i ;^*_ United States General Accounting Office * Fact Sheet for the Chairman, Select ; -GA!0 Committee on Hunger, House of ‘;, : .: Representatives .:.i ‘-.‘..,’ <.x:: :+,I,’ C.‘. :,: $$@.~~;~,.~:~~; ‘:’1,_ I; ,1,’ ..‘:,. j y&” +$!&q. ?. : :.:., “._ “c&4- .:;:r 3, ,-::;*i -ia. .,. -: i:-I(..:. ._j.:;. =;~~~*~, j’::es, ‘. ASIAN AMERICANS A Status Report RESTRICTED-- Not to be released outside the General Accounting Office unless specifically approved by the Offke of Congressional Relations. GAO United States General Accounting Office Washington, D.C. 20548 Human Resources Division B-237669 March 8, 1990 The Honorable Tony Hall Chairman, Select Committee on Hunger House of Representatives Dear Mr. Chairman: As requested April 7, 1989, by the late Chairman of the Select Commit- tee on Hunger, Representative Mickey Leland, and as subsequently agreed with your office, this fact sheet provides information about the status of Asians in the United States-hereafter referred to as Asian Americans. Specifically, we were asked to provide information on Asian American . income, employment, education, health, and nutrition status and . enrollment in nine federal welfare programs: Aid to Families With Dependent Children; Supplemental Security Income; Medicaid; Low- Income Housing; Food Stamp; the Special Supplemental Food Program for Women, Infants, and Children; School Lunch; School Breakfast; and Summer Food. In addition, we were asked to identify (1) possible barriers to Asian American participation in the above programs and (2) existing pro- grams, in selected communities, to assist new Asian immigrants and ref- ugees in achieving economic self-sufficiency. We reviewed available studies; spoke with federal, state, and local offi- Review Scope and cials, as well as nonprofit Asian American organizations and other com- Methodology munity organizations; and analyzed available data from the U.S. Bureau of the Census. We also obtained information about the laws and regula- tions, eligibility criteria, and funding for federal programs that assist immigrants and refugees. We used the Census Bureau’s definition of Asian Americans, which includes all people who categorized themselves as from 1 of 28 Asian countries of origin or ethnic groups or from 1 of 25 identified Pacific Island cultures (see table 1.1 and footnotes). In 1980, the Chinese, Filipino, Japanese, Indian, Korean, and Vietnamese groups accounted for about 89 percent of the Asian American popula- tion. (See pp. 12-19.) Page 1 GAO/HRD!W36FS Asian Americans B-237669 Available information indicates that Asian Americans overall are com- Results in Brief parable with the U.S. population overall for per capita income, employ- ment, educational attainment, general health and nutrition status, and participation in U.S. public assistance programs. However, data on Asian Americans are limited, primarily because (1) Asian Americans make up a small portion of the total U.S. population and (2) available studies, for the most part, do not contain sufficient data about Asian Americans to make statistically valid projections nationwide. Data on Asian Americans by country of origin or ethnic group generally are not available except for the 1980 census, which reveals wide varia- tions among people from different groups. For example, recent arrivals from Southeast Asia (Cambodia, Laos, and Vietnam) have lower incomes and educational levels, as well as higher poverty, unemployment, and welfare-program participation rates than other Asian American groups. Barriers to welfare programs exist, but do not prevent Asian American enrollment. Various federal, state, and local programs have been established to help new arrivals adjust to life in the United States, enroll in public assis- tance programs, and achieve self-sufficiency. Although the average household income for Asian Americans was 28 Income and percent higher than the U.S. average in 1985, the average size of the Employment Asian American household was larger. Thus, on a per capita basis, Asian American income was about the same as the national average. Incomes varied widely among Asian American groups, however. For example, data from the 1980 census showed that, in 1979, the average annual per capita incomes for Indian and Pakistani Americans were over $8,000, compared with the national average annual per capita income of $7,400. On the other extreme, Southeast Asian groups had average annual per capita incomes ranging from $1,600 for Laotian Americans to $3,200 for Vietnamese Americans. The same patterns emerged for employment. In 1980, Asian American adults aged 16 and over had slightly lower unemployment rates and were somewhat more concentrated in white-collar occupations overall than U.S. adults. However, among some Asian American groups, such as the Laotians and Cambodians, the unemployment rate was much higher and the percentage employed in white collar occupations was much lower. (See pp. 20-25.) Page 2 GAO/HRD-90-36s Asian Americans B-237669 In 198.5, Asian American adults over the age of 25 had an average of Educational Levels of 12.27 years of education. This compared favorably with the total I1.S. Adults adult population over the age of 25, which had an average of 12.39 years of education. However, a greater proportion of Asian American adults (48.4 percent) had attended college than the total U.S. adults (38.4 percent). Again, wide variation exists among Asian American groups. A 1982 Department, of Health and Human Services (1~s) study showed that over 75 percent of Southeast Asian adults emigrating from Vietnam between 1978 and 1982 had less than a high school education. HHS officials told us that Southeast Asians who came later had even less education. (See pp. 26-28.) Although national statistics on Asian American disease and death rates Health and Nutrition generally are lacking, data suggest that their health and nutrition Status appear at least as good as the U.S. population’s in general. Available data show that Asian Americans have longer life expectancy, lower death rates from all causes, and lower infant mortality rates. Data on the nutritional status of Asian American children show it to be compar- able with U.S. standards. However, Southeast Asian refugees suffer higher rates of tuberculosis and hepatitis B than the U.S. population as a whole and experience more nutritional and mental health problems. (See pp. 29-37.) Asian Americans made up from 1.4 to 3.4 percent of all participants in Welfare Program the welfare programs we reviewed. In 1985, about the same percentage Participation of Asian Americans as the total U.S. population participated in these programs. However, a large proportion-58 percent to 73 percent-of recently arrived Southeast Asian refugees participate in special assis- tance programs established specifically to help refugees. (See pp. 38-42.) Asian American community groups we spoke with said that some Asian Barriers to Program Americans experience difficulties and delays enrolling in welfare pro- Participation grams, primarily because of a limited knowledge of English. In addition different attitudes toward welfare and government make some Asian Americans reluctant to enroll. However, such obstacles generally do not prevent eventual participation; the groups with the most language diffi- culties have among the highest participation rates in welfare programs. (See pp. 43-46.) Page 3 GAO/HRD90-36FS Asian Americans ES-237669 In fiscal year 1988, federal agencies provided almost $150 million to vol- Programs to Assist untary agencies and, through the states, to nonprofit, community orga- New Arrivals nizations for services to help new arrivals overcome obstacles to self- sufficiency. Such services include resettlement, English language instruction, job training, and job placement. Other federal grant moneys are also available to enable school districts, local government agencies, and community organizations to provide employment training for low- income or limited English-speaking people. In addition to using federal funds, community organizations use funds from a variety of other sources-states, cities, and counties, private donors, and grants from corporations and charitable organizations-to help new arrivals in their communities. (See pp. 47-53.) As agreed with your office, unless you publicly announce its contents earlier, we plan no further distribution of this fact sheet until 30 days after its issue date. At that time, we will send copies to interested par- ties and make copies available to others on request. If you have any questions about this fact sheet, please call me on (202) 275-1793. Other major contributors are listed in appendix VIII. Sincerely yours, Franklin Frazier Director, Income Security Issues (Disability and Welfare) Page 4 GAO/HRD-9036FS Asian Americans Page 5 GAO/HRD-90-36s Asian Americans ~- Contents Letter 1 Map of Asia and the 10 Pacific Islands Section 1 12 Introduction The Asian American Population 12 Objectives, Scope, and Methodology 16 Section 2 20 Overall Income and Income and Poverty Rates 20 Unemployment and Occupation 23 Employment Status Comparable With U.S. Population, but Varies Widely Among Asian American Groups Section 3 at; Overall Adult Educational Levels Same or Higher Than Total U.S. Adults, but Vary Widely Among Asian American Groups Section 4 29 Health and Nutrition Health Status of Asian Americans Reported to Be Good 29 Nutrition Status of Asian American Children Reported to 33 Appear to Compare Be Generally Comparable With U.S. Standards Well With U.S. Health and Nutrition Problems Cited for Southeast Asians 34 Population Overall, Except for Southeast Asian Refugees Page 6 GAO/HRD-SO-36FS Asian Americans Contents Section 5 Welfare Participation Approximates Representation in U.S. Population Section 6 43 Barriers Exist, but Do Limited Knowledge of English Causes Most Difficulties 43 Certain Attitudes Make Some Asian Americans Reluctant 4.5 Not Prevent Welfare to Accept Welfare Participation Section 7 47 Programs Help New Federal Agencies Fund Special Programs for Refugees 47 Examples of Programs Assisting Asian Americans in Five 50 Arrivals Attain Localities Economic Self- Sufficiency Appendixes Appendix I: Chronology of Selected U.S. Laws and 54 Presidential Actions Affecting Asian Immigration to the United States Appendix II: Data Limitations 56 Appendix III: SIPP Methodology 57 Appendix IV: Asian American and Other Local 61 Community Organizations GAO Contacted Appendix V: Detailed Statistics on Asian American 62 Education Appendix VI: Cancer Deaths per 100,000 Population 63 (1978-81) Appendix VII: Cultural and Religious Barriers Facing 64 Southeast Asian Refugees Seeking Medical Treatment Appendix VIII: Major Contributors to This Fact Sheet 65 Bibliography 66 Tables Table 1.1: Asian Americans by Yational or Ethnic Origin 13 (1980) Page 7 GAO/HRD-SO-36FS Asian Americans Contents Table 1.2: ,4sian Immigration by Country of Origin 16 (198188) Table 1.3: Areas of Greatest Concentration by Large 19 Immigrant Asian Groups (1980) Table 2.1: Average Annual Household and Per Capita 22 Income of Asian Americans, by National Origin or Ethnic Group (1979) Table 2.2: Percentage of Asian American Families With 23 Incomes Below the Poverty Level, by National Origin or Ethnic Group (1979) Table 2.3: Occupations of Asian Americans (1980) 24 Table 3.1: Educational Levels of Asian Americans Aged 26 25 or Over, by National Origin or Ethnic Group (1980) Table 3.2: Educational Levels of Southeast Asian 27 Refugees, Aged 17 or Over, Upon Entry to the United States (1978-82) Table 3.3: Department of Education Programs for Refugee 28 and Immigrant Children Table 4.1: Nutrition-Related Abnormalities Among 33 American Children, Through 9 Years of Age, in Selected States, by General Ethnic Group (1979-83) Table 4.2: Disease Rates Among Southeast Asian Refugees 35 Compared With Whites, Blacks, and the Total U.S. Population (per 100,000 Population) Table 5.1: Asian American Participation in U.S. Public 39 Assistance Programs Table 6.1: Asian Americans’ Ability to Speak English, by 44 National Origin or Ethnic Group (1980) Table 7.1: Major Federal Grant Programs That Help 48 Refugees Attain Self-Sufficiency Table 7.2: Funding of Major Federal Refugee Grant 49 Programs Table 7.3: Examples of Federally Funded Job Training 50 Programs for People With Low Income or Limited English Proficiency Table III. 1: SIPP Data Used in Analysis 58 Table 111.2:Sampling Errors for SIPP Data 59 Table V. 1: SIPP Data on Educational Levels of Asian 62 Americans Compared With the Total U.S. Population, Aged 25 or Over (1985) Page 8 GAO/HRDM-36FS Asian Americans Contents Table V.2: Annual Housing Survey Data on Educational 62 Levels of Asian Americans Compared With the Total 1J.S.Population, Aged 25 or Over (1987) Figures Figure 1.1: Immigration to the United States (Fiscal Years 1981-88) Figure 2.1: Comparison of Average Monthly Household and Per Capita Incomes for Asian Americans and Total U.S. Population (1985) Figure 2.2: Comparison of Household Sizes for Asian 21 Americans and Total U.S. Population (1985) Figure 4.1: Life Expectancy of Asian Americans 30 Compared With White Americans in California (1960) and Hawaii (1980) Figure 4.2: Mortality Rates for White, Black, and Asian 31 Americans (1979-8 1) Figure 4.3: Infant Mortality Rates for White, Black, and 32 Asian Americans (1986) Figure 4.4: Mean Height-for-Age of Asian Americans 34 Compared With U.S. Standard (1981-89) Figure 4.5: Study of Southeast Asian Refugee Mental 37 Health h’eeds in California (1986-87) Figure 5.1: Asian Americans Receiving Benefits From 40 Selected U.S. Public Assistance Programs (1985) Figure 5.2: Participation of Southeast Asian and Other 42 Refugee Groups in Selected U.S. Public Assistance Programs (1987) Abbreviations AFDC Aid to Families With Dependent Children CDC Centers for Disease Control GAO General Accounting Office HHS Department of Health and Human Services JTPA Job Training Partnership Act ORR Office of Refugee Resettlement PHS Public Health Service SIPP Survey of Income and Program Participation SSA Social Security Administration SSI Supplemental Security Income WC Special Supplemental Food Program for Women, Infants, and Children Page 9 GAO/HRD-So-36FS Asian Americans Map of Asia and the Pacific Islands Y, I lndla Phlllpplnes A r (I h i a tz Sea . Sri Lanka Maldives 5 I n d i a n 0 c e a n Page 10 GAO/HRD-SO-36FS Asian Amrricans P a c i f i c 0 c e a n Hawaii &-OS -I. 0 . 