The development of the Khmer acculturation scale

International Journal of Intercultural Relations 26 (2002) 653–678

The development of the Khmer acculturation scale$ Kaine V. Lima, Elaine Heibya,*, Richard Brislinb, Bion Griffinc a

Department of Psychology, University of Hawaii at Manoa, 2430 Campus Road, Honolulu, HI 96822, USA b School of Business Administration/Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA c Department of Anthropology, University of Hawaii at Manoa, Honolulu, HI, USA

Abstract The purpose of this investigation was to develop a multidimensional, culture-specific acculturation measure, the Khmer acculturation scale (KAS), for use with Cambodians living in the United States. The KAS development was guided by Berry’s [W. H. Holtzman, T. Z. Bornemann (Eds.), (1990) Mental health of immigrants and refugees, Hogg Foundation for Mental Health, Austin, TX, pp. 90–102] framework and involved two studies. The first study involved the derivation of 130 questionnaire items and demonstration of content validity using 22 expert informants and judges, relevant literature on Cambodian and American cultures, and existing acculturation scales that had been developed for other ethnic groups. Items were created for two KAS subscales written in both English and Khmer, the Khmer orientation scale (KOS) and Anglo-American orientation scale (AOS). The second study inspected reliability and validity of KAS scores obtained from 410 Cambodian participants living in nine states. The two subscales were reduced in length via factor analyses and were found to have high internal consistency and stability reliability. Criterion validity was supported by a modest significant correlation between the KAS and scores on the Suinn–Lew Asian self-identity acculturation scale [Suinn, Rikard-Figueroa, Lew, & Vigil, Educ. Psychol. Meas. 47 (1987) 401]. Construct validity evidence for the KAS was indicated by its factor structure and support for the following predictions derived from Berry’s acculturation framework: (1) Those who were in the higher SES and educational levels, of a younger generation, and employed were more acculturated compared to their counterparts; (2) Lower psychological distress as measured by the Hopkins Symptom Checklist-25 [Mollica, Wyshak, de Marneffe, Khuon, &

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This article is based on the first author’s Masters thesis. Funding for the project was made possible by grants from the East–West Center and the Department of Psychology at the University of Hawaii at Manoa. We are grateful to the research assistants. *Corresponding author. Tel.: +1-808-942-0738; fax: +1-808-956-4700. E-mail addresses: [email protected] (K.V. Lim), [email protected] (E. Heiby), brislinr@ busadm.cba.hawaii.edu (R. Brislin). 0147-1767/02/$ - see front matter r 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 1 4 7 - 1 7 6 7 ( 0 2 ) 0 0 0 4 0 - 8

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Lavelle, Am. J. Psych. 144(4) (1987b) 497] was associated with greater acculturation; (3) Those who acculturate in the integration mode, on average, scored in the normal range on the HSCL-25, while those in the separation mode scored, on average, in the clinical range. r 2002 Elsevier Science Ltd. All rights reserved. Keywords: Acculturation; Khmer; Cambodian; Khmer acculturation scale

1. Development of the Khmer acculturation scale A little over two decades ago, the first wave of Cambodian refugees came to the United States. Since then some understanding has been achieved regarding their adjustment process in the US and their mental health (see Chandler, 1991, for a thorough treatment of Cambodian political history dealing with the Khmer Rouge; Kinzie & Boehnlein, 1989; Mollica, Wyshak, & Lavelle, 1987a; Sack, 1985; Sack et al., 1994; Sack, Angell, Kinzie, & Rath, 1986). However, little is known about how this group of refugees has acculturated to their new homeland. The paucity of research addressing acculturation of this population may be due to several reasons including: (1) there has not been a psychometrically sound acculturation instrument developed specifically for use with Cambodians living in the US; (2) Cambodians living in the US are scattered in several states, making access to research populations difficult; and (3) Cambodians may be unfamiliar with and reluctant to participate in social science research. It is the purpose of this study to develop an acculturation scale that may be clinically useful for Cambodians living in the US acculturation may be significant in understanding the psychopathology exhibited by Cambodians (APA, 1994; Betancourt & Lopez, 1993; Carter, 1995; Castillo, 1997; Comas-Diaz & Griffith, 1988; Kleinman & Good, 1985; Gaw, 1993; Marsella & Westermeyer, 1993; Rack, 1982). Acculturation status of an individual may also inform tailoring clinical assessment and treatment procedures (Aponte, Rivers, & Wohl, 1995; Ponterotto, Casas, Suzuki, & Alexander, 1995). Existing acculturation scales can be categorized as either culture-specific (e.g., Cuellar, Arnold, & Maldonado, 1995; Felix-Ortiz, Newcomb, & Myers, 1994; Landrine & Klonoff, 1995), or culture-general (Anderson et al., 1993; Phinney, 1992; Sodowsky, Kwan, & Pannu, 1995; Suinn, Rikard-Figueroa, Lew, & Vigil, 1987; Tsushima, 1996). In the clinical setting, culture-specific acculturation scales may more likely yield the level of information that guides effective prevention and treatment programming (Dana, 1998; Leong, Wagner, & Kim, 1995; Lonner & Ibrahim, 1996). More general instruments, such as the Acculturation Scale for Southeast Asians (Anderson et al., 1993), and the Suinn–Lew Asian self-identity acculturation scale (SL-ASIA; Suinn et al., 1987) are useful in assessing cultural commonalities among Asian–American groups (Atkinson & Gim, 1989), but less informative for individualizing clinical services for Cambodians living in the US Therefore, the Khmer acculturation scale (KAS) developed in this study is designed

