Etiology and Prevention of Substance Use Among Asian American ...

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Prevention Science [PREV]

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Style file version Nov. 04, 2000

Prevention Science, Vol. 2, No. 1, 2001

Etiology and Prevention of Substance Use Among Asian American Youth Tracy W. Harachi,1,2 Richard F. Catalano,1 Sunah Kim,1 and Yoonsun Choi1

Among populations identified by the U.S. Bureau of the Census, it is anticipated that the Asian/Pacific Islander (API) population will experience the greatest change between 1990 and 2050 (U.S. Bureau of the Census. [1996, February]. Current population reports. Series P25-1130. Washington, DC: U.S. Government printing office). Limited studies focus on APIs as a racial group and still fewer disaggregate samples to specific ethnic Asian subgroupings. This paper begins with definitions of the API communities, then examines rates of adolescent drug use, risk and protective factors, and preventive intervention effectiveness focused on API communities. The limited epidemiological data suggest that in general, APIs are at a relatively lower risk for drug use than youth from most other ethnic groups. However, the available data also suggest that use may not be as low as generally assumed with rates for alcohol use, smoking, and some illicit drugs being equal to or exceeding those of African Americans and European Americans. Despite the paucity of available data on particular Asian subgroups, the available data demonstrate that there are differences among API subgroups, underscoring the importance of identifying Asian subgroups when studying substance use and when planning prevention and treatment. The limited data examining the etiology of drug use across API subgroups suggests that some of the risk and protective factors derived from majority based research may also be predictors for these populations. These data support the utility of examining the generalizability of existing tested prevention approaches among different API communities. Finally, further efforts should be made to encourage and support the evaluation of community-based programs that already target and deliver services to API youth. KEY WORDS: etiology; prevention; substance use; Asian American youth.

INTRODUCTION

ventions. They note that studies of the prevalence and incidence of drug use within ethnic groups provide important information on developmental points at which initiation or escalation occurs. This information can help determine the optimal timing of preventive interventions for different ethnic groups by mounting, for example, universal prevention efforts just prior to the developmental period when initiation occurs or escalates. Secondly, research can investigate the relative importance of risk and protective factors for different ethnic groups. Those that are significant and strongly related to use provide important targets for prevention activities. Thirdly, they suggest that comparative research on the effectiveness of preventive interventions for different ethnic groups can provide important information about the appropriateness of

This paper examines drug use initiation and frequency of use, risk and protective factors for substance use, and the effects of substance use preventive interventions for Asian American youth. This paper is organized according to the criteria suggested by Catalano and colleagues (1993) for research to inform the design of ethnically appropriate preventive inter-

1

Social Development Research Group, University of Washington, Seattle, Washington. 2 Correspondence should be directed to Tracy Harachi, Social Development Research Group, University of Washington, 9725 3rd Avenue, N.W., Suite 401, Seattle, Washington 98115; e-mail: [email protected]

57 C 2001 Society for Prevention Research 1389-4986/01/0300-0057$19.50/1 °

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Harachi, Catalano, Kim, and Choi

program recruitment and delivery. Hence, this paper begins with definitions of the Asian Pacific Islander (API) communities, then examines rates, risk and protective factors, and finally, preventive interventions. API is a racial category that has been utilized by the census bureau (Office of Management and Budget—U.S. Department of Commerce, 1978) for the last two decades. Under Directive No. 15, API includes any person having origins as any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. APIs encompass over 60 separate racial/ethnic groups and subgroups (Sue, 1987). It is anticipated that the APl population will experience the greatest change between 1990 and 2050 (U.S. Bureau of the Census, 1996). By the year 2000, it is estimated that the Filipinos, followed by the Chinese, Vietnamese, Koreans, Asian Indians, and Japanese will comprise the largest API subgroups (Kim, 1995).