0 Wake *= Mariana Islands b Trust Territory \ Guam of the Pacific Islands -0 44 k, Marshall Yap i ,Islands . l - v_* C 0 B *** /- 4 Caroline Islands . Palau 0 / r) e L s New Guinea i a 3 CD \a b \ .h Solomon Islands Tokelau 0 d, / b Western /’ Samoa o Q American 9 Samoa s Tahiti a /’ 8. Tow ’ Fiji * Page 11 GAO/HRD90-36FS Asian Americans Section 1 Introduction Asian Americans, including Pacific Islander Americans, numbered 3.7 The Asian American million or 1.6 percent of the LJ.S.population, according to the most Population recent census in 1980. Subsequent survey data from the U.S. Bureau of the Census indicate that by 1985, the Asian population in the IJnited States had increased to about 5.9 million or 2.5 percent of the U.S. popu- lation. As shown in table 1.1, the Census Bureau records data for people who classify themselves as from 1 of 28 Asian countries of origin or ethnic groups or from 1 of 25 identified Pacific Island cultures (see map on pp. 10 and 11). The Chinese, Filipino, Japanese, Indian, Korean, and Vietnamese groups accounted for about 89 percent of Asian Americans in 1980. A large portion of the Asian American population is foreign born, in part because of legislation restricting Asian immigration before 1965 (see app. I). Page 12 GAO/HRD90-36FS Asian Americans Section 1 Introduction Table 1.1: Asian Americans by National or Ethnic Origin (1980) Percent National or ethnic origin’ Population Total Asians Foreign born Chinese 812.178 22 63 Flliplno 781,894 21 65 Japanese 716,331 19 28 ~..---~ lndlanb 387,223 10 70 Korean 357,393 16 82 --.~~ -. - Vietnamese 245,025 7 90 Hawaiian 172,346 5 2 Laotian 47,683 1 94 Thai 45,279 1 82 Samoan 39,520 1 36 -~ Guamanlan 30,695 1 10 -- --. --~.- Cambodian 16,044 c 94 __- PakIstani 15,792 c 85 lndoneslan 9,618 c 83 -_____- Tonqan 6,226 75 Hmong” 5,204 c 91 Other Mtcroneslane 4,813 c 44 Melanesian’ 3,311 c 81 Other Polynestang 2,186 c 5 All other Asian Americans” 27,679 1 Total Asian Americans 3,726,440 100 “Based on respondents’ classlflcatlon of themselves. “Includes only those who tdentlfied themselves as AsIan Indian ‘Less than 1 percent “The Hmong are a hllltop tribe who migrated to northeast Laos from Chlna and Vietnam in the first part of the 19th century Thetr culture IS dlstlnct from that of other Laohans. elncludes Carolmlan, Salpanese. TInIan Islander, Marshallese, Blkinl Islander, Entwetok Islander, Kwajaleln Islander Mlcronesian, Palauan, Ponapean, Tarawa Islander, Trukese, and Yapese. These groups are not reported separately by the Census Bureau. (Guamanlan, also a Mlcroneslan group, IS reported separately ) ‘Includes FIJIan, Melanesian. Papua New Gulnean. Solomon Islander, and New Hebrides Islander These groups are not reported separately by the Census Bureau. glncludes Polynesian, TahItIan. Tokelauan These groups are not reported separately by the Census Bureau (HawaIIan, Tongan. and Samoan-which are also Polynesian groups-are reported separately ) ‘Includes Bangladeshi, Ehutanese, Bornean, Burmese, Celebesban. Cernan, Indochmese. Iwo Jiman, Javanese, Malayan, Maldivlan, Nepall. Oklnawan, Slkklm, Singaporean, Sri Lankan, and other Asian Americans Although the Census Bureau collects data on each of these lndivldual groups, It does not publish the data on them separately Data not avallable. ‘May not add due to rounding. Source Census Bureau, Aslan and Paclflc Islander Population tn the United States, 1980 (1988). Page 13 GAO/HRD-90-36F’S Asian Americans Section 1 Introduction In 1965, new legislation reopened the door to Asian immigrants, with preference to those with relatives in the United States and highly skilled professionals. Data from the Immigration and Naturalization Service indicate that of the recent growth in the Asian population in the United States, about three-quarters is from immigration. Since the 1980 census, more refugees and other immigrants have come to this country from Asia and the Pacific Islands than from any other region of the world,’ A as shown in figure 1.1. Nearly half of the immigration from Asia and the Pacific Islands is due to the large influx of Southeast Asians from Viet- nam, Cambodia, and Laos, following the Vietnam War. (See table 1.2.) ‘A “refugee” is defined as a person who is outside his or her native country and is unable or unwell- ing to return for fear of persecution on the basis of race, religion, nationality, membership in a partrc- ular social group, or political opinion. (In certain circumstances, people within their native countries may also qualify as refugees.) 8 U.S.C. llOl(aX42). Refugees are admitted to the United States every year in accordance with an overall ceiling established by the President in consultation with the Con- gress. 8 USC. 1157(a)(2). ‘An “immigrant” is defined as any alien (including refugees) except those that belong to certain specr- fied classes, such as foreign government officials, tourists, or students. 8 USC. 1lOl(aX15). Except for several classes of immigrants, since 1980 the number of immigrants admitted to the United States annually has been limited to 270,000. Of this number, there are quotas, based on family relatronshrps or job skills, for various preference groups. Although there is an annual limit of 20,000 from any one country, there are no more discriminatory quotas based on country of origin. 8 U.S.C. 1151(a L 1152(a). Page 14 GAO/HRD-SO-36FS Asian Americans Section 1 Introduction Figure 1.1: Immigration to the United States (Frscal Years 1981-88) 2500 immigrants in Thousands 1 Other immigrants Refugees dThe Census Bureau defrnrtron of Asra/Pacrfrc Islands was used hlncludes the countries of Afghanistan, Bahrarn, Cyprus, Iran, Iraq, Israel, Jordan, Kuwart Lebanon, Oman, Palestme, Qatar, Saud1 Arabra, Syria, Turkey, United Arab Emirates, Yemen (Aden) and Yemen (Sanaa) %cludes rmmrgrants from countrres outsrde these regrons, such as Australia and New Zealand, lmmr- grants from unknown countrres of ongin, and stateless rmmrgrants. Source U S Department of Justrce. Statrstrcal Yearbooks of the lmmtgratron and Naturaltzatron Servrce (1981-88) Page 15 GAO/HRD-90-36Fs Asian Americans Section 1 Introduction Table 1.2: Asian Immigration by Country of Origin (1981-88) Percent of total Asian Country of origin Immigrantsa immigrantsb Southeast Asia: Vtetnam 549 462 23 Cambodia 222,642 9 Laos (tncludtng Hmong) 207.713 9 Subtotal 979,817= 42c Other Asian countries and Pacific Islands: Phtltpptnes 374,523 16 Chtna” 343,607 15 Korea 272,355 12 lndra 200,038 9 Thatland 48,188 2 Paktstan 43,714 2 Japan 32,669 1 lndonesta 9,319 Tonga 4 343 Samoa 2.147 Guam 5 Other 41,458 2 Subtotal 1,372,366 58 Total Asian immigration 2,352,183 100 %cludes refugees bMay not add due to roundrng. ‘in addrtton, about 166,700 Southeast Asrans arrived durrng 1980, and most were not counted In the 1980 census, accordtng to R W. Gardner G Rogey. and P C Smith Asian Amencans Growth. Change, and Drversrty,‘~ Populatron Bullettn (1985) dlncludes emtgratton from Tarwan, Hong Kong, and Macau ‘Less than 1 percent Source U S Department of Justrce, lmmigratron and Naturalrzatton Service, Stattstrcal Yearbooks of the lmmrgratton and Naturalization Servrce (1981-88) The objective of our review, requested by the late Chairman, House Objectives, Scope, and Select Committee on Hunger, was to assess the status of Asian Ameri- Methodology cans. Specifically, we were asked to provide information on Asian American l income, employment, education, health, and nutrition status and Page 16 GAO HRD-YO-3BFS Asian Americans Section 1 Introduction l enrollment in nine federal welfare programs: Aid to Families With Dependent Children (AFDC); Supplemental Security Income (SSI); Nedi- caid; Low-Income Housing; Food Stamp; Special Supplemental Food Pro- gram for Women, Infants, and Children (wrc); School Lunch; School Breakfast; and Summer Food. In addition, we were asked to identify (1) possible barriers to Asian American participation in the above programs and (2) existing programs in selected communities to assist new Asian immigrants and refugees in achieving economic self-sufficiency, As agreed with the Select Committee, we relied primarily on readily available and published information. (For a bibliography, see pp. 66-69. ) Data on Asian Americans in general are limited, primarily because Asian Americans make up a small portion of the total U.S. population. (For further details on data limitations, see app. 11.) To determine Asian American income status and educational attain- ment, we examined data from the 1980 census, the U.S. Department of Education, and the Office of Refugee Resettlement (ORR) within the I-3. Department of Health and Human Services (HHS). We analyzed the Cen- sus Bureau 1985 Survey of Income and Program Participation (SIPI') data. (See app. III for details on our methodology.) In addition, we dis- cussed issues relating to Asian American income and education with social service agencies and community organizations serving Asian Americans in various cities throughout the United States (see app. IV for a list of the community organizations contacted). We relied primarily on published reports and interviews with officials from the U.S. Public Health Service (PHS) and other offices within uns for information on the health and nutrition status of Asian Americans. We also conducted interviews with Asian American community health organizations in San Francisco and Oakland, California. To determine Asian American enrollment in the nine public assistance programs, we requested reports from each of the federal agencies responsible for administering the programs: HHS for the AFDC, SSI,and Medicaid programs; the U.S. Department of Agriculture for the Food Stamp, WIC, School Lunch, School Breakfast, and Summer Food pro- grams; and the U.S. Department of Housing and Urban Development for the Low-Income Housing program. We were able to obtain data on Asian American participation in eight of the nine programs. Asian American enrollment in the School Breakfast program was too small to be Page 17 GAO/HRD90-36FS Asian Americans Section 1 Introduction reflected accurately on the basis of the sampling techniques used; there- fore, its enrollment was not included in the Agriculture reports. We did not verify the accuracy of the data provided by the various agencies. To obtain another perspective, we independently analyzed the Census Bureau 1985 SIPP data to determine what portion of the Asian American population participates in these programs compared with the total U.S. population. To identify the nature and extent of barriers to participation in public assistance programs, we surveyed 23 local community organizations serving Asian Americans (see app. IV). We also spoke with five state social service agencies in California, Kew York, Pennsylvania, Texas, and Washington; as well as two county social service agencies in Los Angeles, California. We obtained descriptions of government programs that help new immi- grants and refugees achieve economic self-sufficiency at the federal, state, and local levels. We obtained information from the federal agen- cies with the largest roles in providing assistance to new refugees and immigrants: ORR and the Department of State Bureau for Refugee Pro- grams To determine which states and communities to speak with for more detailed descriptions of these programs at the local level, we reviewed 1980 census data for where the largest immigrant Asian groups were likely to have settled (see table 1.3).” ,‘Although the 1980 census data are old, they are the most current nationwide data available. In addition, in its 1988 report to the Congress, ORR said the geographic distribution of newly resettled refugees follows the residential pattern of refugees already established since most new arrivals are joining relatives. Thus, we hypothesized that those areas with large populations of particular groups in 1980 (1) would still, in 1989, have among the largest populations in the United States and (2) would most likely have more programs established over time to help those groups. Whether or not this is true cannot be verified until data from the next census, in 1990, are analyzed. Page 18 GAO/HRD9@36FS Asian Americans Section 1 Introduction Table 1.3: Areas of Greatest Concentration by Large Immigrant Asian Metropolitan areas of greatest concentration of Asian Groups (1980) Asian groupa groups (in rank order) Chinese San Francisco/Oakland, CalIf New York City. N.Y Los Angeles/Long Beach, Calif Flllplno Los Angeles/Long Beach, Callf San Francisco/Oakland, Callf. Honolulu, Hawaii Korean Los AnclelesiLona Beach, Callf. New York City, N.Y Chicaao. Ill Indian New York Citv, N Y Chicago, Ill Los Angeles/Long Beach, Calif. Southeast AslanD Los Angeles/Long Beach, Calif. Anaheim/Santa Ana/Garden Grove (Orange County), Callf - Houston, Tex. “The large Aslan lmmlgrant groups speclfted here are those ldentlfled In table 1 2 p 16 %outheast Astans Include Vietnamese. Cambodians. and Laotians (Including Hmong, a Laotian sub- group). Source Census Bureau. Aslan and Paclftc Islander Population in the United States. 