Socially Isolated Cambodians in the US

Recommendations for Health Promotion


  • S. Megan Berthold University of ConnecticutSchool of Social Work
  • Sengly Kong
  • Jason Ostrander
  • Seiya Fukuda



Cambodian, genocide, social isolation, community leaders, community-based health promotion


Community organizations in the United States are severely challenged to serve Cambodian refugees who experience health disparities associated with their traumatic experiences. Community leaders have identified a sub-set of community members of particular concern: those at either end of the age spectrum (elders and young people) who are socially isolated. As part of a larger community-based participatory research project, we conducted a focus group with seven Cambodian community leaders from six cities. The study sought to better understand the phenomenon of social isolation of Cambodian elders and young people in order to inform health promotion efforts. Cambodian leaders expressed keen concern for those community members who rarely seem to leave their homes or interact with the Cambodian community. Prominent themes identified by leaders related to isolation were: a generational pattern; benefits of extended family; health concerns; cultural influences and language; impact of stigma; fear and safety concerns; and lack of sufficient resources. In addition, leaders identified several possible solutions to address the phenomenon of social isolation in their communities. Health promotion efforts with this population should identify isolated individuals and enhance their social connectedness and support networks as part of a larger integrated effort.


Baek, Y. M., Bae, Y., & Jang, H. (2013). Social and parasocial relationships on social network sites and their differential relationships with users' psychological well-being. Cyberpsychology, Behavior, Social Networking, 16(7), 512-517. doi:
Berkson, S. Y., Tor, S., Mollica, R., Lavelle, J., & Cosenza, C. (2014). An innovative model of culturally tailored health promotion groups for Cambodian survivors of torture. Torture, 24(1), 1-16.
Berthold, S. M., & Fischman, Y. (2014). Social work with trauma survivors: Collaboration with interpreters. Social Work, 59(2), 103-110. doi:
Berthold, S. M., Loomis, A. M., Kuoch, T., Scully, M., Hin-McCormick, M. M., Casavant, B., & Buckley, T. (2018). Social disconnection as a risk factor for health among Cambodian refugees and their offspring in the United States. Journal of Immigrant and Minority Health. Published online May 23, 2018. doi:
Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, social media and adolescent well-being: A systematic narrative review. Children and Youth Services Review, 41, 27-36. doi:
Bowers, M. E., & Yehuda, R. (2016). Intergenerational transmission of stress in humans. Neuropsychopharmacology Reviews, 41, 232-244. doi:
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.
Brummelte, S., & Galea, L. A. (2016). Postpartum depression: Etiology, treatment and consequences for maternal care. Hormones and Behavior, 77, 153-166. doi:
Bryant, R. A. (2016). Social attachments and traumatic stress. European Journal of Psychotraumatology, 7, 1-7. doi:
Cacioppo, J. T., Cacioppo, S., Capitanio, J. P., & Cole, S. W. (2015). The neuroendocrinology of social isolation. Annual Review of Psychology, 66(1), 733-767. doi:
Cacioppo, J. T., & Hawkley, L. C. (2003). Social isolation and health, with an emphasis on underlying mechanisms. Perspectives in Biology and Medicine, 46(3), S39-S52. doi:
Centers for Disease Control and Prevention. (2013). Suicide and suicidal ideation among Bhutanese refugees - United States, 2009-2012. Morbidity and Mortality Weekly Report, 62(26), 533-536. Retrieved from
Center for Technology and Aging. (2011). Eliminating barriers to care: Using technology to provide medication therapy management to the underserved—A Center for Technology and Aging Grant Program. Retrieved from
Chang, J., Rhee, S., & Berthold, S. M. (2008). Child abuse and neglect in Cambodian refugee families: Characteristics and implications for practice. Child Welfare, 87(1), 141-160.