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to have Cambodian culture-specific content that could supplement the more culturegeneral instruments. In addition to the culture specificity distinction among acculturation scales, they also can be classified as being based on unidimensional or multidimensional models. Early scales operationalized acculturation as a linear construct (Suinn et al., 1987) such that when an individual becomes highly acculturated to a host culture (e.g., the American), he or she must become less enculturated in the former culture (e.g., Cambodian). More recently, however, acculturation has been conceived as a multidimensional construct (Berry, 1990; Cuellar et al., 1995; Marin & Gamba, 1996) in order to not only account for those who retain their original culture and those highly acculturated to the host culture, but also those whose behavior simultaneously reflects both cultures as well as those whose behavior minimally reflects either of the original or host cultures (Berry, 1990). The only acculturation questionnaire specific for Cambodians was developed for acculturation to New Zealand (Cheung, 1995). This scale is based on a unidimensional model and enjoys construct validity support in terms of high acculturation scores being inversely related to psychiatric symptoms among Cambodians living in New Zealand. In order to assess Cambodians acculturation to the US so that both original and host cultural behaviors are measured separately, the KAS developed in this study follows Berry’s (1990) multidimensional model of four modes of acculturation. According to Berry (1990), the integration mode of acculturation refers to when an individual retains elements of the original culture as well as acquires elements of the host culture. If a person acquires a new cultural behavioral repertoire and does not retain the original repertoire, the individual would be undergoing the assimilation mode of acculturation. The separation mode of acculturation involves the rejection of the new culture and retention of the original. The marginalization mode of acculturation involves rejection of both the original and the host cultures. The KAS developed in this study includes two subscales (Anglo-American and Khmer) to permit classification of acculturation according to Berry’s four modes. Berry’s model also guided the selection of construct validity indices for evaluation of the KAS. Berry’s (1990) framework postulates that individuals in each of the acculturation modes may experience acculturative stress differently. Berry, Kim, and Mok (1987) demonstrated that confusion, anxiety, depression, feelings of marginality and alienation, heightened psychosomatic symptom level, and identity confusion are some examples of psychological distress that occur during the process of acculturation. Berry suggests that those in the marginalization mode fair worst than those exhibiting the other three modes and those in the integration mode fair the best in terms of their psychological health. While some findings do not fit Berry’s model (e.g., Cuellar & Roberts, 1997), there is strong empirical support for the existence of the four modes of acculturation among some groups and degree of psychological and socioeconomic adaptation predicted for each mode (Berry, 1983; Berry, Kim, Power, Young, & Bujaki, 1989; Kim & Berry, 1985; Krishnan & Berry, 1992; Smith, 1985; Ward & Kennedy, 1994; Ward & Rana-Deuba, 1999; WongRieger & Quintana, 1987).

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Berry’s (1990) four modes of acculturation among Cambodians living in the US have not been investigated. However, using the unidimensional SL-ASIA, one study of Cambodian adolescents living in the US (Lim, Levenson, & Go, 1999) found that acculturation scores were higher among adolescents than among their parents. One possible reason for greater acculturation among adolescents includes school attendance, which encourages adaptation to American norms and peer groups. In addition, a study on Cambodians’ acculturation to New Zealand found socioeconomic (SES) status and education level to be positively related, and age to be negatively related to the degree of acculturation (Cheung, 1995). Studies of acculturation by other groups report similar findings (Burnam, Hough, Karno, Escobar, & Telles, 1987; Celano & Tyler, 1991; Georgas, Berry, Shaw, Christakopoulou, & Mylonas, 1996; Liebkind, 1996; Negy & Woods, 1992; Sodowsky, Lai, & Plake, 1991; Padilla, 1980; Suinn, Ahuna, & Khoo, 1992; Szapocznik, Scopetta, Kurtines, & Aranalde, 1978). Therefore, the construct validity evaluation of the KAS in this study includes inspection of the relation between mode of acculturation and measures of demographic variables and psychological distress. In hopes of enhancing content validity of the KAS, item construction was guided by definitions of cultural behavior offered by Brislin, Landis and Brandt (1983), Brislin (2000) and Triandis (1994) and by the theoretical framework of all complex human behavior offered by Staats (1996). In particular, culture-related thoughts, feelings, and actions (Brislin, 2000) that are objective and subjective (Triandis, 1994) were classified according to cognitive, language, emotional–motivational, and sensory–motor basic behavioral repertoires (Staats, 1996). Staats framework was selected because of its explicit attention to language in addition to familiar cognitive, emotional, and overt aspects of behavior. Existing acculturation scales (Cuellar et al., 1995; Felix-Ortiz et al., 1994; Harris & Verven, 1996; Landrine & Klonoff, 1994; Marin & Gamba, 1996; Mendoza, 1989; Rezentes III, 1993; Suinn et al., 1987) have incorporated different elements. For instance, Cuellar and colleagues included language, ethnic identity, and ethnic interaction factors on their instrument; Landrine and Klonoff included cultural beliefs and practices, socialization, traditional food preparation and consumption, possession of cultural items, attitude, and cultural superstitions; and Suinn and colleagues included reading/writing/cultural preference, ethnic interaction, affinity for ethnic identity and pride, generation identity, and food preference factors in their acculturation measurement. The content construction of the KAS was also guided by the content of existing instruments, as reported in Study 1 below. Study 2 inspects internal consistency and stability reliability of the KAS developed in Study 1 as well as its validity by evaluating the following hypotheses: (1) As evidence of criterion validity, it was expected that the KAS would moderately correlate with the SL-ASIA (Suinn et al., 1992) because these two instruments conceptually overlap in terms of common elements of Asian culture. Because the KAS is designed to specifically assess acculturation among Cambodians, and the SL-ASIA is designed for Americans of all Asian ancestries, it is expected that the correlation between the two instruments will not be high. Construct validity of the KAS was evaluated by the following

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hypotheses. (2) Those who are in the higher SES and educational levels, younger in age, and employed will be more acculturated compared to their counter parts. (3) Those who fall into the integration mode of acculturation on the KAS will report a less psychological distress, as measured by the Hopkins Symptom Checklist-25 (HSCL-25; Mollica, Wyshak, de Marneffe, Khuon, & Lavelle, 1987b) than those in other modes of acculturation. (4) The factor structure of the KAS reflects cognitive, language, emotional–motivational, and sensory–motor cultural repertoires.

2. Study 1: KAS item construction and content validity Because the KAS was constructed to reflect Berry’s (1990) multidimensional framework, items were designed for two subscales, the Khmer orientation scale (KOS) and Anglo-American orientation scale (AOS). The KOS is designed to assess the degree of enculturation to the Cambodian culture, and the AOS is designed to assess the degree of acculturation to the American culture. All items for the KAS were derived following a culture-specific paradigm, and were intended to represent objective and subjective aspects (Triandis, 1994) of cultural feelings, actions, and thoughts (Brislin, 2000) in terms of Staats (1996) four behavioral repertoires (language, cognitive, emotional–motivational, and sensory–motor). 2.1. Participants Participants for Study 1 included 12 experts of whom six were informants on Cambodian culture and six were informants on American culture. Among the six Cambodian informants, two were females and four were males with ages ranging from 27 to 59 years. Two were Cambodian foreign college students (graduate and undergraduate) studying at the University of Hawaii; three were Cambodians who were permanent residents or citizens of the US; and, one was a Caucasian American who had studied Cambodian culture extensively. Among the six American informants, three were females and three were males ranging in age from 22 to 45 years. Four were graduate students, one was an English teacher, and one was a college professor. Five were Caucasian Americans, and one was African-American. In addition to the informants, 10 expert judges were recruited for the study. Five were judges on Cambodian culture, and the other five on American culture. Among the five Cambodian judges, three were females and two were males ranging in age from 26 to 56 years. All Cambodian judges were permanent residents or citizens of the US whose term of residence in the US ranged from 5 to 23 years. Their occupations included the following: graduate students, customer service agent, store supervisor, and clinical psychologist. Among the five American judges, two were females and three were males with ages ranging from 22 to 63 years. Their occupations included graduate students, psychiatrist, clinical psychology intern, and real estate broker.

