In November, NINR participated in the 2023 National Research Conference for the Prevention of Firearm-Related Harms, held in Chicago. Dr. Hsing-Fang Hsieh, research assistant professor in the Institute for Firearm Injury Prevention at the University of Michigan, presented her NINR-supported work on “Mental Distress as a Mediator between Racism Experience and Firearm Behavior among Asian Americans”. In the presentation, Hsieh discussed the relationship between racism experience, mental distress, and firearm-related behavior among Asian Americans during and after the COVID-19 pandemic. For this work, Dr. Hsieh received the Equity and Justice Award – chosen from over 330 other presentations that were given at the conference.
The presentation was part of a wider multidisciplinary collaboration between Dr. Hsieh at the University of Michigan Institute for Firearm Injury Prevention and Dr. Tsu-Yin Wu, a nurse researcher from Eastern Michigan University School of Nursing. In this interview, Dr. Hsieh discusses the impact of NINR funding on their research, the potential application of their work, and the promise of nursing science to address health inequities in firearm harms.
What does this research build upon? What inspired this project?
Although Asian Americans have been experiencing racism in the United States, at both interpersonal and structural levels, it was often a less discussed and understudied topic until the COVID-19 pandemic. During the period between March 2020 to February 2021, there were almost 3,800 incidents of racism reported by Asian communities in the US. Studies have revealed that in some large cities such as New York City, Asian American hate crimes increased in 2020, compared to 2019.
There were also mass shootings such as the Atlanta Spa shooting in March 2021, which gathered national media attention and triggered fear and mental distress in Asian American communities. Understandably, living in fear during the pandemic, we also saw a sharp rise in firearm purchases nationwide across different communities, including among Asian Americans.
Unfortunately, there were no data that allowed us to investigate in detail what this all means in terms of firearm injury risk among Asian Americans. So, my colleagues and I started collecting data during the pandemic and found that the increased racism targeting Asian Americans was associated with an increase in gun ownership in these communities.
Now, about two years after, with the funding support of NINR, we can expand our data collection to further examine this relationship between structural racism, interpersonal racism, and firearm injury risk post-COVID-19 pandemic. In this current analysis, we wanted to answer two key questions:
- How strong is the link between racism experience and firearm-related behavior among Asian Americans mid- and post-pandemic?
- What is the role of mental distress in this relationship?
Have any of your preliminary results surprised you? What is their importance and meaning?
Personally, I was not surprised to see that the influence of racism on firearm-related behavior, including purchasing a gun, storing guns unsafely, or carrying a firearm more frequently, continued to be strong two or three years after the pandemic. This finding suggests two things:
- The racism acts targeting Asian Americans that were provoked during the pandemic continue to happen within our communities.
- There may also be the prolonged, accumulated effects of racism acts since the pandemic that continue to influence mental health and firearm-related behavior among Asian Americans.
Data collected during the pandemic in 2021 showed that mental distress explained the relationship between racism and firearm-related behavior. What surprised us was that mental distress no longer explains the racism experience and post-pandemic firearm-related behavior. However, we still saw a robust link between racism and both mental distress and firearm behavior post-pandemic.
These findings are from our preliminary research using two separate cross-sectional studies. Our cross-sectional data does not allow causal inference or temporal relationships. However, these findings offer a first look at the associations and insight into the critical pathways between racism, mental distress, and firearm behavior.
How has NINR funding supported your research in firearm injury prevention?
NINR funding allowed us to conduct this research in a critical and timely manner. It allowed us to collect this cross-sectional data in 2023 to pilot-test our hypotheses before launching a national survey. Using NINR funding, we will be moving forward and collecting longitudinal data from a nationally representative sample of Asian Americans that will allow us to examine further the mechanisms between racism, mental distress, substance use, and firearm behavior.
With the examination of multiple risk behaviors associated with firearm injury risk, we can better our understanding of their relationships and identify intervention points. We will also learn more about the protective factors at individual, interpersonal, community, and policy levels that will help mitigate risk.
