September 1996 Substance Abus Guide 'tfrce Asian a Pacific Office of Minority Health AmericansResource Center Islande PO Box 37337 DC gton, 20013-7337 From the Director of CSAP... 1 As with many other communities, AsianAmerican and Pacific Islander (A&PI) populations are seriously impacted by substance abuse related problems. Culturally appropriate prevention resources for A&PI audi- ences on substance abuse issues remain a critical need. CSAP/SAMHSAis strongly commit- ted to the integration ofA&PI issues throughout all of our programs. And, information is a primary tool in Prevention Materials 1 prevention. This Resource Guide Studies, Articles, provides information and referrals to & Reports 5 help prevention specialists, educators, and community leaders locate re- Groups, Organizations, & Programs 13 sources appriate for use with diverse AsianAmerican and Pacific Islander Internet Access Sites 15 communities. Elaine M. Johnson, Ph.D. SAMHSA 4 CenterforSubstanceAbuse Prevention PieventionWOKKS! OS MS408 The listing ofmaterials orprograms in this resource guide does notconstitute or imply endorsementby the Centerfor Substance Abuse Prevention, the Public Health Service, or the Department ofHealth and Human Services. The materialshavebeenreviewed for accuracy, appropriateness, and conformance withpublic healthprinciples. This Substance Abuse Resource Guide was compiled from a variety of publications and data bases and represents the most current information to date. It is not an all-inclusive listing of materials on this topic. This guide will be updated regularly, and your com- ments or suggestions are welcome. To suggest information or materials that mightbe included in future editions, please write to the National Clearinghouse forAlcohol and MD Drug Information (NCADI), P.O. Box 2345, Rockville, 20847-2345. Produced by the National Clearinghouse for Alcohol and Drug Information, Vipapan Owtrakul, Robert Riccio, and Andrea B. Miller, Editors. J. For further information on alcohol, tobacco, and other drugs, call 1-800-729-6686, 301- TDD 468-2600, or 1-800-487-4889. Please feel free to be a "copy cat," and make all the copies you want. You have our permission! Prevention Materials for and Asian Pacific Islander Americans Some Traditions Should Be alcoholism, children of alcoholics, and Broken expressing feelings are addressed in a set of comprehension and discussion Year: 1992 questions. Format: VHS video Length: 30 minutes Topic: Tobacco Lam The Nao De Bao Ve Sue Language: English with Korean subtitles Khoe/How to Protect Your Target Audience: Korean Boys and Men, Health Schools, and Community Organizations Availability: Korean Youth and Community Year: 1992 Format: Booklet Center, 680 South Wilton Place, Los An- geles, CA 90005; 213-365-7400 Length: 187 pages Topic: ATOD and Prevention; AIDS; Mental 1 his videotape shows the effects that Health smoking cigarettes has on one's health. Language: Vietnamese It focuses on the pressures on young Target Audience: Vietnamese General Pub- Korean men to initiate smoking. The lic story features a Koreanboy who quits Availability: Santa Clara County Health De- smoking after his father developslung partment, 595 Millich Drive, Suite 100, cancer. The Korean Youth and Com- Campbell, CA 95008; 408-378-6805 munity Center also has a cartoonbook on tobacco in Korean and a brochure on 1 his book contains information about smoking inboth English and Korean. the legal aspects and health effects ofal- cohol use and the medical and social problems oftobacco use. Prevention Children of the Mahant Dorai tips for parents about drugs, AIDS, and Year: 1992 mental health issues are covered. Re- Format: VHS Videotape with Two Workbooks sources and references are included. The Length: 45 minutes Santa Clara Health Department also of- Topic: Alcohol fers brochures on AIDS and alcohol, a 6- Language: English with Khmer (Cambodian hour educational course on driving language) Subtitles while under in the influence (in Viet- TargetAudience: Cambodian Families; Ele- namese), and a parent's guide to pre- mentary and Junior High School Students ventionbooklet. Availability: Khmer Health Advocates, Inc., 545 ProspectAvenue, West Hartford, CT Making Prevention Work: 06105; 1-800-50-KHMER Actions for Asian/Pacific 1 his videotape depicts a Cambodian Islander Americans family that abuses