RATES OF API ADOLESCENT DRUG USE Despite their growing presence in the population, API as an ethnic group category is not currently included in the most extensive surveys of adolescent drug use, such as the National Household Survey on Drug Abuse (NHSDA) sponsored by the Substance Abuse and Mental Health Services Administration and the Monitoring the Future Study (MTF) sponsored by the National Institute on Drug Abuse. However, there are a few state and local epidemiological surveys with Asian American samples. Examples include the 1983 and 1990 New York State surveys of secondary students (Barnes & Welte, 1986; Barnes et al., 1993; New York, 1991; Welte & Barnes, 1987), the 1985–89 National High School Seniors Survey (Bachman et al., 1991) and the Washington State Survey of Adolescent Health Behaviors (Einspruch & RMC Research Corporation, 1999). Skager and Austin (1993) conducted the 1991 California Student Substance Use Survey (CSS), which provides comparison data on 586 Asian Americans 9th and 11th graders and is summarized by Austin (1999). According to the CSS (Austin, 1999), Asian Americans generally report the lowest prevalence rates among ethnic populations across ten categories of licit and illicit drugs. However, in some categories (e.g., weekly drinking of any alcohol [11%]; heavy drinking in last 2 weeks [14%]; daily or past month smoking rates [20%]; cocaine [4%], amphetamine [4%], LSD [3%], and inhalant [8%] use in past

6 months) Asians equaled or exceeded rates reported by African Americans, which was the next lowest use group. These data also suggest that Asian American youth who do drink are relatively heavy consumers. A similar finding was reported by the 1983 and 1990 New York surveys of secondary students. Additionally, these data suggest that while Asian American females generally have amongst the lowest drug prevalence rates, rates for cigarette smoking (19%) and illicit (19%) drug use were similar to those of Asian American males (20% and 20%) and higher than those of African American females for cigarette use (16%), cocaine (5% for Asian American females vs. 3% for African American females), amphetamines (3% vs. 1%) and LSD (1.5% vs. 0.4%). Data from the Minority Youth Health (MY Health) project in Seattle (National Institute on Child Health and Human Development and Office of Minority Programs, R.F. Catalano, Principal Investigator) included a sample of 2,542 urban middle school students (grades 6–8), 713 (28%) of the sample selfidentified as European American, 551 (22%) as API, 455 (18%) as African American, 60 (2%) as Hispanic, 22 (1%) as Native American, and 741 (29%) as bi- or multiracial. The 1994 youth survey contained a number of items related to drug and alcohol use, specifically age of initiation, frequency of binge drinking (5+ drinks) in the past month, and age when first drunk or high. See Table 1 for frequencies of these items by ethnicity. API students were less likely to have initiated use of alcohol, marijuana, or to have sniffed glue in comparison to European Americans and African Americans. API students were less likely to report binge drinking (5.7%) in comparison to European Americans (6%) and African Americans (10%). Additionally, API students were less likely to report ever being drunk or high (11.6%) in comparison to European Americans (15.8%) and African Americans (18.5%). Table 1. Item Frequencies and Means by Ethnicity Yes (%) White Black Asian Have you ever smoked a cigarette? Have you ever drank alcohol? Have you even used pot? Have you ever sniffed glue? Have you even used crack or cocaine? Have you ever gotten drunk or high?

33.29 43.78 11.29 8.00 1.30 15.80

Past month, how many times did you have more than 5 drinks?a

6.0

a

Figures represent mean values.

40.23 36.28 49.54 37.62 22.63 8.23 7.00 6.60 0.90 1.90 18.54 11.56 10.0

5.7

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Etiology and Prevention of Substance Use Among Asian American Youth They were slightly more likely (36.3%) to have ever smoked cigarettes than European Americans had (33.3%), but less than African Americans had (40.2%) at this age. API students were more likely to have used crack/cocaine (1.9%) in comparison to European Americans (1.3%) and African Americans (0.9%) though group differences were not statistically significant. In terms of age of initiation of the various substances, there was only one statistically significant group difference for age when student first drank with European Americans reporting the earliest initiation (mean = 10.1 years, SD = 1.93), followed by African Americans (mean = 10.5 years, SD = 1.92) and APIs (mean = 10.6 years, SD = 1.99). In terms of drug use progression, API students tended to begin drinking first, or about the same time as initiating cigarette smoking and glue sniffing before moving on to marijuana. Few studies allow for the examination of drug use by Asian subgroups. Austin (1999) provides data from the CSS (9th and 11th graders) for disaggregated Asian subsamples, including Chinese, Filipino, Japanese, Korean, Pacific Islander, and Southeast Asian (see Table 2). In general, Pacific Islanders appear to be the most drug involved subgroup with rates equivalent to those of non-Asian Americans with the