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Selection criteria for the Cambodian informants and judges included being born in Cambodia, having lived in the country for some parts of their life, and some proficiency in Khmer (Cambodian language). This latter criterion was chosen because much of Cambodian culture is taught through and embedded in the Khmer literature. Furthermore, expert informants and judges must have been able to communicate fluently in English, and have a good understanding of scientific endeavors reflected in this study. Selection for the American informants and judges included having grown up and lived in the United States for the majority of their lives, ability to communicate fluently in English, and good understanding of scientific endeavors reflected in this study. 2.2. Procedure The item derivation process was divided into four phases. 2.2.1. Phase I, review of the literature and the existing acculturation scales This phase included an examination of available validated acculturation scales (Cuellar et al., 1995; De Leon & Mendez, 1996; Felix-Ortiz et al., 1994; Harris & Verven, 1996; Landrine & Klonoff, 1994; Marin & Gamba, 1996; Rezentes III, 1993; Suinn et al., 1987) to find items that would represent the four repertoires of cultural behavior listed above. A review of the existing acculturation instruments yielded the following content: language use and preference, food consumption and preference, typical cultural behaviors/practices (i.e., attending church/temple), identification with and attitude toward one’s ethnic group, beliefs, and values. Review of literature specifically pertaining to Cambodian culture (Bit, 1991; Cambodian folk stories, 1990; Chandler, 1991; Chandler et al., 1985; Ebihara, 1968; Ebihara, Mortland, & Ledgerwood, 1994; Fitzsimmons, 1957; French, 1994; Ledgerwood, 1990; Pym, 1968; Ratliff, 1997) further contributed to the item pool for the KAS. Based on the literature and the existing acculturation scales, a total of 79 items were derived for the KOS, with five items in the language repertoire, four items in the emotion repertoire, 12 items in the sensory–motor repertoire, and 58 items in the cognition repertoire. Review of literature specifically pertaining to the American culture (Barnes & Burns, 1999; Burns & Rockwell, 1996; Cochran, 1985; Cochran, 1972; Conway, 1993; Corwin & Peltason, 1967; Farber, 1991; Hammond & Morrison, 1996; Helms & Carter, 1990; Hickok, 1991; Maslansky & Mann, 1994; Mieder, Kingsbury, & Harder, 1992; Zinn, 1999), and review of the acculturation scales contributed to the item pool for the AOS. A total of 51 items were derived for the AOS, with five items in the language repertoire, six items in emotion repertoire, 10 items in the sensory– motor repertoire, and 30 items in the cognition repertoire. 2.2.2. Phase II, semi-structured interview with expert informants Cambodian and American expert informants reviewed and discussed the questionnaire items derived for the KOS and the AOS, respectively, from the above

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process by the principal investigator. The discussion was based on these questions: (1) Whether the derived items reflect Cambodian/American culture in general? (2) Whether the items reflect the category (sensory–motor, cognition, emotion, and language) under which they were classified? (3) If any other questions should be added to the existing pool of questions to more completely define Cambodian/ American culture? (4) Should the wording of the questions be changed in order to more accurately reflect the Cambodian/American culture? Lastly, (5) How can you prove yourself to be a Cambodian/American without a legal identification (e.g., passport)? After revision, 78 items were retained for the KOS, and 51 items were retained for the AOS. 2.2.3. Phase III, rating by expert judges The items resulting from phase II were then subject to rating by expert judges with Cambodian judges rating the items derived for the KOS, and the American judges rating the items in the AOS. Judges were asked to rate each item on (1) conceptual clarity, and (2) cultural relevance (to Cambodian and American cultures, respectively) on a five-point Likert scale. One represents the worst score, and five represents the best score. Only items that were given a score of four or five by at least three of the judges were retained. Feedback and recommendations from this review were discussed between the judges and the principal investigator, and modifications and revisions of the items were made accordingly. 2.2.4. Phase IV, translation All items were translated and back-translated following the method recommended by Brislin (1970). Seven Cambodian assistants took part in the translation process. Furthermore, Cambodian–English Dictionary (Headley, Lam, Lim, & Chen, 1977) and the English–Khmer Dictionary (Huffman & Im, 1978) were used as the main references in the translation process. Two Cambodian assistants, who are undergraduate students at the University of Hawaii at Manoa, translated the questionnaire items from English to Khmer (language of Cambodia). One of these translators completed high school in Cambodia and has lived in the US for 8 years and the other finished 3 years of university education in Cambodia and has lived in the US for 5 years. Two other Cambodian assistants, who are primary school teachers, back-translated the Khmer version of the questionnaire. Both completed high school in Cambodia and one completed a bachelor degree in the US while the other is an undergraduate. Three other Cambodian assistants reviewed the translation for conceptual and linguistic parallels. Out of the three, one is a history professor at a university in Cambodia and is pursuing a master’s degree at a university in the US; another is a college graduate from Cambodia and is pursuing a doctoral degree at a university in the US The third is a community worker in Massachusetts, and had about 6 years of education in Cambodia and a bachelor degree from an US university. Items on both scales are presented in statements in both English and Khmer. Each statement has four answer choices, rating degree of agreement labeled 1, 2, 3, and 4, presented in a Likert-like fashion. A higher score on the AOS indicates a higher

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degree of acculturation and a higher score on the KOS indicates a higher degree of enculturation. 2.3. Results As discussed in Section 2.1, a rational method of item derivation, using a multidimensional acculturation framework, yielded a total of 65 items for the KOS subscale and 65 items for the AOS subscale. There were 10 items for language, four items for emotion, 14 items for sensory–motor behavior, and 37 items for cognition repertoires for both subscales. The KOS and the AOS together comprise a total of 130 items. In addition to the acculturation items, 21 demographic questions and two other questions (1. ‘‘What language did you use to answer the statements (acculturation items) above?’’ 2. ‘‘Would you complete this questionnaire again in two weeks?’’) were also included. The latter item is pertinent because one goal of Study 2 was to conduct a retest for the purpose of obtaining stability reliability data. Altogether, the KAS comprises 153 items. 2.4. Discussion The KAS was developed as a content valid multidimensional acculturation instrument containing two subscales, the KOS and AOS. The AOS is designed to measure the degree to which someone acculturates to the American culture, and the KOS is designed to measure the degree to which Cambodians enculturate to the Cambodian culture. The KOS and the AOS contain the same number of items and cultural repertoires, and appear to have conceptual equivalence. Furthermore, the items appeared to adequately represent the major domains (e.g., language, ethnic identity, cultural beliefs and practices, and food preference) represented in the existing acculturation instruments.

