QL has been used to examine the well-being of various groups of youth and adolescents in the population. To date, in the United States, QL research with children and adolescents that examines racial/ethnic disparities has focused on differences across the three largest racial/ethnic groups in the country (Olson, Lara, & Frintner, 2004), non-Hispanic Whites (63.7%), non-Hispanic African American (12.6%), and Hispanics (16.3%) (Humes et al., 2011). Although some QL studies have included Asian American youth in their samples (e.g., Cremeens, Eiser, & Blades, 2006; Varni, Limbers, & Burwinkle, 2007), there is no study we are aware of that has reported on the QL of this group specifically or disparities that may exist between Asian American youth and other groups. Research has been conducted, however, reporting differences between Asian American children adolescents and other racial/ethnic groups in specific dimensions of the physical, emotional, and social domains usually constituting QL.

In the area of physical health, studies find Asian American youth generally healthier than their non-Asian peers in almost every measurement. For example, Asian American youth have lower morbidity rates than non-Hispanic whites (Yu & Vyas, 2009). They also have the highest rates of “no missed school days” in comparison with other racial/ethnic groups (Bloom et al., 2006). Asian American youth have lower rates of chronic and congenital diseases than non-Hispanic white youth (Yu & Vyas, 2009). In addition, data from the 2005 National Health Interview Survey indicate that parents of Asian American youth rate their health higher, with only 0.4% describing them as being of “fair or poor” health, in contrast to parents of non-Hispanic white (1.5%), non-Hispanic African American (3.3%), and Hispanic (3.2%) children (Bloom et al., 2006). In terms of weight class, Asian American adolescent girls report less than half the rates of obesity than non-Hispanic White girls (4% and 10%, respectively) (Wang & Beydoun, 2007).

In contrast to these positive findings in the physical domain for Asian American children and adolescents, other studies show that they experience substandard psychosocial health in comparison with other racial/ethnic groups (Chang, Morrissey, & Koplewicz, 1995; Onoda, 1977; Pang, 1991; Rhee, Chang, & Rhee, 2003). Higher rates have been reported among Asian American youth in depression (Centers for Disease Control & Prevention, 1995, 1997; Chang et al., 1995) and anxiety (Onoda, 1977; Pang, 1991), as well as lower self-esteem (Greene, Way, & Pahl, 2006; Rhee et al., 2003). High prevalences of fighting and suicidal ideation have also been reported among Asian American/Pacific Islander high school students (Grunbaum, Lowry, Kann, & Pateman, 2000). The literature finds high rates of anxiety, depression, and social stress among Chinese American adolescents in contrast to their non-Asian American peers (Zhou et al., 2003). In terms of social well-being, Asian American high school students report high rates of on-campus discrimination and harassment from their non-Hispanic African American and Hispanic peers (Rosenbloom & Way, 2004). Most of this research, however, has focused on adolescents (about 12–18 of age). There has been a dearth of research on younger children, especially just prior to the transition to adolescence.

Although the literature on Asian American youth presents findings suggestive of better physical and poorer psychosocial health, it also reports considerable variation in health within this group (Gong-Guy, 1987; Yu, Huang, & Singh, 2004). Asian Americans, although often treated as such, are not a homogeneous ethnic group. Most obvious is that their heritage is rooted in quite different regions and cultures, ranging from India and Pakistan to Korea and Japan and many different locations in between. In addition, Asian American youth may have very different levels of acculturation, ranging from those who were born and partially raised in their country of origin and who are still closely immersed in their home culture, to those whose families have resided in the United States for five generations or more and who are very much integrated into the majority U.S. culture. For these reasons, the diversity of Asian Americans challenges research. Even a large sample study would have to significantly oversample Asian Americans to be able to make even gross differentiations within this group.

We acknowledge that the present study, like most others preceding it, is unable to make finer discriminations within the Asian American group, as desirable as that would be. Yet this study provides a distinct opportunity to examine QL broadly in a sizable sample of Asian American youth at an important specific point in development, in fifth grade toward the end of elementary school and prior to the transition to middle school. Therefore, this information can provide a baseline against which to illuminate changes that may occur during adolescence. We take advantage of the Healthy Passages project for this purpose, which is a prospective longitudinal cohort study tracking health risk indicators and their correlates in youth from 5th grade through 10th grade. This project was designed to examine disparities among Hispanic, non-Hispanic African American, and non-Hispanic white youth but did not exclude members of other ethnic groups in the catchment areas from enrolling. Thus this study enrolled Asian American youth in sufficient numbers to enable comparison of them to age peers from the other three major racial/ethnic groups. The rationale and methods of Healthy Passages are detailed elsewhere (Windle et al., 2004).

This study will thus examine Asian American youth’s QL within the three core domains of wellness—physical, emotional, and social—plus the school domain. Wellness in the school domain is important because within this environment occur important interactions with both peers and nonfamilial figures of authority (teachers) as well as preparation for future productivity. To supplement information about QL and in light of previous findings on Asian American youth’s psychosocial and physical functioning, we also examine youth’s self-concept, social integration, and standard overall health status. We also examine possible race/ethnicity-by-gender interactions and adjust comparisons for socioeconomic differences that may exist among racial/ethnic groups. Thus with the specific aim to examine differences that may exist in QL between Asian American youth and their non-Asian peers, based on existing literature we expect that the Asian American youth will report physical QL in the range of the non-Hispanic white majority population. We further expect that this group will report psychosocial QL (emotional, social, and school domains) in the range of the Hispanic and non-Hispanic African American minority populations.