1980 (1988) On the basis of these data, we spoke with Asian American and other community groups for information on resettlement services provided in four metropolitan areas: Los Angeles, San Francisco, New York City, and Houston. We did our review between May and August 1989, in accordance with generally accepted government auditing standards. Page 19 GAO/HRD-90-36Fs Asian Americans Overall Income and Employment Status Comparable With U.S. Population, but Varies Widely Among Asian American Groups Asian Americans have comparable per capita incomes and poverty rates lower unemployment, and higher concentrations of white-collar professionals than the U.S. population overall, according to 1980 census and 1985 SIPP data. However, wide variations exist among Asian Ameri- can groups. Some Asian Americans are doing well compared with U.S. averages; others, poorly. Asian American average household income exceeded the U.S. average in Income and Poverty 1985 by about 28 percent, with an average monthly household income Rates of $2,973, compared with the U.S. average of $2,325. But when per cap- ita income is examined, the difference disappears.’ (See fig. 2.1.) Figure 2.1: Comparison of Average Monthly Household and Per Capita Dollars incomes for Asian Americans and Total 3,,c,, U.S. Population (1985) 1 2!ioo HOUSEHOLD INCOME PER CAPITA INCOME Source Census Bureau, SIPP (1985) ’ Due to the small number of Asian Americans m the sample and the resulting large margin of sam- pling error, the apparent difference between the average monthly per capita income for Asian .4meri- cans. 6827 ( 2 570). and the total LT.S.population, 5888 ( i- $1 l), is not statistically significant. (See app. III. p. 59.) Page 20 GAO/HRD-90-36FS Asian Americans Section 2 Overall Income and Employment Status Comparable With U.S. Population, but Varies Widely Among Asian American Groups Average per capita income was similar to the L1.S.average because most Asian American households were larger than U.S. households. On the average, U.S. households had 2.6 members: Asian American households, 3.5 members. Almost two-thirds of Asian American households had 3 01 more members, and about one-fourth had 5 or more (see fig. 2.2). Figure 2.2: Comparison of Household Sizes for Asian Americans and Total U.S. Population (1985) 2 5 or More Members 5 of More Members l-2 Members l-2 Members I 3-4 Members A 3-4 Members ASIAN AMERICANS TOTAL U.S. POPULATION Source Census Bureau, SIPP (1985). Although Asian Americans overall have per capita income comparable with that of the total U.S. population, incomes vary considerably among Asian American groups. For example, census data from 19i9 show that Vietnamese, Cambodian, and Laotian Americans had much lower aver- age annual household incomes than those of Indian, Pakistani, and .Japa- nese Americans.’ Southeast Asian groups also had the largest households and, thus, even lower per capita incomes. (See table 2.1.) ‘The most recent data on mcome by national or ethnic group come from t hc l!)HOCIYISI~~. whwh gathered income data from 1979. Page 21 GAO/HRD-90-36FS Asian Americans Section 2 OveraIl Income and Employment Status Comparable With U.S. Population, but Varies Widely Among Asian American Groups Table 2.1: Average Annual Household and Per Capita Income of Asian National origin or ethnic Annual household Persons per Annual per Americans, by National Origin or Ethnic group incomea household capita incomea Group (1979) Total U.S. population $20,300 2.7 $7,400 All Asian Americans 23,700 3.4 6,900 Filipino ____- 25600 38 6 700 lndlan _____~. -~ ~~~ 25,000 29 8.800 Pakistan1 _____ -. 23,800 2.9 8300 Chinese 23,700 31 7500 Japanese 22,900 29 7800 Korean -~ 22,500 43 5200 lndoneslan 21,000 28 7400 That 20,500 ~~ ~~ 41 5000 Guamanian 19,700 36 5.500 HawaIIan 19,500 35 5600 Melanesian 19,200 41 4 700 Tongan 18,400 46 4000 Samoan 16,500 49 3400 Vietnamese 15300 48 3200 Cambodian 12.500 45 2800 Hmong 9,100 59 1600 Laotian 8,300 54 1 600 %ounded to the nearest 100 Source Census Bureau, Aslan and Paclflc Islander Population In the Untted States 1980 (publlshed 1988) Similarly, although about the same percentage of Asian American households and total U.S. households had incomes below the poverty level in 1979,:’ the incomes of much higher percentages of Southeast Asian groups (Vietnamese, Cambodian, Hmong, and Laotian) were below the poverty levekf (See table 2.2.) “In addition based on our analysis of SIPP data, 13 percent of both Asian Amencan and total 1. S. households had income below poverty in 1985. ‘The poverty level varies by household size and composition. In 1979, the poverty level for a f;url~l> of four was an annual household income of $7,412. Page 22 GAO/HRD-SO-36PS Asian Amwicaus Section 2 Overall Income and Employment Status Comparable With U.S. Population, but Varies Widely Among Asian American Groups Table 2.2: Percentage of Asian American Families With Incomes Below the Percent below poverty Poverty Level, by National Origin or National origin or ethnic group level Ethnic Group (1979) Total U.S. population 9.6 All Asian Americans 10.7 JaDanese 42 Fllclno 62 In&an 74 Paklstant 105 Chinese 105 Melaneslan 11 5 Guamanlan 11 6 Korean 13 1 Thai 134 HawaIIan 143 lndoneslan 152 Tonaan 180 Samoan 27 5 Vietnamese 35 1 Cambodian 46 9 Hmona 65 5 Laotian 67 2 Source Census Bureau, We, the Aslan and Paclflc Islander Americans (1980 census data publlshed in 1988) In 1980, Asian American adults had lower unemployment rates and Unemployment and were more highly concentrated in white-collar occupations than U.S. Occupation adults overall. Of Asian American adults, 5 percent were unemployed, compared with 7 percent of U.S. adults overall. In addition, 57 percent of Asian Americans in the labor force were employed in white-collar occupations classified as managerial, professional, technical, sales, or administrative, compared with 49 percent of the U.S. population. How- ever, occupation and employment status differed among the various Asian Americans groups. For example, whereas 72 percent of Indian Americans worked in white-collar jobs in 1980 and 6 percent were unemployed, only 18 percent of Hmong Americans were white-collar workers and 20 percent were unemployed. (See table 2.3.) Page 23 GAO/HRD-90-36FS Asian Americans Section 2 Overall Income and Employment Status Comparable With U.S. Population, but Varies Widely Among Asian American Groups Table 2.3: Occupations of Asian Americans (1980) Numbers In percent ~ -.-~~~~~ Civilian labor forcea Precision Technical, Farming, production, National origin or ethnic Managerial, sales, fishing, crafts, Laborer, grow professional administrative Service forestry repair operator Unemployedb TotaP Total U.S. population 21 28 -- 12 3 12 17 7 100 All Asian Americans 28 29 15 2 8 14 5 100 Indian 46 26 7 d 5 9 6 100 Pakistan1 43 25 10 1 5 10 6 100 Chrnese 31 29 18 d 5 12 4 100 Japanese 28 33 12 4 10 10 3 ..___._~~ 100 Filrpino 24 32 16 3 a 13 5 100 Korean 24 26 16 d 9 19 6 100 lndonesran 23 -28 18 d 10 15 6 100 Thai 22 22 23 d 9 ia 6 100 Hawaiian 16 26 20 3 11 17 7 100 Guam 13 32 17 1 13 17 7 100 Vretnamese 12 25 14 d 13 27 8 100 Samoan 11 24 ia 2 11 24 10 100 Tonoan 10 17 24 6 11 23 8 100 Cambodian 10 19 16 2 13 30 11 100 Hmong a 10 ia 2 12 31 20 100 Laotian 7 10 19 3 12 35 15 100 aPeople aged 16 and older Occupatron and employment status is based on respondents’ classrfrcatrons bThose In the labor force who do not have lobs, are lookrng for work, and are available to accept jobs ‘May not add to 100 due to rounding ‘Less than 1 percent Source, Census Bureau, Asran and Pacrfrc Islander Populatron In the Unrted States: 1980 and 1980 Census of Populatron General Socral and Economrc Charactenstrcs. The income and employment disparity among Asian American groups is a reflection of their diversity. Factors influencing the ability of different groups to support themselves include when they or their ancestors came to the United States, their job skills, and their familiarity with Western culture and the English language. First-generation or second-generation Asian Americans, for example, are generally integrated into the U.S. work force and able to support themselves. Among more recent immi- grants, some groups come primarily from urban centers that are highly Page 24 GAO/HRLNO-36F?3 Asian Americans Section 2 Overall Income and Employment Status Comparable With U.S. Population, but Varies Widely Among Asian American Groups Westernized and thus they are better prepared for American life. Specif- ically, many of the more recent arrivals from Korea, Hong Kong, and India are highly educated and skilled. In contrast, many recent arrivals from Southeast Asia come from rural areas! with values and behaviors very different from the predominant U.S. culture. Adjusting to U.S. life for such groups is generally difficult. For example, rural Hmong and Vietnamese accustomed to farming and fishing trades are likely to have little or no education, be unfamiliar with Western technology, and have few transferable job skills. As a result, Asian American community organization officials said, the pov- erty and unemployment rates among Southeast Asian groups remain high. Page 25 GAO/HRD90-36FS Asian Americans Section 3 Overall Adult Educational Levels Same or Higher Than Total U.S. Adults, but Vary Widely Among Asian American Groups Our analysis of SIPP data for 1985 indicates that Asian American adults over the age of 25 had an average of 12.27 years of education. This com- pared favorably with the total U.S. adult population over the age of 25, which had an average of 12.39 years of education. However. 1985 SIPP and 1987 Annual Housing Survey data also indicate that a greater pro- portion of Asian American adults had attended college than total c’.S. adults. (For more details, see app. V.) Moreover, 1980 census data indi- cate that educational levels vary widely among Asian Americans of dif- ferent national origin or ethnic groups. Several Asian American groups had higher percentages of high school graduates and college-educated adults than the U.S. overall. For other groups, such as the Cambodian, Laotian, and Hmong, the percentages were much lower. (See table 3.1.) Table 3.1: Educational Levels of Asian Americans Aged 25 or Over, by National Numbers In percent Origin or Ethnic Group (1980) Graduating from high Attending at least 4 National origin or ethnic group school years of college Total U.S. population 66.5 16.2 All Asian Americans 74.8 32.9 lndoneslan 89.8 33 3 PakIstanI 87.0 58 4 Japanese 81.6 26 4 lndlan 80.1 51 9 Korean 78.1 33 7 FillDlno 74.2 37 0 Thai 72.4 32 3 Chinese 71.3 36 6 Hawatlan 68.4 96 Guamanlan 67 9 82 Tonqan 66 1 129 Vietnamese 62 2 129 Samoan 61 2 73 Melaneslan 47 4 108 Cambodian 42.6 77 Laotian 31 4 56 Hmong 22.3 29 Source Census Bureau, We, the Aslan and Paclflc Islander Amencans (1980 census data publlshed In 1988) Those groups with low educational attainment include large numbers of new immigrants who arrived in the United States with relatively little education. For example, of the Southeast Asian refugees aged 17 or over Page 26 GAO/HRD-SO-36FS Asian Americans Section 3 Overall Adult Educational Levels Same or Higher Than Total U.S. Adults, but Vary Widely Among Asian American Groups who entered the United States between 1978 and 1982, about 75 pct‘cdent arrived with less than a high school education. (See table 3.2.) Table 3.2: Educational Levels of Southeast Asian Refugees, Aged 17 or Numbers In percent Over, Upon Entry to the United States Level of educationa -- Vietnamese Chineseb Laotians TotaF (1978-82) No formal education 1.6d 6 53 21 0 8.3 Elementary 34 5 50.3 566 44.2 Secondary 27.4 240 12.2 22.2 High school graduates 22.6 155 49 15.9 Some college 13.8 3 76 5.1 9.2 TotaP 100.0 100.0 100.0 100.0 “Source did not Indicate what grades were Included In elementary, secondary, or high school levels of education “From Vletnam ‘Percentages based on totals for the three groups combined “This percentage IS based on fewer than 50 observattons ‘Way not add due to roundrng Source HHS ORR, Southeast Aslan Refugee Self-Sufflclency Study (1985) Reports from ORR indicate that Southeast Asians arriving since 1982 have entered the United States with even less education than previous arrivals. More recent Cambodian and Vietnamese arrivals, particularly those from rural areas, were sometimes illiterate in their own languages. Others had their education interrupted during the Vietnam War. Some recent arrivals, such as Hmong, came from societies in which written forms of communication are rare. Community organization officials told us that adults arriving with little education have the greatest difficulties adjusting to life in the llnited States, including learning English, participating in job training, and obtaining jobs with sufficient wages to support their often large fami- lies. The officials added that Asian Americans arriving in the United States as young children tend to adapt well to school and to be highly motivated; those arriving at high school age tend to have greater diffi- culties in school, particularly if they arrive without age-appropriate education and knowledge of English. The Department of Education administers two programs that provide supplemental grants to school districts to help refugee and immigrant Page 27 GAO/HRDML36FS Asian Americans Section 3 Overall Adult Educational Levels Same or Higher ‘man Total U.S. Adults, but Vary Widely Among Asian American Groups children achieve and maintain a satisfactory level of academic perform- ance: the Transition Program for Refugee Children and the Emergency Immigrant Education Program (see table 3.3). Table 3.3: Department of Education Programs for Refugee and Immigrant Children Dollars In mullions ___- Funding in fiscal Program Eligible recipients year 1988 Services authorized ..