alcohol to ease their Format: Fact Sheet pain and problems resulting from the Length: page Mahant Dorai (time of great destruc- Topic: AT1OD and Prevention tion). Issues concerning peer pressure, Language: English Asian and Pacific IslanderAmericans Page 1 WA TargetAudience: General Public Suite 18, Bellevue, 98005; 206-637- Inventory Number: MPW018 7011 Availability: National Clearinghouse forAl- cohol and Drug Information, P.O. Box 1 his brochure offers suggestions to as- MD sist parents in preventing alcohol or 2345, Rockville, 20847; 301-468-2600; other drug related problems with their 1-800-729-6686 children. Suggestions include starting 1 his fact sheet presents 14 ways to pre- to talk about alcohol while children are vent alcohol, tobacco, and other drug young, setting boundaries, setting a use among Asian and Pacific Islanders. good example, and being aware of other The pointers include: help recent immi- influences such as television and peers. grants cope with the English language and American culture; acknowledge, re- An spect, and celebrate prevention/healing This Is A.A.: Introduction to the A.A. Recovery Program practices of traditional cultures; and in- corporate prevention in culturally-based Format: Booklet support systems such as families and Length: 21 pages communities. Topic: Alcohol and Intervention/Treatment Languages: Cambodian, Chinese, Korean, A Vietnamese, or others Taking Responsibility: Sub- TargetAudience: General Public stance Abuse Information and Availability: Alcoholics Anonymous World Prevention Guide for Filipino Services Incorporated, General Service Parents Office, PO Box 459, Grand Central Sta- Format: Booklet tion, New York, NY 10163; 212-870-3400 or Length: 16 pages fax 800-437-3584 Topic: ATOD and Prevention 1 ranslated from one of A.A.'s original Language: English and Taglog publications, this small booklet dis- TargetAudience: Filipino Parents cusses alcoholism as a disease, the Availability: Asian American Recovery Serv- twelve steps and twelve traditions of ices, Inc., 785 MarketStreet, 10th Floor, A.A., and now to get in touch with an San Francisco, CA 94103; 415-541-9285 A.A. group. 1 his booklet is designed to help Fili- pino parents understand the facts about Story—telling: Culture As Preven- drug use and to discuss theAeffects of tion Korean Folktales drugs with their children. fold out Year: 1995 chart contains descriptions and pictures Format: Audiotape ofvarious drugs, including alcohol, co- Length: 45 minutes caine/crack, barbiturates, and tobacco. Topic: ATOD and Prevention Language: English Talking to Your Kids About Context: Available separately or as part of Alcohol the package "Storytelling: Culture As Prevention Conference" audiotapes Year: 1995 Format: Brochure TargetAudience: Prevention Professionals, Length: 8 pages Treatment Professionals, Community Topic: Alcohol and Other Drugs Leaders, Asian and Pacific Islanders Language: English, Chinese, Laotian, Viet- Inventory Number: CSP95-13 namese, Cambodian, orSpanish Availability: Conference Recording Service, TargetAudience: Parents ofChildren ages 1308 Gilman Street, Berkeley, CA 94706; 5-12 Years 800-647-1 1 10, fax 510-527-8404 Availability: Washington State Substance 1 he conference, "Storytelling: Culture Abuse Coalition, 12729 NE 20th Street, as Prevention," promoted the use of sto- Page2 ForfurtherInformation,writeto NCADI, P.O. Box 2345 Rockville, MD 20847-2345 . rytelling to foster resiliency factors that 1 he artist Hiro symbolizes the courage aid in the prevention ofalcohol, tobacco, and determination of the Asian Pacific and other drug abuse. The speaker tells American mother. He demonstrates the Korean creation story and a story love and hope for a brighter future for called the "Seventh Daughter." The both her child and herself. The arm of moral of the "Seventh Daughter" is that the mother lovingly cradles her infant; children should love their parents re- the mother's body is the ancient Asian gardless of their deeds, and that parents character for "women eternal;" and the A should value every child. third story calligraphy of her red earring represents tells of a father who has an evil second the word for "heart and soul with a ' wife, how she tries to have him kill his "yin/yang" flourish. seven sons from a previous marriage, and the resulting punishment she suf- New New A