3. Study 2: reliability and validity of KAS 3.1. Method 3.1.1. Participants A total of 32 research assistants from eight states took part in the recruitment of participants. Assistants were people from the community where the data were gathered. Twenty-one of the research assistants were from California, one from Florida, one from Hawaii, one from Massachusetts, three from Minnesota, two from Oregon, two from Texas, and one from Washington state. All research assistants received an explanation about the study, a standard set of instructions on questionnaire administration and distribution, and information regarding participant confidentiality. All research assistants maintained contact with the senior author via telephone or/and e-mail.

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A total of 440 Cambodians (female=212, male=196, unspecified=2) living in the US from nine states (California, Connecticut, Florida, Hawaii, Massachusetts, Minnesota, Oregon, Texas, and Washington) participated in the study. However, scores from 30 participants were excluded from the study. Scores from eight of the participants were excluded because the volunteer failed to meet the age requirement (18 years and older), and scores from 22 were eliminated because the volunteers failed to complete at least two-thirds of the KAS. Four hundred and ten participants were included in the data analysis. Out of these, 47 of them completed the KAS twice for retest purposes. On the average, 2.42 months elapsed between the first administration of the KAS and the second. Participants’ mean age was 34.7 (SD=12.4, range of 18–79). Participants’ reported level of education in the US was as follows: 56 (13.7%) had no formal education, 51 (12.4%) had 6 years of education or less, 20 (4.9%) had between 7 and 9 years of education, 63 (15.4%) had between 11 and 12 years of education, and 184 (44.9%) had a college degree or higher. Thirty-six (8.8%) of the participants failed to report their education level. One hundred fourteen (27.8%) of the participants reported an annual income less than $10,000, 62 (15.1%) earned between $10 and 20,000, 104 (25.4%) earned between $20 and 35,000, 53 (12.9%) earned between $35 and 50,000, one (0.2%) earned between $75 and 90,000, and five (1.2%) reported an income above $90,000. Forty-eight (11.7%) of the participants did not report their income. Eighty-five (20.7%) of the participants indicated that they were not employed while 314 (76.6%) reported being employed. Eleven (2.7%) of the participants failed to report the status of their employment. Twenty-two (5.3%) of the participants came to the US before 1979, 303 (73.9%) arrived in the US between 1979 and 1986, and 79 (19.3%) came to the US between 1987 and 1999. Twenty-two (5.4%) of the participants were born in Thailand, 4 (1.0%) in the US, one (0.2%) in the Philippines, and one did not specify the place of birth. The majority (380) of the participants, however, were born in Cambodia. Two hundred sixty-two (63.9%) of the respondents indicated that they were living close to other Cambodians, and 132 (32.2%) indicated that they were not. Sixteen (3.9%) did not indicate the proximity of their residence to other Cambodians. 3.1.2. Materials/assessment All materials, including the informed consent form used in this study were presented in both English and Khmer. Socio-demographic information was gathered using a two-page questionnaire created for this study. Items included country of birth, age, year left Cambodia, occupation, year arrived in the US, number of children, state (in the US) of residency, gender, marital status, level of education, annual income, employment status, and proximity of residence to other Cambodians. Acculturation was measured using the KAS developed in Study 1 and the Suinn– Lew Asian self-identity acculturation scale (SL-ASIA; Suinn et al., 1992). Cronbach’s alpha is reported to be 0.91 for the SL-ASIA; and its validity is supported by correlates with total years of attending school in the US, age upon

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attending school in the US, years living in the US; age upon arriving in the US, years lived in a non-Asian neighborhood, and a self-rating of acculturation (Suinn et al., 1992). The psychometric data for the KAS are presented in the Results section of Study 2. The Hopkins Symptom Checklist-25 (HSCL-25) (Mollica et al., 1987b) was used to assess psychological distress as well as anxiety and depressive symptoms. This measure has been used extensively with Southeast Asian refugees, particularly with Cambodians. Mollica and colleagues translated the HSCL-25 into Khmer reported reliability and validity support. The validation of the HSCL-25, Southeast Asian version, was performed by comparing the degree of specificity and sensitivity obtained from the checklist and that from the DSM-III (American Psychiatric Association, 1980) diagnoses given by a psychiatrist who was blind to the HSCL-25 results. The sensitivity and specificity for the presence of depression according to the DSM-III criteria for major depression was 0.88 and 0.73, respectively. The sensitivity and specificity coefficients for anxiety and total checklist scores were not reported. HSCL-25 scores, however, were found to be highly correlated with patients’ selfreport of clinical improvement over a 6-month follow-up. The test-retest coefficient was 0.89 for the total score, and 0.82 for both anxiety and depression.

3.1.3. Procedure Volunteer participants were recruited by research assistants and by the principal investigator. Explanations about the study were given and consent to participate was obtained at each administration of the questionnaires. All participants were encouraged to complete the questionnaires in one sitting. Due to the relatively small number of Cambodians in the US and the large number of participants needed for this study, community organizations/agencies, apartment complexes, and collegiate student associations where there was a concentration of Cambodians were targeted for recruitment. Furthermore, questionnaires were distributed to Cambodians who sought services from some of these community agencies. All of the research assistants were living in Cambodian communities (e.g., Long Beach, CA, Lowell, MA, and Houston, TX), and administrated the questionnaires. They recruited those living in the community, as well as friends and family members for the study. One research assistant went door-to-door to recruit participants for the study. One hundred fifty of those recruited from the community (not from community agency or collegiate association) received a monetary incentive of $10.00 each (limited funding from the East–West Center) for completing the questionnaire packet. The decision to allocate monetary incentive to this subgroup of participants was based on the fact that a community sample is the most difficult to obtain. In order to minimize order effects, a Latin square design was used to counterbalance the order of the questionnaires in the packet. While questionnaires were available in both the English and Khmer languages, research assistants were also available to administer the questionnaires orally. The questionnaires were orally administered in Khmer to three participants.