~_____ - TransItron Program for Refugee School drstrlcts with at least 20 refugee $15.2a Bilingual educatron and other special Chrldren studentsb English Instructron and materials In-service trarnrng for teachers Counseling and gutdance services Other support servrcesc Emergency lmmlgrant Educatron School districts where newly arrived Immigrant 30.0d Supplementary educatronal services Program students number at least 500 or make up at least 3 percent of total enrollment Basic instructron for lmmlgrant children In-servtce trafnrng for teachers ‘These funds served an estimated 80 215 refugee children, for an average expenditure of about $190 per child “Refugee children are ellglble if they have been In the Unlted States for no more than 2 years at the elementary school level or no more than 3 years at the secondary school level. ‘Such as tralnmg for parents and services deslgned to meet the special educational needs of refugee children ‘These funds served an estimated 428,688 immigrant students. with an average expenditure of about $70 per child Sources Code of Federal Regulations, title 34, part 538, “TransItIon Program for Refugee Children, and part 581, ‘Emergency lmmlgrant Educatton Program, ” and House CommIttee on Appropnatlons. Sub- commlttee on the Departments of Labor, Health and Human Services, Education. and Related Agen- cues, Appropriations for 1989, Hearings (Washington, D C U S Government Prlntmg Office. 1988). part 6. pp 462,481, and 485 Page 28 GAO/HRD90-36s Asian Americans Health and Nutrition Appear to Compare Well With U.S. Population Overall, Except for Southeast Asian Refugees With the exception of Southeast Asian refugees, the limited available information suggests that the health and nutrition of Asian Americans appear to be at least as good as that of the lJ.S. population generally.’ In a 1988 report,’ the U.S. Public Health Service (PHS) concluded that the Health Status of Asian health status of Asian Americans as a group was good. It reported that LktllWiCZlllS Reported to although national morbidity and mortality figures for Asian Americans Be Good were generally lacking, available data indicate that Asian Americans enjoyed a longer life expectancy than whites and lower death rates from all causes, including heart disease and cancer (see figs. 4.1 and 4.2). i However, the data were generally limited to only a few Asian American groups and were 7 to 10 years old.-’ Infant mortality rates also were found to be lower for Asian Americans. (See fig. 4.3.) The PHS report acknowledged that more detailed research was needed to further define the health status and needs of Asian Americans. ‘Comprehensive data on the health and nutrition status of Asian Americans are not readily available. This is a category not covered by the decennial census. Other surveys (such as the U.S. Department of Agriculture’s tidtionwide Food Consumption Survey and the National Health Interview Survey as well as the Health and Nutrition Examination Survey conducted by the PHS National Center for Health Statistics) do not publish data on Asian Americans because the Asian portion of the samples is too small, according to agency personnel. ‘Disease Prevention/Health Promotion: The Facts. Office of Disease Prevention and Health Prom* tion, PHS, HHS (1988). Data cited in the report are primarily from the National Center for Health Statistics (1978-1981); the Census Bureau (1980); and the Report of the Secretary’s Task Force on Black and Minority Health. HHS (1986). “The data also indicated, however, that the death rates from different cancers varied widely among Asian American groups (see app. VI). ‘PHS officials told us that more recent disease prevalence rates are difficult to develop because accu- rate population projections are unavailable between censuses. Page 29 GAO/HRD-9036FS Asian Americans Section 4 Health and Nutrition Appear to Compare Well With U.S. Population Overall, Except for Southeast Asian Refugees Figure 4.1: Life Expectancy of Asian Americans Compared With White Americans in California (1960) and Hawaii Years of Life Expectancy 85 (1980) 60 75 70 65 60 1960 Study 1999 study Conducted in Cond~~cled In California (a) Hawaii (a) Chinese Americans Filipino Americans(b) “Information was gathered only on the Aslan Amencan groups shown and Includes combtned data for both sexes %llplno Americans were not Included In the 1960 Caltfornla study Source: R W Gardner, R. Robey, and P C Smith, “Aslan Amencans Growth. Change, and Diversity Population Bulletin (1985), as presented In the PHS report, The Facts (1988), p 191 Page 30 GAO/HRD90-36FS Asian Americans Section 4 Health and Nutrition Appear to Compare Well With U.S. Population Overall, Except for Southeast Asian Refugees Figure 4.2: Mortality Rates for White, Black, and Asian Americans (1979-81) 14w YALEDEATHPER100,ooo PoPuLATloN (a) 1400 FEMALE DEATHS PER 100,ooO POWLATKN,,) lzw 1200 Iwo rwo so0 SW 600 wa wa 400 200 zoo 0 cl All cam kit- CAUSESOF DEATH aAverage annual age-adjusted death rates bThese data are based on only three groups of Asran/Pacrfrc Amerrcans Chrnese, Frlrprnos, and Japanese ‘The PHS report, The Facts (1988). notes that “Death rates for Asran/Pacrfrc Amerrcans are probably underestrmated due to less frequent reportrng of these rates on death certrfrcates as compared wrth the Census ” ‘Under the age of 45 Sources HHS. PHS, Natronal Center for Health Statrstrcs; Census Bureau, and the HHS Report of the Secretary’s Task Force on Black and Mrnority Health, Vol I (1985), partrally presented rn the PHS report, The Facts, pp 191-3 Page 31 GAO/HRD!ML36FS Asian Americans Section 4 Health and Nutrition Appear to Compare Well With U.S. Population Overall, Except for Southeast Asian Refugees White, Black, and Asian Americans 20 Deaths per 1,000 Live Births (a) (b) (1986) aThe NatIonal Center for Health Statistics notes that infant mortality rates for Asian Amencans should be Interpreted with caution because of InconsistencIes In reporting race on birth and death certificates “Infant mortality rates from 1982, presented in the PHS report, The Facts (1988). showed similar dlrfer ences among groups -Includes deaths among Hawallans and part-Hawaiians Source HHS. PHS, National Center for Health Statlstlcs VItaI Statistics of the Unlted States. Vol 11 (1986) Nutrition Status of ered by the PHS Centers for Disease Control (CDC). CDC only gathers data Asian American from participants in publicly funded programs (primarily WC) in about Children Reported to 29 states; therefore, CDC cautions that the data are not representative of Asian American children in the general population. Data in its last pub- Be Generally lished annual report (issued in August 1985) indicate,’ however, that the Comparable With U.S. nutrition status of Asian American children was generally comparable with U.S. standards, as measured by the weight-for-height and blood Standards content indexes for the period 1979 to 1983 (see table 4.1). ‘Publication of annual reports was discontinued after 19%. according to CDC officials. Page 32 GAO/HRD-90-36FS Asian Americans Section 4 Health and Nutrition Appear to Compare Well With U.S. Population Overall, Except for Southeast Asian Refugees Table 4.1: Nutrition-Related Abnormalities Among American Percentage with an abnormal indicatoP Children, Through 9 Years of Age, in Indicator of abnormality” White Black Hispanic Native Asian Selected States, by General Ethnic Low weight-for-height 29 37 36 31 49 Group (1979-83) High weight-for-height 67 77 79 100 48 Low height-for-age 85 75 93 al 24 1 Blood content I’ Low hemoglobm 55 -~ 91 4.4 31 55 Low hematocrlt 6.4 75 10.0 62 64 ‘Abnormality IS defined as being In the (1) lower or upper 5th percentlle of the National Center for Health Statlstlcs reference population for weight-for-height or (2) lower 5th percentlle for height-for age and blood content lndlcators “Hemoglobin IS the Iron-contalnlng protein In red blood cells, hematocnt IS the ratlo of the volume of packed red blood cells to the volume of whole blood Low hemoglobm and hematocnt are lndlcators of anemia Source HHS PHS. Centers for Disease Control Nutntlon Surveillance. Annual Summary 1983 @sued Aug 1985). pp 17 and 24 The height-for-age index indicated a potential problem area for Asian American children. According to more recent data we obtained from CM’. however, short stature has become less prevalent among Asian Ameri- cans over time. The 1989 data indicate that Asian American children are approaching the U.S. height-for-age standard. (See fig. 4.4.) Page 33 GAO/HRB90-36FS Asian Americans Section 4 Health and Nutrition Appear to Compare Well With U.S. Population Overall, Except for Southeast Asian Refugees Figure 4.4: Mean Height-for-Age of Asian Americans Compared With U.S. Standard 60 Mean Percentiles (1981-89) 50 40 *****--1***** ***********- **.**---- *****I---- ***--- 30 ******* 20 10 0 1991 1992 1993 1994 1995 1995 1997 1999 1999 YEARS - U.S. Standard -1-1 AsianAmericans Source, Data from the Pedlatrlc Nutntlon Surveillance System, provided to GAO by HHS, PHS. CDC (July 1989) Due to tracking by the PHS Office of Refugee Health and CDCand clinical Health and Nutrition studies conducted in selected regions, more detailed information is avail- Problems Cited for able about the health and nutrition status of Southeast Asian refugees. Southeast Asians These studies indicate that Southeast Asian refugees are carriers of-or suffer from- tuberculosis, hepatitis B, and malaria at much higher rates than the U.S. population generally. (See table 4.2) Studies also indicate that (1) up to 80 percent of Southeast Asian refugees have intestinal parasites and (2) Southeast Asians experience some nutrition and mental health problems. Page 34 GAOjHRD-90-36F3 Asian Americans Section 4 Health and Nutrition Appear to Compare Well With U.S. Population Overall, Except for Southeast Asian Refugees Table 4.2: Disease Rates Among Southeast Asian Refugees Compared Southeast With Whites, Blacks, and the Total U.S. Asian Total U.S. Population (per 100,000 Population) Disease refugees Whites Blacks population TubercuIosIs” 250 4 28 -__~ 9 Heoatltls W Chrome InfectIon 10,000 190 850 300 Overall infectlon 70,000 3 %I0 13,700 4,800 Malaria’ 150 - 3 1 4 ‘Rates for Southeast Aslan refugees are based on disease stallstIcs from 1987 for refugees arrlvlng in 1986 Accordmg to CDC, the nsk of Infection IS greatest during the year after lmmtgration “Rate for Southeast Aslan refugees IS from early 1980s Rates for whites blacks and total U S popula tlon are from the 1976-80 National Health and Nutrltlon Examlnatlon Survey Rates based on Southeast Asian refugees arrlvlng between 1980 and 1988 Rates for total U S popula- tion based on 1985 population estimates and Infections reported between 1983 and 1988 Vlalarla lnfec- tlons are only acquired abroad, according to CDC ‘A breakdown for whites versus blacks was not available Source CDC (July and Aug 1989) A study examining Southeast Asian refugees who had relocated in Con- necticut indicated that nutritional abnormalities may be more prevalent among refugee children.” The study examined 36 refugee children, aged 1 to 12, between September 1979 and November 1980. The study found that 17 (47 percent) were below the height-for-age index, and 8 (22 per- cent) were below the weight-for-height index. These percentages are substantially higher than the rates found during a comparable time period for Asian Americans overall. (See table 4.1, p. 33.) Other regional studies have revealed differences among various South- east Asian groups. For example, a San Diego study showed that the Vietnamese are at greater risk than the Laotians for tuberculosis and have different risks for different types of intestinal parasites. To ensure that arriving refugees do not pose a public health threat and to ensure their good health, PHS operates several programs coordinated by the Office of Refugee Health. These include CDC medical screening of U.S.-bound refugees in camps in Thailand, screening at U.S. ports-of- entry, and notification of appropriate state and local health depart- ments of health problems of resettled refugees. “Michele Barry. M.D., and others, “Chnical Findings In Southeast Asian Refugees.” .Journal of the American Medical Association (June 17, 1983). Page 35 GAO/HRD90-36FS Asian Americans Section 4 Health and Nutrition Appear to Compare Well With U.S. Population Overall, Except for Southeast Asian Refugees According to CDC,tuberculosis and hepatitis B among Southeast Asian Americans pose significant public health challenges. Nonetheless, CDC hopes to eliminate tuberculosis in this country by the year 2010 by (1) developing new technologies for treatment, diagnosis, and preven- tion and (2) integrating these technologies into clinical use. The major goal concerning hepatitus B is to increase immunizations and thereby help prevent (1) transmission at birth, (2) childhood infection, and (3) primary liver cancer. CDCdoes not currently consider malaria and other parasitic diseases-which rarely result in fatal illness-and nutri- tional abnormalities among refugee children to be major public health problems.; Various studies estimate that mental health disorders afflict as many as 50 percent of newly arriving refugees. Traumatic experiences in their countries of origin, conditions in resettlement camps, and difficulties in acculturation have been cited as reasons for refugees’ mental problems. Recognizing the significant presence of diagnosable mental health condi- tions among the refugee population, in September 1985, the HHS ORR entered into an interagency agreement with the National Institute of Mental Health to encourage the development and implementation of cul- turally relevant diagnostic and treatment procedures. A 1986-87 study conducted in California under this program found that over 40 percent of the 2,773 refugees interviewed had a moderate or severe need for mental health treatment. (See fig. 4.5.) The study reported that most Southeast Asian refugees interviewed were forced to spend years in camps awaiting resettlement, and more than half expe- rienced separations