This story is adapted from 'It Just Stays With You': The Corrosive Health Effects Of Decades Of Anti-Asian Violence, originally published with NPR member station WBUR.

Days after a man shot and killed six Asian women and two other people in Asian owned spas in the Atlanta area in March, Doris Chang sat with her 11-year-old son to learn who the victims were. The news held their faces and their names – Asian faces, Asian names just like his.

"My son looked at a picture and he said, 'that looks like Ā-pó,' which is my mother," Chang says. "So, it was really, really hard not to personalize [the shootings] as something that could have happened to anybody in my family, anybody that I know."

Chang and her family, like many other Asian Americans, can see themselves in the thousands of reported hate incidents against Asians over the past year, and it's adding a new layer of stress to their lives.

"For many Asian Americans, these acts of harassment and violence are activating old wounds, memories of racial traumas. For others, they may now worry about going out alone to the grocery store, worrying about loved ones," she says.

Racism against Asians has a long history and anti-Asian hate incidents have been on the rise in recent years. But research into the health effects on Asian Americans of living with such violence is sparse. Health scientists like Chang say that's been damaging to the Asian community, and the research gap needs to close as soon as possible.

As an associate professor of psychology at New York University, Chang is particularly sensitive to how racial violence can sow fear and trauma throughout the community. She's studying some of the health effects from the recent wave of violence.

"We really need more data to see how these events are being experienced differently by folks."

Those data have been exceedingly hard to come by. Yan Zhang, a criminal justice researcher at Sam Houston State University, recently published a paper on anti-Asian hate crime statistics.

"We noticed that there's almost no prior research focused on Asian Americans," she says. "As a researcher, we always want to have high quality data to do analyses. But we don't have that."

There's a lot scientists don't know about the ways racial violence affects Asian Americans, and the things that influence health and wellbeing for the community, Chang says.

Past research on other communities of color finds that repeated exposure to racism and racial violence can grind one's physical and mental health down. Race-related stress has been linked to higher infant mortality rates and cardiovascular disease in African American communities, and researchers continue to find more insidious ways racism harms health.

Without the research specific to Asian Americans' experience, it means any problems currently facing the Asian American community will likely continue to fester, unnoticed and unaddressed.

"It contributes to the invisibility of Asian Americans in conversations about policy needs. If we can't adequately describe the problems facing our community in terms of health equity issues, poverty, achievement, and racial violence, we can't make the case we need more resources," Chang says. "It's very difficult to make that case without data, even though we know, anecdotally, there are very vulnerable members of our communities."

There are several likely reasons why Asians are not prioritized in research, Chang says. One is the model minority myth, which can suggest that Asians don't suffer economic or health disparities compared to whites.

Ideas like this can lead to a general disinterest in funding research on Asians. Federal research dollars dedicated to studying the Asian American community are conspicuously anemic. From 1992 to 2018, only 0.17% of the National Institutes of Health's budget went to studying Asian, native Hawaiian and Pacific Islander Americans.

"That makes it really hard to collect high quality data on Asian Americans, especially around health disparities. It feeds into the popular idea that Asian-Americans don't have problems and that translates into fewer dollars," Chang says. "There's this vicious cycle of lack of data, misconceptions that this is a community that doesn't have problems, and that contributes to the health disparity gap."

Conducting research on Asian Americans can also be a foray into the tower of Babel, Chang says. While we may be grouped into one racial group, the population can be broken down into some 50 different ethnic groups who speak dozens of different languages.

"To do a really rigorous study on Asians, you need very robust outreach efforts because we're spread out as well. Sampling is expensive. Then you need to translate all your measures and tools into a variety of different Asian languages. That's also expensive and difficult to do," Chang says. "There's so many great Asian American scholars doing the best with the resources we have. But it's frustrating as a researcher. It feels unfair that it's so hard to get the support we need."

A language and cultural barrier might also be contributing to the lack of data on Asian Americans and racial violence in another way, says Sam Houston State University's Yan Zhang. Asians, particularly immigrants, may not feel comfortable speaking about hate incidents and crimes with researchers or reporting them to the police or media if they don't speak English well.

"We know from some prior research that Asian Americans have lower report rates for victimization experiences," Zhang says. "Aside from the language barrier, immigrants may not understand the justice system and that may be another reason that prevents them from reporting."

Zhang says even victims from high-profile incidences of anti-Asian hate hadn't reported prior experiences of violence or bias. When a man shouted at a D.C. tea shop owner and pepper sprayed him, the owner said it wasn't the first time his shop had been targeted. After a man trashed a Korean business in Charlotte, North Carolina while yelling racial slurs, the owners said it was the most recent of a long history of attacks.

"If you look at all those cases, you will find that many people had the same or similar experiences before they reported," Zhang says.

From March 19, 2020 to Feb 28, 2021, a period encompassing the ballooning of the country's coronavirus pandemic and some politicians' insistence on linking the virus to China, the Stop AAPI Hate Reporting Center recorded nearly 3,800 separate incidents of hate against Asians in the United States.

But that count may miss how widespread such incidents are.

In one of Chang's ongoing studies, she surveyed roughly 700 Asian Americans across the U.S., at least 40% of them reported one or more incidents of in-person racism including verbal harassment, physical assaults and property damage. Those experiences also came with a decrease in mental health for Chang's participants.

"That shows us how under-reported these events really are, how pervasive they are across our community, and that they're happening to many, many more of us than are actually reporting it," Chang says.

Racism through the form of repeated silencing or ignoring of Asian voices may be yet another reason why Asians rarely report incidents of hate, says Jenny Wang, a psychologist based in Houston.

"If you go to Asia, there are plenty of Asians who advocate for themselves just fine. The problem is that when we speak up [in America] and it's silenced, we then internalize this message that my speaking up has no effect," Wang says. "White toxicity and racism have put an inordinate amount of pressure on Asians living in diaspora communities to cope with the trauma of being in an environment that does not see them and does not protect them."

Wang says that might lead to some Asian Americans feeling that racism against us would be ignored. In order to cope, she thinks many numbed themselves to injustices and, under the threat of white supremacy, tried to diminish themselves to survive. Wang says that can have pronounced mental health consequences.

"I have seen this play out clinically in that a lot of my [Asian] clients really struggle with speaking up for themselves, expressing their emotions, being vulnerable," she says.

The full health impact of racial violence on communities of color likely extends far beyond what studies have so far captured, Wang says. Many analyses have been limited in scope or duration, often collecting data for only a few months, so they can't always be extrapolated to the length of a human life. But racism is a constant, going on day after day, long after the researcher's microscope has turned away.

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