exception of cocaine and amphetamines. On the other hand, Southeast Asians and Chinese students generally reported the lowest rates. Sasao (1994, 1999) reported on a sample of high school Vietnamese and Chinese students (n = 953). As expected, these students had significantly lower use of cigarettes as well as lifetime use of alcohol than did Hispanic and European American students. In this sample, the 30-day use of cigarettes and marijuana in the past 12 months are significantly higher for Vietnamese (means 0.45 and 0.67) than for Chinese (means 0.29 and 0.47) though the sample sizes are quite small. On the other hand, alcohol use was similar between the two subgroups with the mean value for 30-day use being 0.24 for Vietnamese and 0.28 for Chinese. A disaggregation of the MY Health (6th–8th grades) Asian racial category allowed for examination of the following subgroups: Southeast Asian (n = 179), Filipino (n = 159), Chinese (n = 103), and other nonspecified Asians (n = 110). See Table 3 for rates of these items for the three identified Asian subgroups. There were significant group differences between the Asian subgroups for rates of initiation. Twentytwo percent of the Chinese subsample had smoked cigarettes, in comparison to 37.8% of Southeast

Table 2. Percentages of Ninth and Eleventh Grade Students Using Substances, 1989 and 1991 California Student Substance Use Survey Samples Combined, by Group Substance use Past 6 months Alcohol Illicit drug Marijuana Cocaine Inhalants Amphetamines Sedatives Past month Smoking Daily Heavy drinkinga,b Any 3 or more times Lifetime use Cigarettesb Illicit drug Alcohol Any substance

Non-Asian Chinese Filipino Japanese Korean Pacific Islander Southeast Asian (n = 8,331) (n = 314) (n = 339) (n = 56) (n = 83) (n = 92) (n = 119) 58.6 17.4 26.9 6.2 11.0 6.6 2.4

20.7 3.9 2.9 1.9 6.7 1.3 0.3

42.6 8.3 13.9 4.1 7.4 4.5 0.9

33.9 5.4 8.9 3.6 8.9 3.6 3.6

42.2 9.9 13.3 1.2 8.5 1.2 2.4

50.0 15.6 23.1 2.2 10.9 2.2 3.3

16.8 8.4 5.0 5.0 6.7 4.2 2.5

27.9 9.6

10.6 1.8

22.8 5.7

14.3 3.6

24.7 5.0

25.0 13.1

10.3 2.7

24.3 8.1

9.1 2.0

14.2 4.5

12.1 0.0

20.0 2.0

35.2 9.3

6.8 3.4

48.2 33.1 82.0 45.1

25.8 3.9 55.3 22.2

39.1 19.8 73.8 28.0

30.3 12.5 58.9 21.2

43.8 18.1 66.3 24.5

57.4 30.8 76.7 50.0

23.9 6.7 47.5 10.9

Source: Skager and Austin (1993); Bachman et al. (1991). a Defined as 5 drinks in a row in the past 2 weeks. b Based on 1991 data only, sample size 584 for all Asians and 4,836 for non-Asians.

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Harachi, Catalano, Kim, and Choi Table 3. Item Frequencies by Group Yes (%)

Have you ever smoked a cigarette? Have you ever drank alcohol? Have you ever used pot? Have you ever sniffed glue? Have you ever used crack or cocaine? Have you ever gotten drunk or high? Past month, how many times did you have more than 5 drinks?a a

SE Asian

Chinese

Filipino

36.78

21.78

45.16

32.16

28.71

49.40

6.43 10.00 2.33

4.00 4.04 1.01

1.30 4.52 1.95

9.36

4.00

18.95

5.9

1.0

9.9

Figures represent mean values.

Asians and 45.2% of Filipinos. A similar pattern was found for students who had reported ever drinking, smoking marijuana, having ever gotten high or drunk, and binge drinking. Southeast Asians reported higher rates for glue sniffing (10%), in comparison to Filipinos (4.5%) and Chinese (4%), and the group difference tended toward significance. There were no significant group differences in terms of age of initiation across the three subgroups. Students across the three groups reported a progression in age from initiating cigarettes at about the same time as alcohol, then sniffing glue, and progressing to marijuana. In summary, findings across these studies suggest that, in general, APIs are at a relatively lower risk for drug use than are youth from most other ethnic groups. However, the available data suggest that use may not be as low as generally assumed with rates for alcohol use, smoking, and some illicit drugs being equal to or exceeding those of African Americans and European Americans. Despite the paucity of available data on particular Asian subgroups, these data demonstrate that there are differences among subgroups suggesting the importance of identifying Asian subgroups in studies and that warrant attention when thinking about intervention programming. For example, Austin’s report of CSS data suggest a much higher prevalence among Pacific Islander students in California. It would be useful to determine whether these rates are similar among Pacific Islanders in other states, including Hawaii or in other U.S. territories and whether rates differ on the basis of immigration patterns. Similarly, there appears to be some inconsistency of results for Southeast Asians in terms of their rank ordering of use among other APIs. It’s likely that