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3.2. Statistical analyses 3.2.1. Factor analysis Because this is the first psychometric evaluation of this instrument, exploratory factor analyses were performed separately for the AOS and KOS using the principle axis factoring extraction method. According to recommendations by Gorsuch (1988) and Tinsley and Tinsley (1987), promax rotation was used on all analyses. The decision rules for eliminating items were as follow: (1) Eigenvalue of o1; (2) items which had a loading below 0.32; (3) items that have a loading in the 0.32–0.399 range that also have a loading X0.20 on another factor(s); (4) items that have a loading in the 0.40–0.499 range that also have a loading X0.30 on another factor(s); and (5) items that do not make conceptual, or theoretical sense within a factor were deleted. However, items with low loading (but above 0.32) were exempted from the rules above if they met theoretical, conceptual, and practical criteria. The minimal factor loading requirement of 0.32 was in keeping with recommendations by Tabachnik and Fidell (1996). All subsequent statistical analyses are based upon the shortened version of the KAS that resulted from the factor analyses.

3.2.2. Determining the mode of acculturation The scalar median, as recommended by Dona and Berry (1994), of the KOS and the AOS were used to categorize participants into Berry’s (1990) four different modes of acculturation. Participants whose scores exceed 50% of the possible total score on both scales are classified into the integration mode. Those whose scores fall below 50% of the total score on both scales are classified into the marginalization mode. Those whose score exceed the 50% mark on the KOS and less than 50% on the AOS are classified into the separation mode. Finally, those scores exceed the 50% mark on the AOS and less than 50% on the KOS are classified into the Assimilation mode. This method was used rather than a median split because forcing an even distribution of the four modes of acculturation obfuscates actual prevalence rates of acculturation modes.

4. Results Factor analyses resulted in retention of 33 items on the KOS and 36 on the AOS. The summary statistics for the 69-item KAS, SL-ASIA, and HSCL-25 scores are reported in Table 1. Out of 410 participants, KAS subscale scores indicated that 382 (93.2%) fell into the integration mode of acculturation, 25 (6.1%) fell into the separation, 3 (0.7%) fell into the assimilation mode, and none of the participants fell into the marginalization mode. Unequal distribution across modes attenuates some of the construct validity evaluations reported below.

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Table 1 Summary statistics Measure

N

Mean

SD

KOS AOS KAS HSCL-25 SL-ASIA

410 410 410 407 406

100.06 100.65 200.71 39.03 30.89

14.02 16.38 16.15 12.75 9.04

Note: KOS: Khmer orientation scale; AOS: American orientation scale; KAS: Khmer acculturation scale; HSCL-25: Hopkins symptom checklist-25; SL-ASIA: Suinn–Lew Asian self-identify scale.

4.1. Reliability Cronbach’s alpha was 0.92 for the KOS, 0.94 for the AOS and 0.82 for the KAS (including both the AOS and the KOS). The test-retest correlation was 0.78 (po0:01) for the AOS, 0.88 (po0:01) for KOS, and 0.78 (po0:01) for the KAS as a whole. 4.2. Criterion validity The KAS and the SL-ASIA were positively correlated (R ¼ 0:12; po0:05) with a modest overlap in domains of acculturation. This criterion validity finding was expected given the KAS is designed as Cambodian culture-specific and the SL-ASIA is designed to be more general to Asian cultures. A significant correlation coefficient of 0.64 (po0:01) between the AOS subscale of the KAS and the SL-ASIA was obtained, indicating an expected moderate commonality between the two scales’ domains relevant to American acculturation. The KOS subscale of the KAS and the SL-ASIA were significantly negatively correlated (R ¼ 0:61; po0:01), which was expected given the unidimensional nature of the SL-ASIA. 4.3. Construct validity 4.3.1. Demographics Construct validity of the KAS was evaluated by inspecting the association between demographic variables and subscale scores. Tables 2 and 3 report the results of standard multiple regression analyses for the KOS and AOS subscales, respectively. Higher scores on the KOS subscale were significantly associated with older age, more years of education in Cambodia, fewer years living in the US, less annual income, and greater likelihood of living close to other Cambodians. Higher scores on the AOS subscale were significantly associated with younger age, greater number of years educated in the US, more years living in the US, and greater income. 4.3.2. Psychological distress Construct validity of the KAS was also evaluated by inspecting the association between subscale scores and measures of psychological distress. As expected, a greater degree of American acculturation was associated with less psychological

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Table 2 Summary of standard regression analysis for variables predicting KOS score (N ¼ 410) Variable AGE SEDUCAMB SEDUUSA YRSINUS INCOME EMPLOY OTHERCAM

B 0.551 1.439 0.801 0.640 1.070 1.354 6.133

SE 0.071 0.597 0.516 0.142 0.528 1.733 1.302

b

Sig. nn

0.489 0.142n 0.089 0.233nn 0.109n 0.039 0.212nn

0.000 0.017 0.122 0.000 0.044 0.435 0.000

n

po0:05: po0:01: Note: KOS: Khmer orientation scale; SEDUCAMB: years of education in Cambodia; SEDUUSA: years of education in the US; YRSINUS: years living in the US; INCOME: annual income; EMPLOY: whether or not employed; OTHERCAM: living in proximity to other Cambodians. nn

Table 3 Summary of standard regression analysis for variables predicting AOS score (N ¼ 410) Variable AGE SEDUCAMB SEDUUSA YRSINUS INCOME EMPLOY OTHERCAM

B 0.582 0.595 3.264 0.830 1.357 2.531 0.551

SE 0.075 0.630 0.544 0.150 0.556 1.826 1.372

b

Sig. nn

0.439 0.050 0.310nn 0.256nn 0.117n 0.062 0.016

0.000 0.345 0.000 0.000 0.015 0.167 0.688

n

po0:05: po0:01: Note: AOS: American orientation scale; SEDUCAMB: years of education in Cambodia; SEDUUSA: years of education in the US; YRSINUS: years living in the US; INCOME: annual income; EMPLOY: whether or not employed; OTHERCAM: living in proximity to other Cambodians. nn

distress, as indicated by a significant negative correlation between the AOS and the HSCL-25 (R ¼ 20:23; po0:01). Enculturation was associated with greater psychological distress, as indicated by a significant positive correlation between the KOS and the HSCL-25 (R ¼ 0:13; po0:01). The KAS total score was not significantly correlated with the HSCL-25. Given the multidimensional nature of the KAS, it is important to evaluate construct validity in terms of the relation between mode of acculturation and degree of psychological distress. Unequal cell sizes prevent group comparisons among Berry’s (1990) proposed four modes. However, HSCL-25 scores for the subjects in the integration (n ¼ 382) and separation (n ¼ 25) modes can be interpreted in relation to the standardization sample. A score of 1.75 or higher on the HSCL-25 is determined to be clinically significant (Mollica et al., 1987b).