This study demonstrates that there are substantial racial/ethnic disparities in youth’s QL. Asian American youth experienced worse status compared with white youth across three quite different domains of well-being—physical QL, global self-worth, social well-being—and experienced better status compared with Hispanic youth on six measures and African American youth on three measures. However the advantages for Asian American youth over Hispanic and African American youth disappeared when the marked socioeconomic differences that are also present among the racial/ethnic groups were taken into account. Thus the observed advantages attributed to Asian American youth may be largely attributable to their advantageous, on average, SES compared with other racial/ethnic minority groups. In contrast, the differences between Asian American and white youth remained after taking into account these socioeconomic differences. In sum, these findings suggest that the disparities that favor white youth over Asian American youth exist independent of SES, in contrast to those that favor Asian American over Hispanic and African American youth, which may be explained by SES.

A theoretical rationale for the observed advantages attributed to Asian American youth can be found in the social gradient theory (Marmot, Rose, Shipley, & Hamilton, 1978). Foundational to much of disparities research, this theory articulates the positive and significant relationship between health and SES. Framed within this theory, the rationale for the observed advantages of Asian American youth over Hispanic and African American youth may be directly attributed to the socioeconomic differences between the groups, as evidenced by those advantages disappearing when SES is introduced into the model.

A rationale for why the disadvantages of Asian American youth compared with white youth did not disappear when the same differences between groups was taken into account poses a more complex question that requires further research focused on this question. One issue that may be considered is the universality of the QL construct (Koot & Wallander, 2001) and whether QL can be measured using the same instrument across cultures. We argue it is useful to do so for among other reasons to stimulate more focused research into QL of disparate groups of youth. For example, interesting research has followed the finding of cross-cultural differences in parent-reported behavior problems in children and adolescents (Verhulst & Achenbach, 1995). As noted in its description previously, the PedsQL has considerable psychometric support for its applicability in a variety of cultures. Yet subtle differences in response style and reporting biases may exist that contribute to between group differences and should be examined.

Our findings challenge findings from previous studies. We had expected Asian American youth to report physical QL in the range of the white youth. This was not the case, however, with the Asian American youth reporting poorer physical QL than the white youth in both the unadjusted and SES-adjusted models (d = −0.28 and −0.25, respectively). Unexpected, too, was that there was no disparity in emotional, social, or school QL between white and Asian American youth in either the unadjusted or SES-adjusted model. This was surprising because much of the literature (e.g., Rhee et al., 2003; Zhou et al., 2003) has suggested that Asian American youth experience deficits in both emotional and social areas. This discrepancy may be a result of our using a broad measure of functioning in these domains, whereas previous research has used more specific and focused measurements.

We did find, however, a disparity in some of our adjunct psychosocial measures that favored white over Asian American youth (global self-worth, social well-being) and African American over Asian American youth (social well-being) in both our unadjusted and SES-adjusted models. These findings are consistent with the current literature that reports deficits in psychosocial well-being among Asian American youth and adolescents. Future research might explore the relationship between these adjunct measures (global self-worth, social well-being) and our psychosocial QL measures among Asian American and non-Asian American youth.

Future research might also explore the influence of parent– child relationship—and more specifically, parental expectation— on Asian American youth’s QL. While the literature suggests that parental expectation of Asian American children can be overwhelming (Kibria, 1993) and is tied to increased risk of anxiety, depression, and low self-esteem (Park & Kim, 2006), there is no study that we know of that examines its influence on children’s QL. Future research might explore this relationship both inside and outside the home. In light of this study’s finding of low social well-being among Asian American youth, future research might explore the quality of friends and social circles among Asian American youth inside the school environment. Are there noticeable differences across racial/ethnic groups regarding social support for youth in the school environment? This could be especially pertinent in light of the high rates of on-campus harassment Asian American students report from their African American and Hispanic peers (Rosenbloom & Way, 2004).

Among limitations in this research, first is the relatively small size of the sample of Asian Americans here. Findings from this study are therefore best viewed as preliminary and stimulation for further research. Moreover, as with the 2003–2004 National Survey of Children’s Health (Kogan & Newacheck, 2007) and the 2001–2004 National Health and Nutrition Examination Survey (Braun et al., 2008), our study had no survey materials for non-English or non-Spanish speaking families. Hence, the least acculturated families of the pool were likely excluded from participation based on low proficiency of English. Another limitation of the study is its aggregation of ethnically and culturally diverse groups into the entity we call “Asian American.” Studies (e.g., Barnes, Adams, & Powell-Griner, 2008) show that there is sizable variation in many aspects of health among Chinese, Filipino, Asian Indian, Japanese, Vietnamese, and Korean groups, yet like most survey studies we were unable to disaggregate this group. Another possible influence on QL and health not examined in our study is acculturation. As a moderating and mediating variable, acculturation is influential in affecting children’s health. An example is the inverse relationship between acculturation and healthy weight class among children and adolescents, with each successive generation more at risk for obesity (Popkin & Udry, 1998). It should be valuable to examine QL in relation to acculturation in future research. Finally, whereas considerable support for the validity of the PedsQL and equivalence of the measurement structure in different cultures exist already, future research would do well to continue to examine the use of this and related measures across cultures.

This study is the first we know of to examine differences between Asian American and non-Asian youth in broadly conceptualized QL, while accounting for socioeconomic contextual factors. These types of measures may describe the health and well-being of children and adolescents in the general population more comprehensively than conventional mortality and morbidity measures and provide better identification of unrecognized conditions, social and emotional problems, and poor functioning (Koot & Wallander, 2001; Szilagyi & Schor, 1998).

The March 2011 U.S. Census Brief (Humes et al., 2011) reports that in the decade between 2000 and 2010 the Asian population in the United States “experienced the fastest rate of growth” of any racial/ethnic group. In light of these statistics, it will serve the children of this group and our population as a whole to better understand the challenges of health and well-being of Asian American children.