some of the inconsistency may be attributed in part to the grouping of several cultural groups into this category, for example, Vietnamese, Cambodian, Laotion, Hmong, and Mien. Here too, it would be useful to disentangle factors of culture, recency of immigration, and geographic location, which may impact rates of drug use. RISK AND PROTECTIVE FACTORS FOR SUBSTANCE USE AMONG APIs The development of preventive interventions requires a thorough understanding of the etiological risk and protective factors for drug use. A number of variables have been studied for their ability to predict drug involvement. For a comprehensive review of risk and protective factors associated with use see Dryfoos (1990), Hawkins et al. (1995), Hawkins et al. (1992), and Lorion et al. (1991). However, there has been limited research examining the generalizability of known risk and protective factors among API groups. Although some studies have contributed to the examination of similarities and differences in racial/cultural etiological factors (see Catalano et al., 1993; Kim, McLeod, & Shantezis, 1992; Maddahian, Newcomb, & Bentler, 1988; Orlandi, 1986; Trimble, Bolek, & Niemcryk, 1992), few have included API among their comparison samples. Data from the Seattle Social Development Project (Gillmore et al., 1990) examined predictors of substance use initiation among 919 urban 5th graders comparing Asian Americans, European Americans, and African Americans. Availability of marijuana and peer use of alcohol were significantly related to drug use for all three groups (0.069 ≤ b ≤ 0.13 and 0.144 ≤ b ≤ 0.226, respectively). Parental disapproval of drinking was significantly negatively related to use for Asian Americans (b = −0.102), marginally related for European Americans (b = −0.052), but not related for African Americans. Intentions to use drugs as an adult was significantly positively related to drug use for Asian Americans (b = 0.088) and European Americans (b = 0.107), but not for African Americans. Conversely, the belief that one will be caught and punished for drug use appeared to inhibit drug use among African Americans (b = 0.016), but had no relationship for Asian Americans or European Americans. The belief that using drugs helps to make friends and acceptability of use was not associated with drug use for any group. SES, as measured by free lunch eligibility, and gender were not significantly related to initiation for any group. In a separate

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Etiology and Prevention of Substance Use Among Asian American Youth analysis examining family factors with the same outcome, Catalano and colleagues (1992) found absence of a deviant sibling (b = −0.134), living with both parents (b = −0.106), and parents’ disapproval of child’s alcohol use (b = −0.120) to be significantly negatively associated with less drug initiation for Asian Americans. Use of proactive family management, parents revoking privileges, parents’ deciding which friends child sees, and attachment to parents were not significantly associated with initiation for Asian Americans in this sample. In the study reported earlier that focused on a combined sample of high school Vietnamese and Chinese students (n = 953), several factors related to a drug use index (lifetime use of cigarettes, alcohol, and marijuana) were found (Sasao 1994, 1999). These factors included grade point average (b = −0.113), lack of subjective well-being (b = 0.89), parents’ disapproval of substance use (b = −0.106), peers’ disapproval of substance use (b = −0.192), foreignborn status (b = −0.083), perceived interethnic tensions among ethnic groups at the students’ school (b = 0.11), and being male (b = 0.103). On the other hand, ethnic identification, self-esteem, sense of not fitting in, and English as a second language were not associated with use. In another study, Zane et al. (1999) found that psychological maladjustment (b = 0.3), greater acculturation (b = 0.37), and family discord (b = 0.39) were significantly associated with alcohol use among a sample of Chinese and Filipino youth aged 12–18. Additionally, acculturation (b = 0.37) and family discord (b = 0.39) were significantly associated with cigarette use. Within the MY Health data, a drug and alcohol use scale was created by averaging together six items regarding the frequency of the following behaviors: drinking, drinking five or more drinks in one occasion, smoking cigarettes in the past month, using marijuana, sniffing inhalants, use of cocaine or crack, and getting high or drunk in the past year. The relationships between the drug use scale with a variety of risk and protective factors were examined. These factors included parent and child involvement in prosocial activities, parent–child attachment, household rules or expectations, family conflict, parents’ attitudes regarding antisocial behavior, perception of peers’ conventional beliefs, perception of peers’ antisocial beliefs, and ethnic identity. Among the Asian subgroups, the relationships between these factors and the drug use scale were all in the expected direction. The magnitude of these