from, or deaths of, family members. Cambodian and Laotian refugees spent an average of nearly 3 years in the refugee camps, and nearly two-thirds of the Cambodians had lost close relatives. The study found that over 16 percent of the Cambodians interviewed met the criteria for post-traumatic stress disorder. According to PHS, this study, as well as those done for other states under the program, showed a high level of need for mental health assistance among Southeast Asian and other refugees in the United States. ‘CDC also recently discontinued surveillance of “sudden unexplained death syndrome” (SUDS) among Southeast Asian refugees because the number of annual cases has been decreasing. A total of 117 cases of SCDS had been reported as of April 1988, primarily among young adult male Laotian refugees who had lived in the United States less than 2 years. Page 36 GAO/HRD!M-36FS Asian Americans Section 4 Health and Nutrition Appear to Compare Well With U.S. Population Overall, Except for Southeast Asian Refugees Figure 4.5: Study of Southeast Asian Refugee Mental Health Needs in California (1986-87) loo Percent With Need tor Treatment All Refupes Vfetnsmese Cambodians Leothe Hmongs Chinws Studied (a) I 1 No Need for Treatment m MildNeedforTreamt Moderate Need for Treatment Severe Need for Treatment aWeighted averages Source The Callfornla Southeast Aslan Mental Health Needs Assessment, Asian Community blental Health Serwces. Oakland, Caltfornta (1988) Language is frequently cited as a barrier to the obtaining of required medical treatment by Southeast Asian refugees. In addition, Southeast Asian refugees experience various cultural and religious barriers to seeking treatment in this country. There are markedly different con- cepts of health and disease in Eastern and Western cultures, and reli- gious beliefs influence refugees’ health beliefs and practices (see app. VII). Page 37 GAO/HRD-90-36FS Asian Americans Welfare Participation Approximates Representation in U.S. Population The proportion of Asian American participants among the U.S. public assistance programs we looked at roughly approximates the proportion of Asian Americans in the U.S. population. In 1985, Asian Americans accounted for 2.5 percent of the U.S. population and 1.8 percent of 1I.S. households. Agency studies conducted during various years throughout the 1980s report that Asian Americans have between 1.4 and 3.4 per- cent of participants in the AFDC, SSI,Medicaid, Low-Income Housing, Food Stamp, WIG, School Lunch, and Summer Food programs.] (See table 5.1.) ‘Data were not available from the U.S. Department of Agriculture showing the number of Asian American participants in the School Breakfast program (see p. 17). Page 38 GAO/HRD-SO-36FS Asian Americans Section 5 Welfare Participation Approximates Representation in U.S. Population Table 5.1: Asian American Participation in U.S. Public Assistance Programs Estimated Asian American Percent of total Program participants participants AFDP 84,675 famllles 23 222,023 children -_______ ~~~~ 31 SSlb 42,100 mdlvlduals (aged 65 or over)c __~.__- ..~18 Medlcaldd 447,713 Individuals 20 Low-Income Houslnge 78,923 households 20 Food Stamp’ 130,000 households 18 WIG 10,243 women 14 26.319 Infants 33 33,827 children (aqed 1 to 4) 21 School Lunch” Free 205,023 children 21 Reduced-once 61,744 children 34 Summer Food’ 30,000 children 20 Note Years for above data vary, as indicated In the footnotes. aHHS, Family Support Admlnlstratlon. Charactenstlcs and Financial Circumstances of AFDC Rectplents (1986) “HHS, Social Security AdmInistratIon, “Number and Percent of Persons Aged 65 and Older Recelvlng Social Security or Supplemental Security Income by Race and Spanish Orlgln” (1980). %cludes participation In other welfare programs, but, according to SSA officials, responses for people 65 years of age or older reflect SSI for the most part. “HHS. Health Care Flnancmg AdmInIstration “MedIcaId Recipients and Expenditures, by Race and State, Fiscal Year 1986 eDepartment of Housing and Urban Development, Annual Housmg Survey (1987) ‘Department of Agnculture, Food and Nutrition Service, Charactenstlcs of Food Stamp Households (1986) gDepartment of Agnculture, Food and Nutntlon Service, Study of WIC Participant and Program Charac- teristics (1986). Data are from 1984. ‘Department of Agnculture, Food and Nutrition Service, Characteristics of the National School Lunch and School Breakfast Program Participants (1988) Data are from 1984 Department of Agnculture, Food and Nutrition Service, An Evaluatron of the Summer Food Service Pro- gram (1988) Data are from 1986. The percentage of the Asian American population receiving benefits from public assistance programs provides another perspective on partic- ipation. (See fig. 5.1.) SIPP data show that for most programs, about the same percentage of Asian Americans received benefits as the total U.S. population in 1985. Differences between the percentages of Asian Amer- icans receiving benefits and the total U.S. population were not statisti- cally significant for the Medicaid, Food Stamp, AFDC, Low-Income Housing, SSI, and WIG programs. (See app. III.) Only in the School Lunch Page 39 GAO/HRD-90-36FS Asian Americans Section 5 Welfare Participation Approximates Representation in U.S. Population and Breakfast programs was Asian American participation significantly greater: 10.6 percent of Asian American households received benefits from these programs, compared with 6.5 percent of U.S. households.2 Figure 5.1: Asian Americans Receiving Benefits From Selected U.S. Public 25 Percent Receiving Benefits Assistance Programs (1985) 20 15 ‘School Lunch and Breakfast reclplents were measured by households IIJ which one or more children, aged 5 to 18, received free or reduced-pnce lunches or breakfasts. All other reclplents were measured by the lndivldual “Includes benefits from public houslng and government rental assistance. ‘-AsIan American sample size (24) was too small for the analysis to be statlsttcally stgnlflcant “Asfan Amencan sample size (14) was too small for the analysis to be statlstlcally slgnlficant Source Census Bureau, SIPP (1985) In contrast with the 1985 SIPP data, 1980 census data analyzed by the Social Security Administration (SSA) showed that Asian Americans aged ‘Participation in the Summer Food Program was not analyzed because the SIPP database did not include data on this program. Page 40 GAO/HRD90-36FS Asian Americans Section 5 Welfare Participation Approximates Representation in U.S. Population 65 or over participated in SSIto a greater extent than their I!.S. counter- parts. Almost 19 percent of Asian Americans aged 65 or over received SSIbenefits, compared with 9 percent of the U.S. elderly. i Proportionately, newly arrived Southeast Asian refugees are much more likely to receive assistance than Asian Americans overall, in part because of special programs established to help refugees. Refugee Cash Assistance and Refugee Medical Assistance are available to low-income refugees who have lived in the United States less than 1 year but are ineligible for AFDC, SSI, and Medicaid because of family composition or other reasons not related to income. The federal government reimburses states for 100 percent of such refugees’ welfare costs. In 1987, the most recent year for which published data were available, Southeast Asian refugees had higher rates of participation in these aid programs than most other refugee groups for whom data were available. (See fig. .5.2.) ‘Despite different SSI participation rates, an equal percentage of Asian American and 1. S. adlilts aged 65 or over lived in poverty in 1980 (15 percent), according to SSA reports. The SSA diremx. Division of Statistical Analysis, Office of Research and Statistics, hypothesized that many eldcrl) Asian Americans rely on SSI because they are immigrants without work histories in the I .mtt>d States and, thus, are ineligible for Social Security benefits. Page 41 GAO/HRD-90-36FS Asian Americans Section 5 Welfare Participation Approximates Representation in U.S. Population Figure 5.2: Participation of Southeast Asian and Other defugee Groups in 100 Percent Paftkipaling Selected U.S. Public Assistance Programs (1987) so 60 40 20 0 SOUTHEAST ASIAN REFUGEES OTHER REFUGEE GROUPS Note Reported data covered the Refugee Cash Assistance. Refugee MedIcal Assistance. AFDC, SSI MedIcaId, and General Assistance programs and only for refugees In the groups shown who were in the Unlted States for 31 months or less aExcludlng Poles. Source HHS, ORR, Report to the Congress. Refugee Resettlement Program (1988) Page 42 GAO/HRD-96-36FS Asian Americans Section 6 Barriers Exist, but Do Not Prevent Welfare Participation Community organizations told us that Asian Americans face difficulties when enrolling in welfare programs, but the problems do not prevent their eventual participation. The barriers most frequently cited were (1) limited knowledge of English and (2) different attitudes toward gov- ernment and welfare. The Asian American groups with the most lan- guage difficulties had among the highest participation rates in welfare programs (as shown on p. 42). People with limited English fluency have difficulties with all aspects of Limited Knowledge of the enrollment process, according to Asian American community organi- English Causes Most zations. Those unable to read program materials have difficulty under- Difficulties standing what programs exist, who is eligible, and what documents to supply. Those with limited knowledge of English have difficulties com- pleting English language program applications and communicating with social service agency intake workers who do not speak Asian languages. In addition, some recent arrivals, particularly the Hmong, are unaccus- tomed to systems requiring documentation and often do not retain nec- essary documents. Limited English lanaguage fluency also poses other problems. For exam- ple, the Southeast Asia Center officials in Chicago, Illinois, told us that from where most Southeast Asians live in Chicago, traveling by train to the welfare office takes at least an hour and requires a transfer. The trip is particularly difficult for recent arrivals with limited English knowledge who cannot read the street signs or maps or ask for and understand directions. The number of non-English or limited-English speakers appears high among those Asian Americans requiring public assistance. For example, in 1980,38 to 69 percent of the various Southeast Asian groups reported that they did not speak English well or at all. (See table 6.1.) The Associ- ation of Asian/Pacific Community Health Organizations also found that about 95 percent of its primarily low-income patients nationwide had limited or no ability to speak English.’ ‘The association 1sa national network of community health centers serving Asian and Pacific Islander populations. headquartered in Oakland, California. Page 43 GAO/HRD-90-36FS Asian Americans Section 6 Barriers Exist, but Do Not Prevent Welfare Participation Table 6.1: Asian Americans’ Ability to Speak English, by National Origin or Numbers in percent Ethnic Group (1980) English-speaking abilitya National origin or ethnic group Wellb Not well Not at all UnknownC Total* All Asian Americans 82 12 3 2 100 Hawaiian 98 0 0 2 100 Ftllplno 91 5 1 j 100 Japanese 90 8 1 1 100 Samoan 88 8 1 3~ 100 lndlan 87 4 1 7 100 Guamanlan 87 2 0 11 100 Thai 86 11 1 2 100 PakIstanI 84 8 2 6 100 Chinese 76 16 7 1 100 Korean 75 20 4 1 100 lndoneslan 69 5 1 25 100 Tongan 65 14 2 18 100 Vietnamese 60 29 9 2 100 Cambodian 37 44 15 4 100 Hmong 34 32 31 3 100 Laotian 27 43 26 4 100 ‘Self-reported ablllty to speak English for people aged 5 and over In households blncludes those speakmg Aslan or Pacific Islander languages at home who reported speaking English very well or well and those who speak only English at home CThe Census Bureau did not report on the English-speaking ablltty of those who reported speaking a language other than English or an Aslan or Pacific Islander language at home dMay not add to 100 due to rounding Source Census Bureau, Astan and Pacific islander Population In the Unlted States. 