Cornwell, E. Y., & Waite, L. J. (2009). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior, 50, 31-48. doi:
Coronado, G., Sos, C., Talbot, J., Do, H., & Taylor, V. (2011). To be healthy and to live long, we have to exercise: Psychosocial factors related to physical activity among Cambodian Americans. Journal of Community Health, 36(3), 381-388. doi:
Cudjoe, T. K. M., Roth, D. L., Szanton, S. L., Wolff, J. L., Boyd, C. M., & Thorpe, R. J. (2018). The epidemiology of social isolation: National Health and Aging Trends Study, The Journals of Gerontology: Series B, gby037. doi:
D’Anna, L. H., Peong, V., Sabado, P., Valdez-Dadia, A., Hansen, M. C., Canjura, C., & Hong, M. (2017, November). Barriers to physical and mental health: Understanding the intersecting needs of Cambodian and Latino residents in urban communities. Journal of Immigrant and Minority Health , 2017, 1-18 [Published online first]. doi:
Dekel, R., & Goldblatt, H. (2008). Is there intergenerational transmission of trauma? The case of combat veterans' children. American Journal of Orthopsychiatry, 78(3), 281-289. doi:
Dinh, K., Weinstein, T. L., Kim, S. Y., & Ho, I. K. (2008). Acculturative and psychosocial predictors of academic-related outcomes among Cambodian American high school students. Journal of Southeast Asian American Education and Advancement, 3, 1-23.
Dorfman, R. A., Lubben, J. E., Mayer-Oakes, A., Atchison, K., Schweitzer, S. O., De Jong, F. J., & Matthias, R. E. (1995). Screening for depression among a well elderly population. Social Work, 40(3), 295-304.
Dubus, N. (2017). A qualitative study of older adults and staff at an adult day center in a Cambodian community in the United States. Journal of Applied Gerontology, 36(6), 733-750. doi:
Ellison, N. B., & Boyd, D. M. (2013). Sociality through social network sites. In W. H. Dutton (Ed.), The Oxford handbook of internet studies (pp. 151-172). Oxford: Oxford University Press.
Field, N. P., Muong, S., & Sochanvimean, V. (2013). Parental styles in the intergenerational transmission of trauma stemming from the Khmer Rouge regime in Cambodia. American Journal of Orthopsychiatry, 83(4), 483-494. doi:
French, L. C. (1994). Enduring Holocaust, surviving history: Displaced Cambodians on the Thai-Cambodian border, 1989-1991. (Order No. 9514851). Available from ProQuest Dissertations & Theses Global. (304117734)
Friis, R. H., Garrido-Ortega, C., Safer, A. M., Wankie, C., Griego, P. A., Forouzesh, M.,.. Kuoch, K. (2012). Socioepidemiology of cigarette smoking among Cambodian Americans in Long Beach, California. Journal of Immigrant and Minority Health, 14, 272-280. doi:
Green, G., Gilbertson, J. M., & Grimsley, M. F. J. (2002). Fear of crime and health in residential tower blocks. A case study in Liverpool, UK. European Journal of Public Health, 12(1), 10-15.
Grigg-Saito, D., Och, S., Liang, S., Toof, R., & Silka, L. (2008). Building on the strengths of a Cambodian refugee community through community-based outreach. Health Promotion Practice, 9(4), 415-425.
Grigg-Saito, D., Toof, R., Silka, L., Liang, S., Sou, L., Najarian, L., . . . Och, S. (2010). Long-term development of a “whole community” best practice model to address health disparities in the Cambodian refugee and immigrant community of Lowell, Massachusetts. American Journal of Public Health, 100(11), 2026-2029. doi:
Gross, E. F. (2004). Adolescent Internet use: What we expect, what teens report. Applied Developmental Psychology, 25, 633-649. doi:
Hepworth, D., Rooney, R., Rooney, G., Strom-Gottfried, K., & Larsen, J. (2010). Direct social work practice: Theory and skills (8th ed.). Belmont, CA: Brooks/Cole.