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relationships, in most cases, were similar across subgroups. The following correlations were significant for each of the subgroups: parent–child attachment ranged from −0.16 to −.2, family conflict (0.19 ≤ r ≤ 0.21), family management (−0.14 ≤ r ≤ −0.21), perception of peers’ conventional beliefs (−0.02 ≤ r ≤ −0.09), and perception of peers’ antisocial beliefs (0.17 ≤ r ≤ 0.28). Parent–child involvement was significant for the Chinese and Southeast Asian subgroups (−0.13 to −0.11 respectively), however, in the same direction but not significant for the Filipino subgroup (r = −0.09). Household rules was significant only for the Filipino subgroup (r = −0.21) though for household rules Chinese (r = −0.1) and Southeast Asians (r = −0.12) were in the same direction. Table 4 highlights a summary of risk factors for substance use and other adolescent problem behaviors derived from research literature (Hawkins & Catalano, 1993). It illustrates that the research to date has only partially examined the relevance of this list of factors among Asian Americans. The limited findings to date do suggest that some of the risk factors and protective factors identified in the literature appear to be relevant for APIs. These include factors residing in the individual and peer domains, as well as those in the family domain. For instance, family conflict or discord was consistently predictive of use, as was parent’s disapproval of drug use among the Asian samples. There is exceedingly limited information that examines relationships among risk and protective factors with disaggregated Asian subgroups. The limited findings suggest some consistency across some subgroups; however, more research needs to be conducted to determine the generalizability of these findings.

IMPLICATIONS FOR PREVENTIVE INTERVENTIONS TARGETING APIs Results from the limited studies that have examined the relationships between predictors and drug use suggest that some of the factors found relevant among European American populations are applicable for API populations. Our analyses, as well as those conducted by Sasao (1994, 1999) and Zane et al. (1999) suggest that appropriate intervention targets include a number of individual and family domain factors derived from research conducted on majority populations. This suggests that a number of strategies shown to be effective in targeting European

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Harachi, Catalano, Kim, and Choi Table 4. Risk Factors for Substance Abuse and Other Problem Behaviors (Hawkins & Catalano, 1993) Risk factors Substance abuse Community Availability of drugs Availability of firearms Community laws and norms favorable toward drug use, firearms, and crime Media portrayals of violence Transitions and mobility Low neighborhood attachment and community disorganization Extreme economic deprivation Family Family history of the problem behavior Family management problems Family conflict Favorable parental attitudes and involvement in the problem behavior School Early and persistent antisocial behavior Academic failure beginning in late elementary school Lack of commitment to school Individual/peer Alienation and rebelliousness Friends who engage in the problem behavior Favorable attitudes toward the problem behavior Early initiation of the problem behavior Constitutional factors

Delinquency

Teen pregnancy

School drop-out

✓

Violence ✓ ✓ ✓

✓

✓ ✓

✓ ✓

✓ ✓

✓

✓

✓

✓

✓

✓ ✓ ✓ ✓

✓ ✓ ✓ ✓

✓ ✓ ✓

✓ ✓ ✓

✓ ✓ ✓ ✓

✓ ✓

✓ ✓

✓ ✓

✓ ✓

✓ ✓

✓

✓

✓

✓

✓

✓ ✓

✓ ✓

✓

✓ ✓

✓

✓

✓

✓

✓

✓ ✓

✓ ✓

✓

✓

✓

American populations may have promise targeting APIs and should be empirically tested for their effectiveness. There is a growing body of empirical research focused on examining the effectiveness of drug prevention strategies. Recently, growing numbers of “lists” of exemplary practices based on a variety of criteria have surfaced [(see e.g., Center for Substance Abuse Prevention Prevention Enhancement Protocol Systems (PEPS; SAMHSA, 1998), National Institute on Drug Abuse Red Book (NIDA, 2000), U.S. Department of Education Promising Approaches (Silva & Thorne, 1997), and Center for the Study and Prevention of Violence Blueprints (2000)]. Unfortunately, there is a paucity of empirical information on the effectiveness of prevention programs targeting APIs. Among 133 program evaluations of drug prevention strategies reviewed between 1980 and 1992, only two reported any results on Asians (Graham et al., 1990; Hansen et al., 1988). Graham and his colleagues (1990), for example, reported consistent program effects among