1980 (1988) Help in Overcoming Federal, state, local, and community agencies offer bilingual services to help Asian Americans overcome problems with English. California, New Language Problems York, and Texas state and local community officials told us that many social service agencies, including federal agencies in areas with large concentrations of Asian Americans, now employ bilingual staff. The Social Security Administration, for example, once a week sends a bilin- gual Cantonese worker to the Oakland Chinese Community Council, in Oakland, California, to enroll the elderly in SSI,Council staff told us. In addition, WIGprogram reports state that in 1984, about 20 percent of WIG clinics nationwide had staff who spoke Vietnamese, Cambodian, or Lao- tian; 10 percent had staff who spoke Thai; and 6 percent had staff who spoke Chinese. Page 44 GAO/‘HRD-90-36FS Asian Americans Section 6 Barriers Exist, but Do Not Prevent Welfare Participation Some Asian American community organizations attempt to hire people with the ability to speak various Asian languages to accompany limited English-speaking clients to social service agencies. serve as translators give help filling out program applications, and make referrals to welfare offices. For example, the director of Northeast Medical Services in San Francisco, California, told us that to help provide social and medical ser- vices to non-English speaking clients, her program employs staff speak- ing Mandarin, Cantonese, Korean, Vietnamese, and Burmese. Asian American community organizations told us, however, that the multiplic- ity of languages and dialects makes it difficult for community organiza- tions and government agencies to provide bilingual services for all Asian American groups. Asian American community organizations told us that some Asian Certain Attitudes Americans are reluctant to participate in welfare programs for reasons Make Some Asian that include their general distrust of government and the stigma Americans Reluctant attached to welfare. They also told us that Chinese and .Japanese Ameri- cans, in particular, have a distrust of American government that stems to Accept Welfare from certain exclusionary and discriminatory legislation, such as the 1882 Chinese Exclusion Act, which denied Chinese individuals the right to U.S. citizenship; the Immigration Act of 1924, effectively stopping Japanese and other Asian immigration to the United States; the World War II evacuation and internment of U.S. citizens of *Japanese origin under Executive Order 9066; and state laws prohibiting ownership and leasing of land by noncitizens. Other Asian American groups had developed a general distrust of gov- ernment in their native countries. For example, Cambodians who fled the war there have had to learn to overcome a fear of government engendered by the violent Khmer Rouge. In addition, some Asian American immigrants fear that accepting public aid will jeopardize their U.S. sponsors or their own ability to sponsor the immigration of additional family members. Moreover, in most traditional Asian societies, the elderly expect their children and grandchildren to care for them and the young accept this obligation. Chinese, Filipinos, and Koreans have particularly strong tra- ditions of relying on family, friends, and social organizations of their own ethnic groups, rather than on the state, for aid. Many consider the receipt of welfare to be disgraceful. Asian American community organi- zations told us! however, that this traditional support is collapsing in Page 45 GAO/HRD-90.36FS Asian Americans Section 6 Barriers Exist, but Do Not Prevent Welfare Participation some Asian American immigrant communities, in part because extended families lack sufficient resources and in part because family ties are weakening in the United States. The breakdown of family support among some Asian Americans may create an additional need for ser- vices and benefits, particularly for the elderly-the age group least likely to seek aid. Page 46 GAO/HRD9@36FS Asian Americans Section 7 Programs Help New Arrivals Attain Economic Self-Sufficiency \ New arrivals often face significant problems in finding employment and attaining self-sufficiency because of such factors as language compe- tence, education, skills, and job opportunities. Refugees and immigrants can receive assistance in these areas through various means. Local gov- ernment agencies, community and other nonprofit organizations, and schools use federal and other funds to provide English instruction; employment services, such as training, placement, and subsidized employment; and assistance with acculturation and resettlement. Some programs are directed towards refugees; others are available to any American with low income or difficulty with English. The Refugee Act of 1980 and subsequent legislation established pro- Federal Agencies Fund grams, administered by the HHS ORR and the Department of State, to help Special Programs for refugees become self-sufficient.’ Funds for a variety of services are (1) Refugees channeled through the states to local government agencies, nonprofit organizations, and mutual assistance associations or through 12 national voluntary organizations to their local affiliates or (2) provided directly to voluntary agencies. (See table 7.1.) ‘In a statement of program goals, priorities, and standards for its refugee program, HHS defines “economic self-sufficiency” as employment in a nonsubsidized job for at least 90 days, at a wage fully adequate for the basic economic needs of the person and his or her family. Page 47 GAO/HRLHlO-36FS Asian Americans Section 7 Programs Help New Arrivals Attain Economic Self-Sufficiency Table 7.1: Major Federal Grant Programs That Help Refugees Attain Self-Sufficiency Agency and program Refugees eligible Types of assistance funded Flow of funds Department of Health and Human Services:” Employment services Vary by state (those recelvlng English InstructIon Through states to local cash or medical assistance are government agencies. nonproflt required to participate) Vocational tralntng organizations, and mutual assistance assoclatlons Job referral and placement On-the-job training Skills recertlflcatlon -.~--- Targeted assistance Those llvlng in localltles with large Vocational English InstructIon Through states to local concentrations of refugees on government agencies and welfare On-the-lob tralnlng nonprofit organlzatlons Job development Voluntary agency matching grant Those in the United States 4 English InstructIon To voluntary agencies months or less Orientation to U S culture Job development Job placement Department of State,‘: Refugee reception and Those In the United States 90 Referral to employment services Through 12 national voluntary placemenF days or less organizations to local affiliates Resettlement aid, Including help (grants based on number of obtaining employment, houslng, refugees served) food, clothing, health care. and Enalish Instructton V addltlon In some years, 01% funds specsal projects In specific localities to ald In resettlement bThe Department of State also admInIsters an Onentatlon and Tralnlng Program, conducted In Refugee Processing Centers overseas, Including ThaIland and the Phlllpplnes The program provides English InstructIon and onentatlon to American Ilfe, work, and schools to refugees departing for the UnIted States “GAO has audlted funds expended under the State Department s Refugee Reception and Placement Program on three separate occasions, covenng different aspects of the resettlement process (For details. see GAO/NSIAD-85-132, GAO/NSIAD-86-69. and GAO/NSIAD-88-91.) Sources HHS. Family Support Admlnlstration. Justlflcatlons of Appropriation Estimates for Committee on Appropnatlons, Fiscal Year 1990, and ORR, Report to the Congress (1987) In fiscal year 1988, HHS and the State Department spent $148 million on the four programs shown in table 7.1. The HHS budget request for fiscal year 1990 proposed reduced funding for its refugee programs because of funding carryovers and an expected reduction in the number of refugees eligible for the programs. The Department of State budget request, on Page 48 GAO/HRD-SO-36FS Asian Americans Section 7 Programs Help New Arrivals Attain Economic SelfSufficiency the other hand, proposed additional funding to increase grants paid to voluntary agencies, (See table 7.2.) Table 7.2: Funding of Major Federal Refugee Grant Programs In mlllions Fiscal year funding Agency and program 1988 obligated 1989 appropriated 1990 proposed Department of Health and Human Serwces Employment serwces $65.7 $64.9 $30 0 Targeted ass/stance 34.5 34.1 0 Gtary agency matching 7.7 15.8 77 Department of State: Refugee reception and Dlacement Total $148.0 $157.8 $84.7 Sources HHS, Family Support Admlnlstratlon, Justlflcatlons of Approprlatlon Estimates for CommIttee on Appropnatlons, Fiscal Year 1990, p. 78, US Department of State, Mlgratlon and Refugee Asststance, Emergency Refugee and Mlgratlon Assistance (Fiscal Year 1990). Other Agencies Assist Community organizations and local school districts use funds received from numerous other federal programs to provide employment-related Refugees and Immigrants services to immigrants (including refugees) with low income or limited proficiency in English. Examples of such programs include job training and summer youth employment, both funded through the Job Training Partnership Act (JTPA), and vocational education. (See table 7.3.) Page 49 GAO/HRD-90-36FS Asian Americans Section 7 Programs Help New Arrivals Attain Economic Self-Sufficiency Table 7.3: Examples of Federally Funded Job Training Programs for People With Low Income or Limited English Proficiency Agency __- and program Eligible participants Types of assistance funded Flow of funds Department of Education Vocatronal education Adults and secondary students Vocatronal skills trarnrng Through states to state and local who are educationally education agencies, public. disadvantaged, deficient in Work-related language tnstructton pnvate, and nonprofit English. in need of tralnlng, or organrzations: and postsecondary handicapped Basic skrlls Improvement instrtutitions Career InternshIps Counseling and guidance Department of Labor JTPA block grant training Economically disadvantaged Job skill training Through states to local adults and youth government and private sector Unsubsldrzed employment partnerships Adults and youth facing serious barriers to employment, including welfare recipients. dislocated workers, those with lrmrted Englrsh proficiency, and the handrcapped JTPA summer youth employment :E;nhosmrcally drsadvantaged Subsidized summer jobs Through states to local and training governments and private sector partnershrps Sources House Committee on Approprlatlons, SubcommIttee on the Departments of Labor, Health and Human Serwces Education and Related Agencies. Approprlattons for 1989 Hearings (WashIngton, D C U S Government Printing Offlce, 1988), part 1, pp 262-5. and part 6, pp 405-8 In addition to these federal programs, city, county, and state govern- ment agencies, as well as corporations, charitable organizations, and others, provide grants to community and other nonprofit organizations to assist new refugees and immigrants. These funds often support such job-related social services as child care, tutoring, summer youth recrea- tion programs, transportation, and counseling. Community organizations tailor services to the specific needs of the Examples of Programs local community and to the regional job market. Most programs include Assisting Asian English instruction and cultural orientation to the United States as Americans in Five essentials to successful employment. Program administrators furnished us with the following descriptions of the services their programs Localities provide. Page 50 GAO;HRD90-36FS Asian Americans Section 7 Programs Help New Arrivals Attain Economic SelfSufficiency Chinatown Manpower The Chinatown Manpower Project offers newly arrived refugees and immigrants vocational training in six areas: office clerical skills. data Project, New York City entry, automated bookkeeping, typing and word processing, vocational English, and counseling on seeking employment. The majority of partici- pants are ethnic Chinese. Since its founding in 1972, the project has placed in jobs, on the average, 90 to 95 percent of its several hundred students per year. Graduates regularly find employment with such com- panies as Citibank, Blue Cross/Blue Shield? and Pinpoint Marketing, Inc. In 1987, the project received federal funding from three sources: the Department of Education Vocational Training Program, the Department of Labor JTPA Program, and the ORR Targeted Assistance Grants. In addi- tion, the project receives contributions from the private sector and the community. Texan Training and The Texan Training and Employment Center offers employment-related services for refugees, immigrants, and low-income people. Its services Employment Center, include vocational training, on-the-job training, outreach to employers, Houston and Dallas job placement, a summer youth employment program, job counseling, and English instruction. In addition, the center runs a state-sponsored Model Outreach for Refugee Employment project that encourages Asian refugee women to work to supplement household income. The center also helps identify support services, such as child care and transporta- tion. About 60 percent of those served are Asian. Some job placements draw upon participants’ skills. For example, the center matched carpenters from Southeast Asia with a wooden toy man- ufacturer, and placed those with cooking skills in a company providing airline meals. In other instances, the center teaches new skills. People participating in the center JTP.4 on-the-job training program learn cook- ing, sewing, and assembly jobs, among others. The vocational education program teaches industrial tailoring for the Dallas garment industry. The center finds employment for about 1,000 people each year through its various services. The center receives virtually all of its funds from the federal govern- ment, including Department of Labor JTPA Block Grants and ORR grants. Page 5 1 GAO/HRD9036FS Asian Americans Section 7 Programs Help New Arrivals Attain Economic !Mf-Sufficiency Korean Youth Center, Los The Korean Youth Center offers numerous programs and activities to serve Korean youths and their families who are recent immigrants or Angeles economically disadvantaged or both. Services include employment assis- tance and placement, family and youth counseling, education and tuto- rial programs, youth recreation leagues, and other community services. The center (1) operates a job bank and a Summer Youth Employment and Training Program funded by the City of Los Angeles and (2) spon- sors seminars with guest speakers from various companies to explain job opportunities and application procedures. Almost all of the 3,000 to 5,000 people served each year are Korean Americans. Korean immigrants often face language and acculturation difficulties that present obstacles to employment. In addition, the faster accultura- tion of youths causes tension within families as traditional Asian and current American values clash. By providing activities and training opportunities, the center attempts to reduce conflicts between youths and their families and communities. The center receives funding from numerous sources, including the fed- eral government (from a federal demonstration block grant through the California Department for Mental Health), the Los Angeles County Com- munity and