Land, Choices: fers. Culturally Specific Curriculum on Alcohol, Tobacco, and Give Life a Chance. Don't Drink Other Drugs for Southeast Asian and Drive Students Year: 1995 Year: 1995 Format: Poster Format: Classroom Material Topic: Alcohol and Prevention Length: 220 Pages TargetAudience: Asian and Pacific Island- Topic: ATOD Prevention, Intervention, and ers, General Public Treatment Availability: Asian American Recovery TargetAudience: Educators ofStudents Services, Incorporated, 785 Market Street, 10th Floor, San Francisco, CA Grades6-12, Asian/Pacific Islander Americans 94103; 415-541-9285 Language: English, SomeVietnamese and 1 his attention-getting poster is of a Khmer skeleton head and hands holding a beer Availability: Metropolitan Indochinese Chil- can and the steering wheel of a car. The dren and Adolescent Services, Southeast text reads "Give Lite a Chance. Don't Asian Family Empowerment Project, 254 Drink and Drive," in seven Asian lan- Adams Street, Dorchester, MA02212; guages: Chinese, Khmer, Korean, Japa- 617-825-1861. nese, Tagalog, Laotian, and Vietnamese. 1 his curriculum was designed to ad- ATOD dress primary prevention of Mother and Child With Heart problems among Vietnamese and Cam- Organization: National Women's Resource bodian youth enrolled inbilingual pro- A Centerforthe Prevention ofAlcohol,To- grams. culturally specific approach bacco, and Other Drug Abuse and was used because it takes into account Mental Illness particular learning needs ofSoutheast Year: 1993 Asian youth, some ofwhom have expe- Format: Poster riences as refugees and immigrants. Context: Part ofthe "Embrace Life" Poster These experiences contribute to the de- ATOD Series velopment of problems. This Topic: Alcohol,Tobacco, and Other Drug approach is also necessarybecause of ATOD Prevention the difference in use patternsbe- Language: English tween American society andSoutheast TargetAudience: PregnantWomen, Gen- Asians. Southeast Asian youth in eral Public America are athigh risk for ATOD Availability: National Women's Resource problems because of factors such as Center, 515 King Street,Suite410,Alex- family fragmentation and limited Eng- andria,VA 22314; 703-836-8761 lish proficiency. Asian and Pacific IslanderAmericans Page 3 Opening Doors: Techniques for The Journey Talking with Southeast Asian Year: 1995 Clients about Alcohol and Format: Videotape Other Drug Issues Length: 10 Minutes Topic: ATOD Prevention Year: 1994 TargetAudience: Cambodian Parents and Format: Videotape and Guide Children TLoepnigct:h:AT1OHDouPrre/v7e0ntPiaogn,esIntervention, and Language: English and Khmer Availability: Khmer Health Advocates, Inc., Treatment 545 ProspectAvenue, West Hartford, CT TargetAudience: Asian/Pacific Islander 06105; 800-50-KHMER. Americans, Prevention orTreatment Professionals, Health Care Providers, 1 heJourneyis a tribute to the suffering Community Service Groups, High-Risk and courage of the Cambodian people; Families, and High-Risk Youth its theme ofhope and family is a power- Language: English, Vietnamese, Khmer ful prevention message. This music Availability: Metropolitan Indochinese Chil- video, written and performed by a dren and Adolescent Services, Southeast group ofCambodian youth ages 6-21, Asian Family Empowerment Project, 254 weaves the past and present, the mod- Adams Street, Dorchester, MA 02212; ern and the traditional. They chose not 617-825-1861. to directly address drugs and alcohol, but to show the reasons why Cambo- 1 his video demonstrates assessment dian families should choose not to use and early intervention methods for them Southeast Asian human service provid- ers working with Southeast Asian cli- ents. Success is achieved by the provid- ers (1) becoming more active in trie early identification, referral and intervention AOD of problems and (2) recognizing AOD the unique aspects of problems within Southeast Asian communities. The accompanying video guide pro- vides information for agency staffwho use the video for training or discussion. The booklet also contains questions from the video and teaching points em- phasized on the tape. Supplemental material on substance abuse in the Southeast Asian community, as well as general substance abuse issues, is in- cluded. Page4 Forfurther information,writeto NCADI, P.O. Box 2345 Rockville, MD 20847-2345 , and Studies, Articles, on and Reports Asian Americans Pacific Islander Government Publica- and (10) Defining Cultural Competence: and An Organizing Framework (M.A. Or- tions Journals landi). Competence Cultural for Evaluators: A Guide for Alcohol Ethnic Differences in Family Factors Related to Early Drug and Other Drug Abuse Preven- Initiation tion Practitioners Working with Catalano, R.F.; Morrison, D.M.; Wells, Ethnic/Racial Communities. CSAP Cultural Competence Se- E.A.; Gillmore, M.R.; Iritani, B.; Hawk- ins, J.D. rRoiceksvil1le, MD: Center for Substance Abuse JournalofStudiesonAlcohol53(3)208-217 1992 Prevention, 1992. 