Hobfoll, S. E. (2001). The influence of culture, community, and the nested-self in the stress process: Advancing conservation of resources theory. Applied Psychology, 50(3), 337-421. doi:
Holt-Lunstad, J. (2018). The potential public health relevance of social isolation and loneliness: Prevalence, epidemiology, and risk factors. Public Policy & Aging Report, 27(4), 127-130. doi:
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237. doi:
Hurtado-de-Mendoza, A., Gonzales, F. A., Serrano, A., & Kaltman, S. (2014). Social isolation and perceived barriers to establishing social networks among Latina immigrants. American Journal of Community Psychology, 53(1), 73-82. doi:
Johnson, B. T., Redding, C. A., DiClemente, R. J., Mustanski, B. S., Dodge, B., Sheeran, P., . . . Fishbein, M. (2010). A network-individual-resource model for HIV prevention. AIDS and Behavior, 14(2), 204-221. doi:
Kiernan, B. (2004). The Cambodian genocide, 1975-1979. In S. Totten, W. S. Parson, & I. W. Charny (Eds.), Century of genocide: Critical essays and eyewitness accounts (2nd ed., pp. 339-374). New York: Routledge.
Kim, T., Nguyen, E. T., Yuen, E. J., Nguyen, T., Sorn, R., & Nguyen, G. T. (2015). Differential role of social connectedness in geriatric depression among Southeast Asian ethnic groups. Progress in Community Health Partnerships: Research, Education, and Action, 9(4), 467-468. doi:
Kinzie, D. J., Riley, D. C., McFarland, D. B., Hayes, D. M., Boehnlein, D. J., Leung, D. P., & Adams, D. G. (2008). High prevalence rates of diabetes and hypertension among refugee psychiatric patients. The Journal of Nervous and Mental Disease, 196(2), 108-112. doi:
Kuoch, T., Scully, M., Tan, H. K., Rajan, T. V., & Wagner, J. (2014). The National Cambodian American Town Hall Meeting: A community dialogue on “Eat, Walk, Sleep” for health. Progress in Community Health Partnerships: Research, Education, and Action, 8(4), 541-547. doi:
Lewis, D. (2010). Cambodian refugee families in the United States: “Bending the tree” to fit the environment. Journal of Intergenerational Relationships, 8(1), 5-20. doi:
Lu, J. J., D’Angelo, K. A., Kuoch, T., & Scully, M. (2018). Honouring the role of community in community health work with Cambodian Americans. Health and Social Care in the Community, 00, 1-9. doi:
Lubben, J. (2018). Addressing social isolation as a potent killer! Public Policy & Aging Report, 27(4), 136-138. doi:
Lubben, J., Gironda, M., Sabbath, E., Kong, J., & Johnson, C. (2015). Social isolation presents a grand challenge for social work. Baltimore, MD: American Academy of Social Work and Social Welfare. Retrieved from
Luo, Y., Hawkley, L. C., Waite, L. J., & Cacioppo, J. T. (2012). Loneliness, health, and mortality in old age: A national longitudinal study. Social Science & Medicine, 74(6), 907-914. doi:
Marshall, G.N., Schell, T.L., Elliott, M.N., Berthold, S.M., & Chun, C-A. (2005). Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA, 294(5), 571-579.