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The average score on the HSCL-25 for participants in the integration mode of acculturation was 1.54, which is subclinical. In contrast, the average score on the HSCL-25 for participants who fell into the separation mode of acculturation was 1.82. Out of these, 13 (52.0%) scored 1.75 or above and had a mean score of 2.26. 4.3.3. Factor analysis The final way construct validity of the KAS was evaluated was by inspection of the factor structure of the KOS and AOS subscales. Each factor was labeled according to which of the four basic behavioral repertoires (BBRs) the items appear to represent. Factor analyses yielded 8 factors (with Eigenvalue greater than 1.00), and 33 items for the KOS (eliminating 32 items; see Tables 4 and 5). Factor 1 (Language BBR—Language Competence) accounted for 27.67% of the variance, and includes items such as: ‘‘I can read novels in Khmer language,’’ and ‘‘I can write personal letters in Khmer.’’ Factor 2 (Cognitive BBR—Gender Roles) accounted for 8.48% of the variance, and includes items such as: ‘‘It is shameful for a woman to be divorced,’’ and ‘‘A woman should not go out with a male friend alone (e.g., for dinner).’’ Factor 3 (Cognitive BBR—Cambodian Identity) accounted for 7.76% of the variance, and includes items such as: ‘‘Most Cambodians consider me as a Cambodian,’’ and ‘‘I consider myself as a Cambodian.’’ Factor 4 (Sensory–Motor BBR—Cultural Practice) accounted for 4.28% of the variance, and includes items such as: ‘‘I make offerings to ancestral spirits,’’ ‘‘I participate in Khmer holidays, traditions, and/or celebrations (for example: go to the temple, participate in the New Year activities, etc.).’’ These items indicate how much participants exhibit cultural behaviors and how much they take part in Cambodian cultural practices and events. Factor 5 (sensory–motor-interaction with Cambodians) accounted for 3.96% of the variance, and includes items such as: ‘‘I use an age-appropriate title when greeting people who are older than me,’’ and ‘‘When greeting elders, I usually ‘‘sompeah’’ them (‘‘sompeah’’ is a Khmer word that means putting your hands together, placing them just below and close to your nose, and bow).’’ Factor 6 (Cognitive BBR—Food Preference) accounted for 3.31% of the variance, and includes items such as: ‘‘I prefer to eat Cambodian food at home over other kinds of food,’’ and ‘‘I prefer to eat Cambodian food in restaurants over other kinds of food.’’ Factor 7 (Cognitive BBR—Idea of Family) accounted for 3.24% of the variance, and includes items such as: ‘‘It is acceptable for children to live in the same household as their parents even after they have been married,’’ and ‘‘My idea of ‘‘family’’ includes mother, father, grandparents, uncles, aunts, and others who also live in the same household.’’ Factor 8 (Emotional–Motivational BBR—Language Preference) accounted for 2.91% of the variance, and includes items such as: ‘‘If I really want to tell someone how much I hate him/her, I would prefer to say it in Khmer over English,’’ and ‘‘If I really want to tell someone how much I love him/her, I would prefer to say it in Khmer over English.’’ For the AOS subscale, factor analyses yielded 7 factors (with Eigenvalue greater than 1.00) and 36 (of 65) items (see Tables 6 and 7). Factor 1 (Language BBR— Language Competence) accounted for 33.43% of the variance, and includes items such as: ‘‘I understand the meaning of this American phrase: ‘It’s cool,’’’ and ‘‘I

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Table 4 Factor loadings for Khmer acculaturation scale (KAS) items on Khmer orientation scale Factor

1

KAS3 KAS2 KAS1 KAS29 KAS8 KAS7 KAS70 KAS71 KAS68 KAS65 KAS66 KAS88 KAS57 KAS59 KAS41 KAS40 KAS90 KAS60 KAS35 KAS42 KAS93 KAS32 KAS77 KAS33 KAS39 KAS38 KAS64 KAS63 KAS79 KAS85 KAS80 KAS10 KAS9

0.997 0.964 0.806 0.792 0.697 0.380

2

3

4

5

6

7

8

0.738 0.702 0.624 0.609 0.454 0.416 0.662 0.630 0.589 0.495 0.489 0.400 0.737 0.609 0.484 0.414 0.396 0.325 0.703 0.686 0.598 0.517 0.760 0.487 0.449 0.752 0.637

understand what is being said in English songs.’’ Factor 2 (Cognitive BBR— American Identity) accounted for 7.47% of the variance, and includes items such as: ‘‘I would choose to be of American nationality in the next life,’’ and ‘‘I consider myself as an American.’’ Factor 3 (Emotional–Motivational BBR—Individualist Values) accounted for 6.52% of the variance, and includes items such as: ‘‘I would like to do things my own way rather than follow others’ footsteps,’’ and ‘‘People can become anything they want, if they have the opportunity, motivation, and hard work.’’ Factor 4 (Cognitive BBR—Societal Roles) accounted for 4.49% of the variance, and includes items such as: ‘‘There are certain rights children have that parents must observe,’’ and ‘‘A husband and wife should share household duties (for example: taking care of children, doing laundry, etc.).’’ Factor 5 (Cognitive BBR— Gender Roles) accounted for 4.37% of the variance, and includes items such as: ‘‘It