307 p. Available from NCADI, P.O. Box 2345, 1 he literature on family predictors of MD Rockville, 20847-2345; 800-729-6686; substance use for the general population Inventory number BKD79. is reviewed and compared to findings for three specific ethnic groups: black, J\s an introduction to a series on the is- white and Asian Americans. Rates of sues of implementing and evaluating al- substance use initiation are examined in cohol and other drug abuse (AOD) pre- a sample of 919 urban 5th grade stu- vention programs, this volume inte- dents. Ethnic differences on measures of grates two types of competence for AOD family predictors are examined and sig- prevention practitioners: program nificant ethnic differences are found on evaluation competence and cultural several of these factors. Finally, separate competence. The chapters provide con- regressions for black, white and Asian ceptual frameworks and practical sug- American youths of family factors on gestions for evaluators working with the variety of substances initiated ex- various ethnic groups. Chapters rele- amine ethnic similarities and differences vant to Asian Americans include: (1) in predictors. The results demonstrate The Challenge ofEvaluating Commu- A significant differences by ethnicity in nity-Based Prevention Programs: family management practices, involve- Cross-Cultural Perspective (M.A. Or- ment in family activity, sibling deviance, landi); (2) Of Kindred Minds: The Ties parental disapproval of children's that Bind Q.P. Butler); (8) Cultural Com- drinking, and family structure. The re- petence for Evaluators Working with gression equations identified unique as Asian-American Communities: Some well as common predictors of the vari- Practical Considerations (S. Kim, J.H. ety of substances initiated by the end of McLeod, and C. Shantzis); (9) Cultural 5tn grade. Implications of the results are Competence for Evaluators Working discussed. with Asian/ Pacific Island-American Communities: Some Common Themes and Important Implications (S. Yen); Asian and Pacific IslanderAmericans Page 5 Ethnic and Multicultural Drug or the United States, prevalence rates for Abuse: Perspectives on Current several behavioral risK factors were Research. Part higher for Vietnamese who had re- II settled in the United States, including Trimble, J.E.; Bolek, C.S.; Nlemcryk, rates of smoking (men), no exercise S.J. (Eds.) (both sexes), never having had choles- NewYork, NY: Haworth Press, Inc., 1992. terol checked (both sexes), not knowing 375 p. cholesterol level (women), never having 1 his special issue of Drugs &Society hcaandcerrecscormemeeninndgetdesbtrse(aswtomaennd)c,earvnidcal (6(3/4), 1992) scrutinizes ethnic and never having had rectal exams (both multicultural drug abuse. It contains the sexes). However, rates of alcohol con- following articles: (1) Research on Drug sumption and hypertension (both sexes) Abuse among Asian and Pacific Ameri- and safetybelt non-use (men) were cans; (2) Hispanic Substance Use; (3) Be- lower than for the total population of havioral andPsychological Profiles of California. Cocaine Users upon Treatment Entry; (4) Structural Equation Model ofFactors Related to Substance Use among Ameri- Drug Abuse Prevention Re- can Indian Adolescents; (5) Ethnicity search Concerns in Asian and and Drug- Taking Behavior; (6) Plan- Pacific Islander Populations ning Programs for Prevention of Devi- Kuramoto, F.H. antBehavior; and (7) Overview ofSe- lected Federal Efforts to Encourage Mi- In: A. Cazares and L.A. Beatty, (Eds.) Scien- nority Drug Abuse Research and Re- tific Methods forPrevention Intervention searchers. Research. NIDA Research Monograph 139. Rockville, MD: U.S. Department of Health and Human Services, 1994. 