Senior Citizens Services, the Los Angeles City Department of Senior Citizens, the United Way, and various corporate and private donors. Filipino-American Service Job counseling and placement are among the services the Filipino-Amer- ican Service Group offers to immigrants in Los Angeles. Many of the Group, Los Angeles Service Group’s clients for employment counseling are retired elderly Filipino Americans who came to the United States to join children. Many are seeking part-time employment since they are ineligible for Social Security or other public assistance programs. Often, they are unfamiliar with the U.S. employment system and require help writing resumes and identifying available jobs. Much of the Service Group’s funding comes from Los Angeles county agencies. It also receives private donations and United Way moneys. Center for Southeast Asian The Center for Southeast Asian Refugee Resettlement provides a variety of services to aid newly arrived refugees and immigrants in the San Refugee Resettlement, San Francisco Bay Area. As a resettlement agency, the center carries out the Francisco functions of the State Department reception and placement program, Page 52 GAO/HRDSO-36FS Asian Americans Section 7 Fkograms Help New Arrivals Attain Economic SelfSufficiency including providing initial assistance in housing and employment. As a social service agency, the center provides such employment services as job orientation, counseling, placement, English instruction, and bilingual vocational education. The vocational education program at the center has three emphases: hotel housekeeping, building maintenance, and American restaurant cooking. The center also operates a small business loan and technical assistance program to assist refugees in opening and expanding their own businesses. Furthermore, the center provides translation and interpretation services to government agencies, schools, private businesses, and others. The center’s funding sources include the Department of State (through a national voluntary agency), ORR Targeted Assistance Grants, Depart- ment of Housing and Urban Development Community Block Grants, Department of Labor JTPA Block Grants, California State Office of Eco- nomic Opportunity, local government agencies, foundations, and fees for services. Page 53 GAO/HRD-SO-36FS Asian Americans Chronology of SelectedU.S. Laws and Presidential Actions Affecting Asian Immigration to the United States Chinese Exclusion Act (1882): Excluded Chinese laborers for 10 years. This was the first time the United States closed its doors to people from any country Alien Contract Labor Law of 1885: Made it unlawful to import aliens under contract for labor services. Scott Act (1888): Prohibited Chinese workers leaving the United States from returning, unless they had certain relatives living legally in the United States, owned property worth at least $1,000, or were owed $1,000. Chinese Exclusion Act Extension (1892): Renewed exclusion for 10 years (until 1902). Chinese Exclusion Act Extension (1902): Renewed and extended exclu- sion to cover Chinese in territories under U.S. jurisdiction. Chinese Exclusion Act Extension (1904): Extended exclusion without limitation. Immigration Act of 1907: Authorized the President to enter into interna- tional agreements to regulate immigration. Subsequently, President The- odore Roosevelt concluded a “gentleman’s agreement” with Japan that limited the number of Japanese admissions. Executive Order 589 (March 14, 1907): Prohibited Japanese and Korean laborers receiving passports to enter Mexico, Canada, or Hawaii from entering the United States because they were considered detrimental to U.S. labor conditions. Immigration Act of 1917: Codified previous exclusions and expanded exclusions to include natives of India, Southeast Asia, Indonesian islands, and New Guinea. Required a literacy test. Quota Act of 1921: Established first immigration quotas. Permitted entry of approximately 350,000 immigrants, primarily from Western and Northern Europe. Act of 1921: Denied all foreign-born women the right to their husbands’ U.S. citizenship. Page 54 GAO/HRD90-36FS Asian Americans Appendix I Chronology of Selected U.S. Laws and Presidential Actions Affecting Asian Immigration to the United States Immigration Act of 1924: Provided for the establishment of permanent quotas on the basis of national origin and not place of birth. Decreed that aliens ineligible for citizenship could not be admitted to the United States as immigrants. (Affected primarily Japanese.) Public Law 78-199 (1943): Repealed the Chinese Exclusion Acts. Public Law 79-27 1 (1945): War Brides Act-allowed immigration of alien spouses and alien children of U.S. servicemen who married foreign nationals during World War II. Public Law 79-483 (1946): Allowed immigrants from India, the Philip- pines, and Pakistan. McCarran-Walter or Immigration and Nationality Act (1952): Revised existing legislation. Eliminated race as a bar to immigration and naturalization Presidential Directive of 1962: Authorized about 15,000 Chinese refu- gees from Hong Kong to immigrate. Public Law 89-236 (1965): Amended the Immigration and Nationality Act to phase out quotas based on national origin. Set annual numerical ceiling of 170,000 immigrants to be admitted under various family rela- tionship or job preference categories. Gave preference to immigrants with relatives in the United States (74 percent), scientists and artists (10 percent), skilled and unskilled labor (10 percent), refugees (6 per- cent). Also authorized immigration of an additional 120,000 “special immigrants” from the Western Hemisphere. No limit was placed upon those classified as immediate relatives. Presidential Directive of 1979: Allowed thousands of Vietnamese boat people to enter the United States. Refugee Act of 1980: Provided a systematic and permanent procedure for the annual admission of refugees and authorized federal assistance to resettle refugees and promote their self-sufficiency. Sources include Linda Perrin, Coming to America: Immigrants from the Far East (1980); H. Brett Melendy, Asians in America: Filipinos, Kore- ans. and East Indians (1977); and the U.S. Statutes at Large. Page 55 GAO/HRLMO-36FS Asian Americana Appendix II Data Limitations Data on Asian Americans in general are limited, primarily because ( 1) Asian Americans make up a small portion of the total U.S. population and (2) available studies, for the most part, do not contain sufficient data about Asian Americans to make statistically valid projections nationwide. The decennial census is the only detailed national data source on Asian Americans, and the Asian American population grew almost 60 percent between 1980 and 1985 and underwent significant compositional changes. The Census Bureau Current Population Survey, which is conducted more frequently, only gathers data on whites, blacks, and “other.” The other national surveys large enough to include data on Asian Americans, such as the Census Bureau SIPP data and the Department of Education Degrees and Other Formal Awards Conferred Survey, for the most part, are not large enough to include data on Asian Americans by national or ethnic group. Asian American and other community organizations told us that much data on Asian Americans may not be accurate. Asian Americans with poor English skills may not be counted and multiple Asian American households that share a dwelling may be counted as one household. Although Census Bureau interviewers attempt to address such problems by using interpreters and correctly identifying all occupants, other surveys may not. Organization officials also told us that the “national origin” classifica- tions in the 1980 census may not be precise. Asian Americans can clas- sify themselves (or be classified) according to their (1) ancestry, (2) country of birth, or (3) country of emigration. For example, Asian Amer- icans of Chinese ancestry may have been born in Laos and have emi- grated from Vietnam. Their national origin could be identified as any of the three countries and classified differently for different purposes. In addition, the classifications do not allow for those of mixed ancestry. Page 56 GAO/HRDSO-36FS Asian Americans Appendix III SIPP Methodology The Census Bureau Survey of Income and Program Participation (SIPP) provides information on economic and demographic characteristics of individuals, families, and households in the United States. The SIPP data- base covers such areas as income, wealth, education, employment, pov- erty, and participation in government programs. The objective of our SIPP analysis was to obtain information on Asian Americans’ income, education, and welfare participation compared with the U.S. population as a whole. In addition, we reviewed other demographic data in SIPP, such as household size, age, sex, and employment, for a better under- standing of Asian Americans relative to the total U.S. population. SIPP is based on a statistical sample of U.S. residents, enabling projection to the population nationwide using Census Bureau weighting and esti- mating procedures. The Census Bureau determines sampling units on the basis of geographic areas and socioeconomic characteristics; within the sampling units, the Bureau systematically selects members of house- holds and group quarters (such as college dormitories and rooming houses) for participation in the survey.’ All participants selected in a given year are referred to as a “panel.” The Census Bureau divides panels into four groups and interviews each group in successive months over a 4-month period, which is referred to as a “wave.” Each group is interviewed eight times over a period of 2-l/2 years. For our analysis, we used a file compiled by the Census Bureau consist- ing of one wave each of the 1984 Panel and the 1985 Panel. We analyzed monthly data using August 1985 because it was the only month within the reference periods for all eight groups in the file. (See table III. 1.) ‘Those living in institutions. such as homes for the elderly, and people living abroad and in military barracks are excluded. Page 57 GAO/HFUMO-36FS Asian Americans Appendix III SIPP Methodology Table 111.1:SIPP Data Used in Analvsis Total Asian Interview Panel Wave Group interviewed Americans month Reference period 1984 7 1 10,794 269 Ott 1985 June July Aug Sept (i9651 2 10.881 277 Nov 1985 July Aug Sept Ott I 1985 3 10.818 246 Dee 1985 Aug Sept Ott No:: : 1985, 4 10.912 224 Sept 1985 May, June. July Aug (19851 1985 3 1 9.082 225 Sept 1985 May, June, July Aug (1985) 2 9,395 193 Ott 1985 June, July, Aug Sept (19851 3 9 439 254 Nov 1985 July, Aug Sept Ckt (1985: 4 9,377 223 Dec. 1985 Aug Sept Ott NOV f 1985 Total 80,698 -1,911 To analyze income status, we determined the average household monthly income, the average per capita monthly income, and household income relative to poverty thresholds. Household income includes earn- ings and property income for all household members aged 15 and over.- Average per capita monthly income was calculated by dividing total monthly income by the total number of people. To determine hous~~hold income relative to poverty, we divided household income by the applica- ble poverty threshold, which is based on household size and the mm~be1 of related children under the age of 18. To analyze education status. RX? determined the highest educational level achieved by adults aged 25 or older, Age 25 was used as a minimum to ensure people were old enough for the highest educational levels the SIPP data include. Finally, we analyzed participation in eight of the nine public assistanctl programs we were requested to review.” SIPP does not contain informa- tion on the Summer Food program; hence, we could not include it in out analysis. For the purpose of our analysis, we defined the Low-Income Housing program to include both public housing and government rental assistance. Program participation was analyzed by a count of people fol all programs except the School Lunch and School Breakfast programs, which were analyzed by a count of households because of the WI) data structure. ?XPP does not gather data on mcome for children under the age of 15. 