What are some potential applications of your research findings for healthcare?
There are multiple ways the findings of this research could be applied to make an impact on healthcare. First, it is important to recognize that health disparities, including those in firearm injuries and mortalities, are affected by racism experienced by Asian Americans, and racism can have harmful effects on health outcomes in this population. Asian Americans are historically an understudied population – a diverse population made of many different ethnic communities with both unique and shared experiences and challenges. The fact that we found racism experiences are linked to increased mental distress and firearm-related behavior during- and post-pandemic emphasized such need for awareness within healthcare settings. It is also important to know the detrimental effects of racism on mental health and related health risk outcomes sustained over time for Asian Americans.
Secondly, structural racism may influence individual access to health services and health technology, and the health and English literacy needed to utilize health care to address firearm injury and mortality. Within this study moving forward, we may also learn more about perceived healthcare discrimination and larger disparities in healthcare access, as part of structural racism, and how they influence firearm injury risk. The key takeaway for healthcare providers is that there is an array of individual and upstream factors that are likely not uniform across all communities. It’s important for healthcare providers to assess and address these risk factors in direct patient care and through the lens of population health, but it is also imperative to take a multi-sector approach to ultimately address the root causes of disparities we are seeing around firearm injury and mortality.
How does this project reflect the perspective of the nursing community and NINR’s strategic plan?
Firearm injury risk is a pressing health challenge in the United States, and nursing research provides a critical perspective to address such a challenge. This project reflects NINR’s focus on health equity and social determinants of health by investigating the structural racism and consequential disparities at the root of firearm injury risks. Our project aims to fill the gaps in health disparities and firearm research by:
- Examining the root causes of firearm injury risks to understand how racism influences risks such as mental distress, substance use, and firearm behavior among Asian Americans.
- Inviting voices from Asian Americans, who have been previously overlooked in firearm violence and injury prevention research.
- Identifying not only risk factors but also multilevel protective factors that help mitigate firearm injury risks.
This project is co-led by Dr. Tsu-Yin Wu, a nurse researcher and colleague who offered insights – in complement with my public health training in theory-informed methodology – in how such work can be translated into preventive efforts within community settings. She has years of experience partnering with Asian community members. Our team also includes a registered nurse and project manager Christopher Rudski, along with a multidisciplinary team with expertise in psychology, criminology, public health, geospatial analysis, and mixed-method research. With such a team deeply connected with health equity and broad disciplines, I believe we are well positioned to develop multi-level solutions for firearm injury prevention.
How can NINR funding help address some of the biggest challenges facing nursing science today?
While it is really challenging work, nursing science speaks to the balance between fundamental research, translational science, and practice. I think nursing science also speaks to the consideration of how to integrate prevention efforts into the competing priorities among nurses and practitioners.
NINR funding for projects like ours is imperative to examine the root causes of health disparities, including firearm injury and mortality, and allows a multi-disciplinary team to identify multisector approaches to prevention efforts. For firearm injury prevention, nurturing junior nurse scientists to lead or participate in team science will promote more translational research to thrive.
Looking ahead, what’s next for this project?
We are excited to soon launch the national survey among Asian Americans that will allow us to learn more about the mechanisms between structural racism, interpersonal racism, and protective factors of firearm injury risks. With the knowledge gained, we will be able to identify potential prevention strategies and develop interventions that are culturally appropriate and effective for our Asian American communities. We look forward to this day.
Disclaimer: This interview has been edited for clarity and length. The content has been reviewed and approved by the interviewee to accurately represent their views and findings.
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RF1NR020753: Moving Upstream: Understanding Racism, Firearm Injury Risks, and Resiliency Among Asian Americans (Hsieh (contact); Wu; U of MI Ann Arbor) RFA-MD-21-004: Understanding and Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities (R01 Clinical Trial Optional)