281 p. Behavioral Risk Factor Survey of (pp. 249-272) Vietnamese - California, 1991 Available from NCADI, P.O. Box 2345, MorbidityandMortality WeeklyReport Rockville, MD 20847-2345; 800-729-6686. (MMWR)4 (5)69-72, 992 Inventory number Ml39 1 1 1 o characterize risk factors for selected 1 he Healthy People 2000 objectives for non-infectious diseases and injuries Asians and Pacific Islanders include the among the estimated 280,200 Vietnam- development and implementation of a ese who have relocated to California, a national process to identify the signifi- Vietnamese-language version of the cant gaps in disease prevention and Centers for Disease Control's Behavioral health promotion data for racial and Risk Factor Surveillance System was de- ethnic minorities. There is no process at veloped for use in a computer-assisted present for drug abuse research among telephone interviewing (CATI) system. Asians and Pacific Islanders. Although Findings are summarized from the 1991 there are about 10 million Asians and survey and compared with data for the Pacific Islanders on the U.S. mainland general California or U.S. population. and in Hawaii, Alaska, and the Pacific The questionnaire included 96 questions Islands there is a need for National Insti- covering 10 target areas: sociodemogra- tute on Drug Abuse (NIDA)-supported phics, acculturation, nutrition, exercise, research regarding these populations. tobacco use, alcohol consumption, hy- The lack of Knowledge regarding sub- pertension, cholesterol, safetybelt use, stance abuse among Asians and Pacific and cancer screening. Of 1,705 eligible Islander populations can be addressed persons who were contacted, 1,011 through research applications to NTDA agreed to participate. When compared and other Public Health Service agen- with the total population ofCalifornia cies. Page6 Forfurtherinformation, write to NCADI. P.O. Box2345 Rockville, MD 20847-2345 , Research on Drug Abuse nity infrastructure make treatment ef- among Asian Pacific forts difficult in serving a myriad of Americans Asian groups. For most Asians undergo- ing treatment, cultural factors need to be Zone, N.;Sasao, T. considered, including the involvement Drugs & Society6(3/4)181-209, 1992 of the family as well as the risk related to its transition under immigration and 1 his chapter provides a critical review the following acculturation patterns. An of the selected literature on substance example ofa specific treatment program abuse among Asian Pacific Americans and activity is discussed in relationship with focus on patterns ofsubstance (1) to the cultural factors indicated above. and abuse, (2) the conceptual models Finally, recommendations are specified that may be applicable in explaining the for future treatment policy, research, substance abuse patterns for this ethnic and services. minority population, and (3) the effec- tiveness ofprevention and treatment programs in serving these communities. Conceptions of Alcoholism Each section is concluded by discussing among Koreans and Americans some research issues and strategies that Cho may prove helpful for advancing re- Y.l.j Faulkner, W.R. search on substance abuse within the InternationalJournalofAddiction28(8)681- larger context of Asian Pacific American 94, June 1993 health and mental health. tomographic research has occasionally .fci reported the presence (or absence) ofthe Substance Abuse Treatment: disease concept of alcoholism in non- Cultural Barriers in the Asian- Western cultures. However, the prob- American Community lem of differences in the nature ofthe concept of alcoholism between cultures Ja, D.Y.;Aoki, B. in which it exists has notbeen seriously JournalofPsychoactive Drugs25(1)61-71 investigated. This study contrasts beliefs 1993 about alcoholism among samples ofKo- reans and Americans at a university in Asians constitute the largest growing the United States. The findings suggest minority in the United States. However, that the concept of alcoholism is present inaccurate perceptions and stereotypes inboth cultures, but Koreans tend to re- continue to mask a full understanding strict their disease to the physiological of the state of knowledge regarding consequences oflong-term alcohol use, their alcohol and other drug abuse. while Americans accept a definition Much of the existing research has con- couched largely in social and behavioral tinued this trend by categorizing