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Table 5 Items for each factor loading for the Khmer acculturation scale items on Khmer orientation scale Factor 1: Language basic behavioral repertoire—Language competence 1. I can give speeches (in front a group of people) in Khmer language 2. I can write personal letters in Khmer 3. I can read novels in Khmer language 7. I understand the meaning of this Cambodian phrase: ‘‘koan ut puuch (child without ancestor)’’ 8. I am familiar with many Cambodian proverbs (for example: ‘‘jol steng taam bot, jol srok taam prateas [enter river follow way, enter town follow country]’’) 29. I read print materials in Khmer language (for example: books, newspapers, magazines, etc.) Factor 2: Cognitive basic behavioral repertoire—Gender roles 65. A virtuous woman should be gentle, calm, patient, soft-spoken, graceful, and have good manners at all times 66. Virginity in a woman is very important before her first marriage 68. A wife should obey her husband 70. It is shameful for a woman to be divorced 71. A woman should not go out with a male friend alone (e.g., for dinner) 88. Politeness is a quality that I think is more important than assertiveness Factor 3: Cognitive basic behavioral repertoire—Cambodian identity 40. Most of the friends I have now are Cambodians 41. Cambodians I know think that I behave like a Cambodian 57. Most Cambodians consider me as a Cambodian 59. I consider myself as a Cambodian 60. I am proud to be a Cambodian 90. I enjoy interacting with Cambodians in the community Factor 4: Sensory–motor basic behavioral repertoire—Cultural practice 32. I listen to Cambodian music 33. I eat steamed rice as a part of my breakfast at home 35. I make offerings to ancestral spirits 42. I participate in Khmer holidays, traditions, and/or celebrations (for example: go to the temple, participate in the New Year activities, etc.) 77. If I were to get married, I would prefer a traditional Cambodian wedding 93. Cupping (a technique using a small pressurized glass to suck on the skin on different parts of the body), and coining (technique using a coin to scratch different parts of the body, especially the chest, until the skin turns red or purple-red) are effective ways to treat some illnesses Factor 5: Sensory–motor basic behavioral repertoire—Interaction with Cambodians 38. When greeting elders, I usually ‘‘sompeah’’ them (‘‘sompeah’’ is a Khmer word that means putting your hands together, placing them just below and close to your nose, and bow) 39. I use an age-appropriate title when greeting people who are older than me Factor 6: Cognitive basic behavioral repertoire—Food preference 63. I prefer to eat Cambodian food in restaurants over other kinds of food 64. I prefer to eat Cambodian food at home over other kinds of food Factor 7: Cognitive basic behavioral repertoire—Idea of family 79. It is acceptable for children to live in the same household as their parents even after they have been married

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Table 5 (continued) 80. Children are obligated to care for their parents when the parents can no longer provide for themselves 85. My idea of ‘‘family’’ includes mother, father, grandparents, uncles, aunts, and others who also live in the same household Factor 8: Emotional–motivational basic behavioral repertoire—Language preference 9. If I really want to tell someone how much I love him/her, I would prefer to say it in Khmer over English 10. If I really want to tell someone how much I hate him/her, I would prefer to say it in Khmer over English

is acceptable for women to have more than one romantic partner before their first marriage,’’ and ‘‘It is acceptable for men and women to choose to be gay or lesbian.’’ Factor 6 (Cognitive BBR—Food Preference) accounted for 3.70% of the variance, and includes items such as: ‘‘I prefer to eat American food at restaurants over other kinds of food,’’ and ‘‘I prefer to eat American food at home over other kinds of food.’’ Factor 7 (Cognitive BBR—Political Awareness) accounted for 3.08% of the variance, and includes items such as: ‘‘I am personally concerned with political changes and events in the US,’’ and ‘‘I understand the structure of the American government system.’’ The items on the AOS and the KOS were designed during Study 1 to represent subjective and objective (Triandis, 1994) aspects of cultural thoughts, feelings, and actions (Brislin, 2000) in terms of four basic behavior repertoires (Staats, 1996; language, cognitive, emotional–motivational, and sensory–motor). It was expected that the item construction procedure would yield a similar factor structure for the two KAS subscales. The factor analyses yielded eight factors for the KOS and seven factors for the AOS, with four similar factors (factors 1, 2, 3, and 6 on the KAS and 1, 2, 5, and 6 on the AOS). All four basic behavior repertoires were represented except there was no sensory–motor factor on the AOS.

5. Discussion The results of Study 2 yielded a 69 item KAS. Content validity of these shown in Study 1 was based on the definitions of acculturation offered by Berry (1990), Brislin (2000), and Triandis (1994) which were operationalized according to four basic behavioral repertoires (Staats, 1996). The results of Study 2 demonstrated that the KAS has good internal consistency and test–retest reliability. Study 2 also provided initial evidence for the KAS in terms of criterion, construct, and factor validity. The findings encourage continued evaluation of the KAS as a multidimensional, culturespecific, acculturation instrument for use with Cambodians living in the US however, the findings of Study 2 must be viewed within the limitations of the method employed. This was a cross-sectional and not a longitudinal study. It is possible that the participants exhibited differences in North American language, cognitions, emotional–motivational characteristics, and sensory–motor practices before leaving Cambodia.

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Table 6 Factor Loadings for Anglo-American orientation scale items of Khmer acculturation scale (KAS) Factor

1

KAS17 KAS16 KAS12 KAS13 KAS15 KAS19 KAS18 KAS20 KAS46 KAS11 KAS43 KAS51 KAS25 KAS95 KAS96 KAS94 KAS97 KAS114 KAS111 KAS115 KAS107 KAS108 KAS130 KAS118 KAS104 KAS106 KAS128 KAS103 KAS109 KAS112 KAS105 KAS100 KAS101 KAS48 KAS44 KAS45

0.909 0.897 0.887 0.879 0.821 0.810 0.780 0.767 0.681 0.679 0.646 0.609 0.538

2

3

4

5

6

7

0.696 0.647 0.620 0.540 0.617 0.583 0.567 0.547 0.493 0.431 0.784 0.651 0.631 0.495 0.608 0.577 0.566 0.534 0.798 0.686 0.583 0.532 0.530

Criterion validity of the KAS was supported by modest yet significant correlations between total and subscale scores of the KAS and total scores on the SL-ASIA (Suinn et al., 1992). The KAS, as a whole, was found to have a positive correlation with the SL-ASIA, suggesting that the instruments share similar acculturation constructs. The AOS was positively while the KOS was negatively correlated with the SL-ASIA. These correlations partly reflect the multidimensional nature of the KAS. The positive correlation between the AOS and SL-ASIA suggests that both instruments measure American acculturation similarly. The negative correlation between the KOS and SL-ASIA is expected given higher scores on the KOS reflect

