Acculturation and Health Services Utilization Among Older Asian Americans: The Roles of Social Support and Psychological Distress

There are relatively few studies about health services utilization among older Asian Americans. Historically, Asian Americans have been treated as one homogenous race group, and the underlying heterogeneity among specific ethnic groups was underappreciated and neglected. This dissertation investigates the relationship between acculturation and health services utilization among older Asian Americans and several specific Asian ethnic subgroups, including Chinese, Japanese, Korean, Filipino, and Vietnamese Americans. In addition, South Asian Americans and members of other Asian groups were also examined. This study employed two samples of older Asian Americans based on the specific healthcare resources evaluated. The first sample employed five waves of data from the California Health Interview Survey (CHIS), including 2011-2020 to examine the association between acculturation and doctor visits, emergency room visits, and hospitalization. The second sample employed three waves of data from the CHIS (2013-2020) to investigate the relationship between acculturation and dental visits. The mediation role of psychological distress and the moderation role of social support were also investigated. Logistic regression results showed that the relationship between acculturation and health services is mixed, depending on the type of services and the specific Asian ethnic group. The results showed that as acculturation increased, the likelihood of visiting a doctor increased among older Chinese adults, and the likelihood of visiting a dentist increased among older Chinese, Filipino, and Vietnamese. Contrary to expectations, the likelihood of emergency room visits increased as acculturation increased among older Koreans and Vietnamese, and the likelihood of being hospitalized increased among older Japanese and Koreans. Social support moderated the relationship between acculturation and doctor visits among older Chinese, and between acculturation and dental services utilization among older Asian Americans and Chinese. Social support also moderated the relationship between acculturation and emergency room visits among older Asian Americans. Finally, the results showed that psychological distress did not mediate any of the relationships. The results of this study imply that programs should be developed to help older Asian Americans learn more about the United States health care system and that health care providers should develop services that are culturally appropriate for the populations they serve