✓ ✓

✓ ✓

Asian American, Hispanic, African American, and White subgroups of students in an evaluation of Project SMART. Preparing for the Drug Free Years, a parent training curriculum, which has demonstrated effectiveness among primarily European American families (Kosterman et al., 1997; Spoth et al., 1995), has been delivered among an urban Samoan community with positive participant satisfaction although it lacks an outcome evaluation among this group (Harachi et al., 1997). Additionally, the Incredible Years (Webster-Stratton, 1984; Webster-Stratton & Hammond, 1997), which has been delivered among a Head Start population that included a sample of Vietnamese parents, received similar positive participant satisfaction and results of an evaluation are forthcoming (Reid & Webster Stratton, in preparation). Within the past decade, community based organizations located in geographic areas with larger concentrations of APIs (e.g. California, Seattle, Denver, St. Paul) have begun to deliver preventive interventions targeting API youth. Kim et al. (1992) state that

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Etiology and Prevention of Substance Use Among Asian American Youth in the absence of etiological or theoretical research on drug use among API adolescents, “many community-based prevention strategies for Asian-American communities have been devised based on conjectures or intuitions. . . . Some have even been implemented without any real knowledge about whether they actually help deter [substance-using] behavior in Asian American communities” (p. 253). Many of these community-driven programs have focused on indicated populations and delivered a variety of strategies, including case management, academic support, crisis intervention, and parent education. Most programs have had limited resources to conduct rigorous evaluations to assess the effectiveness of these strategies. A few community programs that conducted pre- and posttest evaluations and found positive results in proximal outcomes such as academic performance, however, did not find differences on drug behavior outcomes (Chase & Clement, 2000). Evaluation efforts are further challenged by the lack of manuals or implementation standards of many of these programs, for example, determining what constitutes a minimum level of program exposure. Also, few have enlisted appropriate comparison groups.

CONCLUSION The research examining the prevalence across API subgroups is extremely limited. Catalano and colleagues (1993) suggest as one principal of prevention that strategies target those who are at higher risk. Given this principal, our limited empirical data suggest that interventions targeting Pacific Islanders, Filipinos, and perhaps Southeast Asians may be warranted. The limited epidemiological data suggest that these subgroups have higher rates of use and in some cases rates that may be comparable to European Americans, often the group with the highest prevalence of drug use. It should, however, be underscored that research in this arena is scarce and more studies are needed to determine the generalizability of existing findings and to further investigate issues of prevalence and etiology among subgroups of APIs. Lastly, within-group cultural differences (e.g., urban vs. rural regions, socioeconomic status, immigration pattern and status, and gender) are also important to investigate. Dent and colleagues (1996) suggest that cultural sensitivity in drug abuse prevention programming is both desirable and necessary to increase program

accessibility and utility. They recommend that further research needs to be conducted to fully address the debate of whether separate new program strategies for specific ethnic groups are necessary. The limited existing data examining the etiology of drug use across API subgroups suggests that a number of risk and protective factors derived from majority based research may also be predictors for these populations. These findings support the utility of examining the generalizability of existing tested prevention approaches among different APl communities. However, as Catalano et al. (1993) point out, if these strategies are used, attention should be paid to utilizing appropriate recruitment and communication strategies. Lastly, further efforts should be made to encourage and support the evaluation of community-based programs that already target and deliver services to API youth. At present, the empirical research on the prevalence, etiology, and prevention of substance use among Asian American youth is in its infancy. Among the limitations of the extant research is the lack of data from national surveys. Without these data, it remains questionable whether the findings from regionally limited samples are generalizable. Also, small sample sizes from Asian subgroups in existing studies preclude the testing of more complex etiological models. Finally, there is a dearth of experimental evaluations on prevention interventions that employ an experimental design and test intervention effectiveness with respect to specific Asian American subgroups. Given the anticipated growth in the API population, it is critical that resources be expended to encourage greater etiological and prevention research focused on these communities. Further, researchers need to acknowledge that the use of “Asian” as an ethnic category may mask the true differences that exist among the 60 plus separate racial/ethnic groups and subgroups that comprise this category. Therefore, future research should not merely focus on the etiology and prevention of drug use among API youth as a group, but should study particular racial/ethnic subgroups of Asian American youth.

ACKNOWLEDGMENTS This research was supported by grant number 5 UO1 HD30097 from the National Institute of Child Health and Human Development and the Office of Minority Programs.

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P1: GDB/GAY

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