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Table 7 Items for each factor loading for the for Anglo-American orientation scale items of Khmer acculturation scale (KAS) Factor 1: Language basic behavioral repertoire—Language competence 11. I can give speeches (in front a group of people) in English 12. I can write personal letters in English 13. I can read novels in English 15. I speak in English frequently 16. I understand what is being said in English songs 17. I understand the meaning of this American phrase: ‘‘It’s cool’’ 18. I am familiar with many American sayings (for example: ‘‘The grass is always greener on the other side of the fence.’’) 19. If I really want to tell someone how much I love him/her, I would prefer to say it in English over Khmer 20. If I really want to tell someone how much I hate him/her, I would prefer to say it in English over Khmer 25. I feel comfortable interacting with Americans 43. I read English print materials (for examples: books, newspapers, magazines, etc.) 46. I listen to American music 51. I can name at least 3 American popular singers, or music groups Factor 2: Cognitive basic behavioral repertoire—American identity 94. Most Americans consider me as an American 95. I would choose to be of American nationality in the next life 96. I consider myself as an American 97. I’m proud to be an American Factor 3: Emotional–motivational—Individualist values 107. I feel that I control my own destiny 108. I value being able to do what I want to do, and say what I think and feel 111. People can become anything they want, if they have the opportunity, motivation, and hard work 114. I would like to do things my own way rather than follow others’ footsteps 115. When meeting with friends, I expect them to show up on time 130. One of the most important things in life is to realize my fullest potential Factor 4: Cognitive basic behavioral repertoire—Societal roles 104. A husband and wife should share household duties (for example: taking care of children, doing laundry, etc.) 106. When disagreeing with an authority, it is important to me to be able to voice my opinion 118. There are certain rights children have that parents must observe 128. If I were playing a game, winning is very important to me Factor 5: Cognitive basic behavioral repertoire—Gender roles 103. It is acceptable for women to have more than one romantic partner before their first marriage 105. It is acceptable for a woman to ask a man out on a romantic date 109. It is acceptable for men and women to choose to be gay or lesbian 112. Romantic partners (i.e., boyfriend, girlfriend) are not obligated to marry one another Factor 6: Cognitive basic behavioral repertoire—Food preference 100. I prefer to eat American food at restaurants over other kinds of food 101. I prefer to eat American food at home over other kinds of food

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Table 7 (continued) Factor 7: Cognitive basic behavioral repertoire—Political awareness 44. I am personally concerned with political changes and events in the US 45. I know what the American Civil War was about 48. I understand the structure of the American government system

Cambodian enculturation and higher scores on the SL-ASIA reflect American acculturation. Construct validity of the KAS was supported in terms of expected relations between acculturation scores and demographic indices as well as a measure of psychological distress. However, the finding that most (93.2%) participants scored on the KAS as exhibiting the integration mode limited the construct validity evaluation in terms of inferential group comparisons. No participants exhibited the marginalization mode, several (6.1%) the separation mode, and only a few (0.7%) the assimilation mode. Due to the convenience sample used in this study and the experimental nature of the KAS, it is unknown whether these findings can be viewed as representative of the prevalence of Berry’s (1990) modes of acculturation among Cambodians living in the US It is possible that Cambodians exhibiting the integration mode are more accepting to participation in research studies such as this one. We found that greater acculturation to American culture in terms of higher AOS scores was associated with higher SES and educational level (education in both Cambodia and US), younger age, longer US residence, employment, and greater likelihood of living among people who are not Cambodian. On the other hand, we found that greater enculturation to the Cambodian culture in terms of higher KOS scores were associated with lower SES, more years of education in Cambodia, being older, briefer US residence, unemployment, and living closer to other Cambodians. These results are consistent with findings on acculturation of other groups (Burnam et al., 1987; Celano & Tyler, 1991; Cheung, 1995; Georgas et al., 1996; Liebkind, 1993; Lim et al., 1999; Negy & Woods, 1992; Padilla, 1980; Sodowsky et al., 1991; Suinn et al., 1992; Szapocznik et al., 1978) and support the construct validity of the AOS and KOS subscales. We had predicted that those in the integration mode of acculturation would report less psychological distress than those in the other three modes. Although data from this study did not allow direct comparison of participants among the four modes of acculturation, normative cutoff criteria were used to interpret HSCL-25 scores for the integration and separation groups. Participants who fell in the integration mode had a mean score on the HSCL-25 in the normal range. On the other hand, participants in the separation mode had a mean score on the HSCL-25 in the clinical range. Additional evidence of an inverse relation between acculturation and psychological distress is the significant negative relationship between the KAS and HSCL-25 total scores. These findings indicate that the more individuals are acculturated to both American and Cambodian cultures, the less likely they will manifest psychiatric symptoms. These results are consistent with the findings by

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Cheung (1995), which indicated that Cambodians who were more acculturated to New Zealand culture were less likely to experience psychiatric symptoms. The results of the current study are also consistent with Berry’s (1990) model. Specifically, data from this study indicated that Cambodians living in the US who are more both acculturated to the American culture and enculturated to the Cambodian culture (integration mode) are less likely to exhibit psychological distress than those who are only highly enculturated to Cambodian culture (separation mode). Therefore, the findings provide some support for the construct validity of the KAS as a measure of Berry’s (1990) model. The final source of construct validity support of the KAS comes from inspection of its factor structure. The AOS and KOS items were designed to be symmetrical in the assessment of language, cognitive, emotional–motivational, and sensory–motor basic behavioral repertoires. However, the two subscales did not yield identical factor structures. The AOS failed to yield a sensory–motor factor, suggesting this scale does not adequately assess common American activities. It is possible that American activities are culturally diverse and therefore difficult to specify. Nevertheless, the two subscales shared four factors, suggesting that the KAS does assess some parallel domains of acculturation and enculturation. In addition, the factor structure of the KAS is somewhat similar to those found on other acculturation scales that partly guided item development in Study 1. The reading/ writing/cultural preference, ethnic interaction, affinity for ethnic identity and pride, and food preference factors (out of the five factors) on the SL-ASIA (Suinn et al., 1992) were identified on the KAS. In addition, the three factors reported for the Acculturation Rating Scale for Mexican Americans-II (Cuellar et al., 1995) were also found on the KAS (language factor, ethnic identity factor, and ethnic interaction or ethnic distance factor).

5.1. Conclusion A need for adequate measurements of acculturation is a concern that has been raised by a number of researchers (Cuellar et al., 1995; Negy & Woods, 1992). The concern is quite pronounced when it comes to such measurements for Southeast Asian populations. Cambodian, along with Laotian and Vietnamese, refugees have been shown to manifest greater psychiatric symptoms than the general population in the US (Kuoch, Scully, Miller, Boua, and Miller, 1996; Lin, Tazuma, & Masuda, 1979; Meinhardt, 1990; Tung, 1985; Westermeyer, 1988). Furthermore, Cambodian refugees have been shown to manifest higher levels of psychological symptoms than Vietnamese, and Laotian refugees (Hays, 1991; Meinhardt, 1990; Rumbaut, 1985). Given this body of literature, it would be important to understand how much these psychological symptoms are moderated by acculturation. The development of the KAS is an attempt to address this concern. Given its strong reliability and preliminary validity support presented here, the KAS may be a useful tool for researchers, educators, and clinicians who work with Cambodians in the US.

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