Asians terms. It thus appears that, in contrast to as "others" or persisting in its attempts America, alcohol consumption in Korea to explain low incidence rates by inves- is relatively high, but alcoholism is rare. tigating metabolic phenomena. More re- The implications of these findings for cent community-based studies have drinkingbehaviors and the diagnosis shown alarming incidence rates of spe- and treatment of alcoholism are dis- cific substance abuse among different cussed. Asian ethnic groups. Asian neterogene- ity and cultural barriers have also con- tributed to the lack of knowledge re- garding substance abuse prevalence rates. Issues related to taboo, denial, and loss of face further mask understanding of the extent of the problem. Institu- tional barriers and the lack of commu- Asian and Pacific IslanderAmericans Page 7 Smoking and the Health Gap in Public Outpatient Mental Health Minorities Services: Use and Outcome Chen, V.W. among Asian Americans AnnalsofEpidemiology3(2)159-64, March Ying,Y.W.;Hu,LJ. 1993 American JournalofOrthopsychiatry V_/ver the past decade, tobacco compa- 64(3)448-55, July 1994 U nies have targeted minority populations se ofpublic outpatient mental health when advertising and promoting their services and treatment outcomes were products, which contam the most studied among Chinese, Japanese, Fili- widely available, legal addictive drug in pino, Korean, and Southeast-Asian the United States. This has contributed Americans in Los Angeles County. Fili- to a greater prevalence of cigarette pinos were underrepresented in the sys- smoking among some minorities and tem, whereas Southeast Asians were lower-income groups. Black males are over-represented and had higher use more likely to smoke than white males rates, but showed less improvement, and more often they smoke hieh-tar than did the other groups. The influence cigarettes. They are also less likely to of therapist-client ethnic match and of quit smoking. Compared to the national clinicians' professional status were as- average, a greater proportion ofHis- sessed andrecommendations made for panic males smoke, but not Hispanic further research based on findings. females. Smoking prevalence rates among Asians andNative Americans are available from local surveys but Effects of Combining Disparate there are no reliable national estimates. Groups in the Analysis of Ethnic Blacks experience substantially higher Differences: Variations among rates ofmortality and morbidity from Asian American Mental Health all causes, heart disease, stroke, and Service Consumers in Level of smoking-related cancers as well as ad- Community Functioning verse pregnancy outcomes. Substan- tially lower rates ofdeath from heart Uehara, E.S.; Takeuchi, D.T.; Smukler, disease, stroke, and cancers are ob- M. served among Asians and Native American JournalofCommunityPsychology Americans than among whites. Dispari- 22(1)83-99, February 1994 ties in cigarette smoking among racial and ethnic groups do not mirror the ob- 1 he Asian Americanpopulation com- served racial and ethnic disparities in prises historically, socially, and cultur- mortality. Other health risk factors, ac- ally diverse ethnic groups. Given this cess to medical care and premature diversity, investigators caution that death from other causes, may partially combining disparate ethnic groups may explain the morbidity/mortality gap be- lead to erroneous conclusions. Whether tween minorities and nonminorities. by choice or necessity, however, mental Reliable national estimates on smoking health studies still typically consider prevalence and morbidity and mortality Asian Americans as a single ethnic cate- among minorities are needed. The role gory rather than as separate ethnic oftobacco use in the etiology of diseases roups. Few investigations have ad- that are disproportionately prevalent fressed the consequences of this prac- among minorities should be studied. tice. This paper examines the implica- Culturally sensitive and acceptable tions of conceptualizing Asian Ameri- smoking interventions should be devel- cans as an ethnic category versus ethnic oped with the involvement ofminori- groups, in an investigation of the com- ties. munity functioning status ofclients in publicly funded mental health programs Page8 Forfurtherinformation,writeto NCADI. P.O. Box 2345 Rockville, MD 20847-2345