Marshall, G. N., Schell, T. L., Wong, E., Berthold, S. M., Hambarsoomian, K., Elliott, M. N., Bardenheier, B. H., & Gregg, E. W. (2016). Diabetes and cardiovascular disease risk in Cambodian refugees. Journal of Immigrant and Minority Health, 18(1), 110-117. doi:
Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126-133. doi:
Miyawaki, C. E. (2015). Association of social isolation and health across different racial and ethnic groups of older Americans. Ageing & Society, 35(10), 2201-2228. doi:
Muzik, M., Morelen, D., Hruschak, J., Rosenblum, K. L., Bocknek, E., & Beeghly, M. (2017). Psychopathology and parenting: An examination of perceived and observed parenting in mothers with depression and PTSD. Journal of Affective Disorders, 207, 242-250. doi:
National Association of Social Workers [NASW]. (2016). NASW Standards for Social Work Practice in Health Care Settings. Retrieved from
Nelson-Peterman, J. L., Toof, R., Liang, S. L., & Grigg-Saito, D. C. (2015). Long-term refugee health: Health behaviors and outcomes of Cambodian refugee and immigrant women. Health Education & Behavior, 42(6), 814-823. doi:
Nguyen, T.-U., Tanjasiri, S. P., Kagawa-Singer, M., Tran, J. H., & Foo, M. A. (2008). Community health navigators for breast- and cervical-cancer screening among Cambodian and Laotian women: Intervention strategies and relationship-building processes. Health Promotion Practice, 9(4), 356-367. doi:
Norman, G. J., Hawkley, L., Ball, A., Berntson, G. G., & Cacioppo, J. T. (2013). Perceived social isolation moderates the relationship between early childhood trauma and pulse pressure in older adults. International Journal of Psychophysiology, 88(3), 334-338. doi:
Ostrander, J., Melville, A., & Berthold, S. M. (2017). Working with refugees in the United States: Trauma-informed and structurally competent social work approaches [Special Issue]. Advances in Social Work, 18(1), 66-79. doi:
Padgett, D. K. (2008). Qualitative methods in social work research (2nd ed.). Thousand Oaks, CA: Sage.
Pantell, M., Rehkopf, D., Jutte, D., Syme, S. L., Balmes, J., & Adler, N. (2013). Social isolation: A predictor of mortality comparable to traditional clinical risk factors. American Journal of Public Health, 103(11), 2056-2062. doi:
Peltzer, K., Pengpid, S., Puckpinyo, A., Yi, S., & Anh, le V. (2016). The utilization of traditional, complementary and alternative medicine for non-communicable diseases and mental disorders in health care patients in Cambodia, Thailand and Vietnam. BMC Complement Altern Med, 16, 92. doi:
Pescosolido, B. A. (2006). Of pride and prejudice: The role of sociology and social networks in integrating the health sciences. Journal of Health and Social Behavior, 47(3), 189-208. doi:
Peterman, J. N., Silka, L., Bermudez, O. I., Wilde, P. E., & Rogers, B. L. (2011). Acculturation, education, nutrition education, and household composition are related to dietary practices among Cambodian refugee women in Lowell, MA. Journal of the American Dietetic Association, 111(9), 1369-1374. doi:
Peterman, J. N., Wilde, P. E., Liang, S., Bermudez, O. I., Silka, L., & Rogers, B. L. (2010). Relationship between past food deprivation and current dietary practices and weight status among Cambodian refugee women in Lowell, MA. American Journal of Public Health, 100(10), 1930-1937. doi:
Portacolone, E., Perissinotto, C., Yeh, J. C., & Greysen, S. R. (2018). “I feel trapped”: The tension between personal and structural factors of social isolation and the desire for social integration among older residents of a high-crime neighborhood. Gerontologist, 58(1), 79-88. doi:
Primack, B. A., Shensa, A., Sidani, J. E., Whaite, E. O., Lin, L. Y., Rosen, D., . . . Miller, E. (2017). Social media use and perceived social isolation among young adults in the U.S. American Journal of Preventive Medicine, 53(1), 1-8 [E-pub]. doi:
Renfrew, M. R., Taing, E., Cohen, M. J., Betancourt, J. R., Pasinski, R., & Green, A. R. (2013). Barriers to care for Cambodian patients with diabetes: Results from a qualitative study. Journal of Health Care for the Poor and Underserved, 24(2), 633. doi:
Rotabi, K. (2007). Ecological theory origin from natural to social science or vice versa? A brief conceptual history for social work. Advances in Social Work, 8(1), 113-129.
