplements. Researchers have shown that increased dietary magnesium intake is linked to a reduced risk of T2DM. In addition, the main language spoken in the household may influence lifestyle and risk of T2DM. The main goal of this study was to identify which factors (age, sex, BMI, waist circumference, WHtR, VAI, sedentary behavior time, dietary magnesium intake, self-reported healthy diet status, and language) were the strongest predictors of HbA1c percentage (a measure of blood glucose control) in Asian Americans. This was completed using the National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2020. Additionally, the study aimed to establish the relationship among multiple predictors of HbA1c percentage, including age, sex, body composition, sedentary behavior time, dietary magnesium intake, self-reported healthy diet status, and language among Asian-American adults, 18 years of age and older, using the same NHANES data.

The study explored experiences of hate, hate crimes and microaggressions among diverse Asian adults living in the United States during the COVID-19 pandemic for a sample (N = 831) that was 26.7% Chinese, 13.6% Japanese, 13.4% Korean, 12.4% Taiwanese, 10.6 % Filipino, 10.3% Indian, 8.5% Thai, 54.9% female, and 86.8% U.S. born—with a mean age of 33. Findings showed participants had: better overall physical health before COVID-19 pandemic versus currently; mental/emotional health declined from before the pandemic to currently; moderate social support; closest to moderate past-year mental distress; closest to “more than once” for experiences of microaggressions; a high level of ability for perceiving racism and oppression; and were in the action stage for coping and responding to racism and oppression. Also, 79% (N = 831) personally experienced hate once to a great number of times, and 43.5% (N = 362) endorsed moderate to very high impact; 79.2% (N = 664) witnessed hate against someone else once to a great number of times, and, 44.5% (N = 370) endorsed moderate to very high impact. Those who received counseling in the past experienced more microaggressions than those who did not seek counseling. The higher the frequency of experiencing microaggressions then higher the age, darker the skin color, lower the self-rating of mental health pre-COVID-19, lower the self-rating of physical health pre-COVID-19, lower the self-rating of mental health during COVID-19, higher the past year depression, anxiety and trauma and overall mental distress, greater the feeling of being unable to control important things in life, higher the ability to perceive racism and oppression, higher the stage of change for coping and responding to racism and oppression, greater the impact of hate, and lower the social desirability. Backward stepwise regression showed significant predictors of a higher frequency of experiences of microaggressions were being born in the U.S, not being a student, past year counseling, older age, lower education, higher overall mental distress, and higher ability to perceive racism and oppression—with 77.4% of variance explained by the model. Implications of findings and recommendations are provided for addressing anti-Asian hate.