1.1111c.h ‘These programs were AFDC. SSI. Medicaid. Low-Income Housing. Food Stamps. \VI(‘. S~~ho~lI School Breakfast. and Summer Food. (See p. 17.) Page 58 GAO/HRD-90-i36FS Asian Amrricans Append.ix III SIPP Methodology We calculated sampling errors at the 95-percent level of confidence for all SIPP data cited in the report, as shown in table 111.2. Table 111.2:Sampling Errors for SIPP Data Estimatesa Sampling errors at Characteristics Amounts 95% confidence Demographics Percentage In the U S Asran Amerrcan rndrvrduals -2.50% t 0 25% Asian American households 1 80 2 020 Average household size (persons) Asian American households 3 51 2 022 Total U S households Income Average household monthly Income Asran American households $2.972.58 r $253 76 Total U S households 2,324.84 z 26 84 Average per capita monthly Income ~- Asian Americans 826.90 I 70 44 Total U S populatron 887.71 t 1051 Education Average hrghest education level achreved (grade) Asian Americans 12.38 IO64 Total U S. population 1227 -- + 007 Percentage of indrvrduals in education ranges No educatron or kindergarten only Asian Americans 5 23% t 3 04% Total U S. populatron 1 13 2 022 Elementary to erghth grade Asian Amerrcans 13.35 -c 464 Total U S. oooulatron I 11 84 + 066 Hugh school (9th to 12th.grade) Asian Americans 32.99 2 641 Total U S population 48.67 2 1 02 College (undergraduate or graduate level) Asran Americans 48 43 2 682 Total U S population 38 37 i 1 00 (continued) Page 59 GAO/HRD9036FS Asian Americans Appendix III SLPP Methodology Estimate@ Sampling errors at Characteristics Amounts 95% confidence Welfare participation Percent participatrng in AFDC Asian Americans 5.87 k 215 Total U S population 3.79 2 028 SSI Asran Amencans 1.39 2 1 07 Total U S population 1 54 i 018 Medicaid Asran Americans 9 63 i 270 Total US population 7 18 i- 037 Low-Income Housrng Asian Americans 4 86 t 1 97 Total U.S. population 3 56 + 027 - Food Stamps Asian Americans 7 91 t 247 Total U.S. population 7.00 It 037 WIG Asian Americans 0.79 k 0.81 Total U.S. population 1 20 k 016 School Lunch and BreakfastO Asran American households 1056 i 3.48 Total U.S. households 6 47 z 038 aEstlmates were calculated using lndlvldual or household weights, as appropriate bHouseholds with children aged 5 to 18 years receiving benefits from at least one of the free or reduced price School Lunch and School Breakfast programs were counted as partlclpating households Page 60 GAO/HRD-SO-36PS Asian Americans Appendix I\ Asian American and Other Local Community Organizations GAO Contacted California Northern California Asian American Health Forum, San Francisco Asians for Job Opportunities in Berkeley, Inc. Association of Asian/Pacific Community Health Organizations, Oakland Catholic Charities, San Francisco County Center for Southeast Asian Refugee Resettlement, San Francisco International Rescue Committee, San Francisco North East Medical Services, San Francisco Oakland Chinese Community Council, Inc. Southern California Korean Community Service Center, Los Angeles Korean Youth Center, Los Angeles Lao Family Community, Inc., Santa Ana Filipino-American Service Group, Inc., Los Angeles United Cambodian Community, Long Beach United Way, Inc., Los Angeles Southeast Asia Center, Chicago Illinois American Refugee Committee, Minneapolis Minnesota Chinatown Manpower Project, Inc., New York City New York Chinese-American Planning Council, Inc., New York City Chinese Consolidated Benevolent Association, New York City Immigrant Social Services, New York City Catholic Charities of the Diocese of Houston/Galveston Texas Texan Training & Employment Center, Houston and Dallas National Pacific/Asian Resource Center on Aging, Seattle Washington Page 61 GAO/HRD9@36Fs Asian Americans ADDendix V Detailed Statistics on Asian American Education According to our analysis of 1985 SIPP data and 1987 data from the Annual Housing Survey,’ a higher percentage of Asian American adults have attended college than U.S. adults overall, although a comparatively higher percentage of Asian American adults have little or no education. (See tables V. 1 and V.2.) Both analyses examined the highest education level attained by Asian Americans and the total U.S. population aged 2,5 and older. Table V.l: SIPP Data on Educational Levels of Asian Americans Compared Numbers In percent With the Total U.S. Population, Aged 25 Highest education level or Over (1985) attained Asian Americans Total U.S. population No educationa 52(t 30) 11 (I 02) Some elementaryb 13 4 ( t 4 6)--- ~~~-~ 11 8(r 07) Some high school 33 0 ( + 6 4) 487(1 10) Some college 484(t68) - 384(l+ 10) Total 100.0 100.0 %cludes kindergarten. blst through 8th grade Source Census Bureau, SIPP (1985) Table V.2: Annual Housing Survey Data on Educational Levek of Asian Numbers In percent Americans Compared With the Total U.S. Highest education level Population, Aged 25 or Over (1987) attained Asian Americans Total U.S. population No educatIona 2.5 (+ 1 5) 0.6(* 0 1) Some elementaryO 8.0 (k 2 6, 10.5(? 06) Some high school 33.0 (2 5 6) 502(? 25j Some college 56.5 (k 7 9) 38 7 ( 5 1 9) Total 100.0 100.0 %cludes kindergarten bl st through 8th grade. Source U S Department of Houslng and Urban Development. Annual Houslng Survey (1987) ‘The Annual Housing Survey, conducted by the Census Bureau. collects demographic data on educa- tion, income, and age, as well as different types of housing. Page 62 GAO/HRD-SO-36FS Asian Americans Appendix VI Cancer Deaths per 100,000 Population (1978-81) White and Hispanic Asian Americans Cancer type Americans Chinese Filipino Hawaiian Japanese All cancer types 163.6 131.5 69.7 200.5 104.2 Bladder 39 17 15 16 18 Breast (female) 26 6 130 80 33 0 99 Cervix uteri 32 2.9 16 4.2 2.7 Corpus uteri 39 43 20 3.0 39 Colon and rectum 21 6 193 8.1 150 172 Esophagus 26 33 19 65 19 Larynx 13 07 04 14 0.2 Lung (male) 69 3 48 2 20 0 88 0 32 7 Lung (female) 2o:ii 21 2 68 31 5 8.6 Multlple myeloma 24 12 12 28 12 Ovary 8.1 42 2.8 70 43 Pancreas 8.4 74 3.3 109 70 Prostate 21 0 75 8.2 11 6 88 Stomach 53 -78 3.3 25 3 175 Note These are average annual age-adjusted death rates Sources (1) HHS PHS. CDC, Natronal Center for Health Statrstics and (2) HHS, PHS, Natronal Institutes of Health, Natronal Cancer lnstrtute Cancer Among Blacks and Other Mrnorrtres Statistrcal Profrles (1986), as presented In Drsease Preventron/Health Promotron The Facts, Office of Disease Preventron and Health Promotron. PHS. HHS (1988). p 193 Page 63 GAO/HRD-SO-36FS Asian Americans Appendix VII Cultural and Religious Barriers Facing Southeast Asian RefugeesSeeking Medid Treatment In Buddhism, the main religion of Southeast Asia, suffering may be per- Religion l ceived as an integral part of one’s life and seeking medical help for a physical pain may be delayed or considered inappropriate. l Surgery and other invasive procedures are perceived as mutilating and may disrupt the soul. The germ theory and principles of anatomy and physiology are foreign Unfamiliarity With l to those Southeast Asians with little or no education. Western Medicine l Southeast Asians rarely seek preventive treatment. l There is no surgical tradition in Southeast Asia. l Southeast Asians tend not to seek formal mental health care. l Use of dual systems of health care (both traditional and Western) are common, Few Southeast Asian refugees are familiar with the process of making Differing Cultural l an appointment to see a doctor. Norms . Decisions to seek medical care and what kind of medical care are often made by the eldest member of the family. 9 Southeast Asian patients may appear unassuming and nod understand- ing rather than acknowledge the fact that they are confused or do not understand a question. . Instant diagnosis and treatment from the first provider encountered is expected. Southeast Asian patients often use their own systems of health care Folk Practices l before resorting to Western medicine. . Folk medicine is almost universally practiced throughout Southeast Asia, with such practices as cao gio, rubbing the skin vigorously with either a coin or a spoon; bat gio, pinching the skin between the thumb and index finger; and giac, applying a hot cup to the forehead or other exposed area for a prolonged time. l Among the hill tribe people of Laos, shamans may be the preferred providers of medical care; they use such practices as tying a cord around the patient’s wrist to enable communication with dead ancestors or to prevent the loss of a sick person’s soul. Page 64 GAO/HRD-90-36FS Asian Americans -Appendix VIII Major Contributors to This Fact Sheet Daniel 34. Brier, Assistant Director (Welfare Issues), (202) 27543616 Human Resources Charles J. Gareis, Assignment Manager Division, Washington, D.C. San Francisco Susan Rothblatt, Site Senior Regional Office RoJeanne Liu, Technical Advisor Richard S. Thomason, Evaluator Page 65 GAO/HRD-SO-36l?S Asian Americans Bibliography Baron, Roy C., and others. ‘Sudden Death Among Southeast Asian Refu- Articles and Books gees: An Unexplained Nocturnal Phenomenon.” Journal of the American Medical Association, Vol. 250, No. 21 (Dec. 1983) pp. 2947-5 1. Barry, Michele, M.D., and others. “Clinical Findings in Southeast Asian Refugees: Child Development and Public Health Concerns.” Journal of the American Medical Association, Vol. 249, Xo. 23 (June 1983) pp. 3200-03. Catanzaro, Antonio, M.D., and Robert John Moser, Ph.D. “Health Status of Refugees from Vietnam, Laos, and Cambodia.” Journal of the Ameri- can Medical Association, Vol. 247, No. 9 (Mar. 1982) pp. 1303-08. Chen, Arthur, M.D., and Laurin Mayeno. Developing a Uniform Data Base Among Community Health Centers. Oakland, Calif.: Association of Asian/Pacific Community Health Organizations, 1989. Gardner, Robert W., Bryant Robey, and Peter C. Smith. “Asian Ameri- cans: Growth, Change, and Diversity.” Population Bulletin, Vol. 40, So. 4 (Oct. 1985). Johnson, Otto, ed. The 1989 Information Please Almanac. Boston: Houghton Miflin Company, 1989. Judson, Franklyn X., M.D., and others. “Health Status of Southeast Asian Refugees.” Western Journal of Medicine, Vol. 141 (Aug. 1984) pp. 183-88. Lin-Fu, Jane S., M.D. “Population Characteristics and Health Care Needs of Asian Pacific Americans.” Public Health Reports, Vol. 103, No. 1 (Jan.-Feb. 1988), pp. 18-27. Melendy, H. Brett. Asians in America: Filipinos, Koreans, and East Indi- ans. Boston: Twayne Publishers, 1977. Peck, Richard E., and others. “Nutritional Status of Southeast Asian Refugee Children. ” American Journal of Public Health, Vol. 7 1, No. 10 (Oct. 1981), pp. 1144-48. Perrin, Linda. Coming to America: Immigrants From the Far East. New York: Delacorte Press, 1980. Page 66 GAO/HRD90-36FS Asian Americans Bibliography Rieder, Hans L., M.D.M.P.H., and others. “Tuberculosis in the United States.” Journal of the American Medical Association, Vol. 262, No. 3 (July 1989) pp. 385-89. Stavig, Gordon R., Ph.D., Amnon Igra, Ph.D., and Alvin R. Leonard, M.D., M.P.H. “Hypertension and Related Health Issues Among Asians and Pacific Islanders in California.” Public Health Reports, Vol. 103, No. 1 (Jan-Feb. 1988), pp. 28-37. ‘Sudden Unexplained Death Syndrome Among Southeast Asian Refu- gees-United States.” Morbidity and Mortality Weekly Report, Vol. 37, No. 37 (Sept. 1988), pp. 569-70. Sutherland, John E., and others. “Indochinese Refugee Health Assess- ment and Treatment.” Journal of Family Practice, Vol. 16, No. 1 (1983), pp. 61-67. California Attorney General’s Asian/Pacific Advisory Committee. Final Government Report. Sacramento, Calif.: Dec. 1988. Publications U.S. Department of Agriculture, Food and Nutrition Service. Character- istics of Food Stamp Participants. Alexandria, Va.: USDA, 1986. ---. Characteristics of the National School Lunch and School Break- fast Program Participants. Alexandria, Va.: USDA, Jan. 1988. ---. Study of WC Participant and Program Characteristics. Lee Rich- man and others, Ebon Research Systems, Washington, D.C.; Alexandria, Va.: USDA, Apr. 1986. U.S. Department of Commerce, Bureau of the Census. Asian and Pacific Islander Population in the United States: 1980. Report PC80-2-IE. Wash- ington, D.C.: Government Printing Office, Jan. 1988. ---. General Social and Economic Characteristics, U.S. Summary. Report PC80- l-Cl, Vol. 1. Washington, D.C.: Government Printing Office, Dec. 1983. ---. We, the Asian and Pacific Islander Americans. Washington, D.C.: Government Printing Office, Sept. 1988. Page 67 GAO/HRDSO-36FS Asian Americans Bibliography U.S. Commission on Civil Rights. The Economic Status of Americans of Asian Descent: An Exploratory Investigation. Washington D.C.: ITS. Commission on Civil Rights, Oct. 1988. U.S. Department of Health and Human Services. Report of the Secre- tary’s Task Force on Black and Minority Health. Washington, D.C.: II~S. 1986. ---. Family Support Administration. Characteristics and Financial Circumstances of AFDCRecipients, 1986. Washington, D.C.: IIHS, 1987. ---. Family Support Administration, Office of Refugee Resettlement, Refugee Resettlement Program: Report to the Congress. Washington, D.C.: HHS. Jan. 1988. ---. Family Support Administration, Office of Refugee Resettlement. Southeast Asian Self-Sufficiency Study. Nathan Caplan, John K. Whit- more, and Quang L. Bui, Institute for Social Research, University of Michigan, Ann Arbor; Washington, DC.: HHS, 1985. ---. Public Health Service, Centers for Disease Control. Nutrition Sur- veillance, Annual Summary 1981. Atlanta, Ga.: CDC, Dec. 1983. ---. Public Health Service, National Center for Health Statistics. S. Taffel. “Characteristics of Asian Births: United States, 1980.” Monthly Vital Statistics Report, Vol. 32, No. 10, Supp. HHS Pub. No. (PHS) 84-l 120. Hyattsville, Md.: Public Health Service, Feb. 1984. ---. Public Health Service, National Center for Health Statistics. Vital Statistics of the United States, 1986. Vol. II, Part A. HHS Pub. No. (PHS) 88-1122. Washington, DC.: Government Printing Office, 1988. ---. Public Health Service, Office of Disease Prevention and Health Promotion. Disease Prevention/Health Promotion: The Facts. Palo Alto, Calif.: Bull Publishing Company, 1988. U.S. Department of Justice, Immigration and Naturalization Service. Sta- tistical Yearbook of the Immigration and Naturalization Service. Wash- ington, D.C.: Government Printing Office, Sept. 1986. Page 68 GAO/HRD90-36FS Asian Americans Bibliography U.S. Department of State, Bureau for Refugee Programs. World Refugee Report. So. 9669. Washington, D.C.: Department of State, Sept. 1988. Wisconsin Department of Health and Social Services, Refugee Health Program. The Next Decade: The 1986 Conference on Refugee Health Care Issues and Management. Madison, Wis.: Sept. 29-30, 1986. Asian Community Mental Health Services. The California Southeast Organization Asian Mental Health Needs Assessment. Oakland, Calif.: Asian Commu- Publications nity Mental Health Services, Sept. 1987. California Tomorrow. Laurie Olsen, and Marcia T. Chen. Crossing the Schoolhouse Border: Immigrant Students and the California Public Schools. San Francisco, Calif.: A California Tomorrow Policy Research Report, 1988. United Way, Asian Pacific Research and Development Council. Nolan Zane, Ph.D., and others. Asian Pacific Needs Assessment Technical Report. Los Angeles: United Way, 1988. United Way, Asian Pacific Research and Development Council. Pacific Rim Profiles. Los Angeles: United Way, 1983. (105469) Page 69 GAO/HRD-90-36FS Asian Americans
Asian Americans: A Status Report
Published by the Government Accountability Office on 1990-03-08.
Below is a raw (and likely hideous) rendition of the original report. (PDF)