Sack, H. W., McSharry, N. S., Clarke, N. G., Kinney, N. R., Seeley, N. J., & Lewinsohn, N. P. (1994). The Khmer adolescent project: Epidemiologic findings in two generations of Cambodian refugees. The Journal of Nervous and Mental Disease, 182(7), 387-395. doi:
Saldana, J. (2013). The coding manual for qualitative research (2nd ed.). Thousand Oaks, CA: Sage.
Sangalang, C. C., & Gee, G. C. (2015). Racial discrimination and depressive symptoms among Cambodian American adolescents: The role of gender. Journal of Community Psychology, 43(4), 447-465. doi:
Seabrook, E. M., Kern, M. L., & Rickard, N. S. (2016). Social networking sites, depression, and anxiety: A systematic review. JMIR Mental Health, 3(4), e50. Published online first. doi:
Sharif, M. Z., Biegler, K., Mollica, R., Sim, S. E., Nicholas, E., Chandler, M., . . . Sorkin, D. H. (2018). A health profile and overview of healthcare experiences of Cambodian American refugees and immigrants residing in Southern California. Journal of Immigrant and Minority Health. Published online first April 28, 2018. doi:
Shensa, A., Escobar-Viera, C. G., Sidani, J. E., Bowman, N. D., Marshal, M. P., & Primack, B. A. (2017). Problematic social media use and depressive symptoms among U.S. young adults: A nationally-representative study. Social Science & Medicine, 182, 150-157 [Published online first]. doi:
Simich, L., & Andermann, L. (Eds.). (2014). Refuge and resilience: Promoting resilience and mental health among resettled refugees and forced migrants. NY: Springer Science + Business Media. doi:
Smith-Hefner, N. J. (1999). Khmer American: Identity and moral education in a diasporic community. Berkeley, CA: University of California Press.
Spies Shapiro, L. A., & Margolin, G. (2014). Growing up wired: Social networking sites and adolescent psychosocial development. Clinical Child and Family Psychology Review, 17(1), 1-18. doi:
Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America, 110, 5797-5801. doi:
Stewart, M., Letourneau, N., Masuda, J. R., Anderson, S., & McGhan, S. (2013). Impacts of online peer support for children with asthma and allergies: “It just helps you every time you can't breathe well.” Journal of Pediatric Nursing, 28(5), 439-452. doi:
Taylor, V., Bastani, R., Burke, N., Talbot, J., Sos, C., Liu, Q., . . . Yasui, Y. (2013). Evaluation of a Hepatitis B lay health worker intervention for Cambodian Americans. Journal of Community Health, 38(3), 546-553. doi:
Turow, J. (1999). The Internet and the family: The view from the family, the view from the press. Retrieved from The Annenberg Public Policy Center of the University of Pennsylvania:
UN General Assembly. (1948, December 9). Convention on the Prevention and Punishment of the Crime of Genocide [United Nations, Treaty Series, vol. 78, p. 277]. Retrieved from
U.S. Census Bureau. (2016). 2016 American Community Survey 1-Year Estimates: Cambodian alone or in any combination by selected population profile in the United States. Retrieved from
Vanderhorst, R. K., & McLaren, S. (2005). Social relationships as predictors of depression and suicidal ideation in older adults. Aging & Mental Health, 9(6), 517-525. doi:
Vanhalst, J., Goossens, L., Luyckx, K., Scholte, R. H. J., & Engels, R. C. M. E. (2013). The development of loneliness from mid- to late adolescence: Trajectory classes, personality traits, and psychosocial functioning. Journal of Adolescence, 36(6), 1305-1312. doi:
Wagner, J., Berthold, S. M., Buckley, T. E., Kuoch, T., & Scully, M. (2015). Diabetes among refugee populations: What newly arriving refugees can learn from resettled Cambodian Americans. Current Diabetes Reports, 15(8), 56-71. doi:
Wagner, J., Burke, G., Kuoch, T., Scully, M., Armeli, S., & Rajan, T. V. (2013). Trauma, healthcare access, and health outcomes among Southeast Asian refugees in Connecticut. Journal of Immigrant and Minority Health, 15(6), 1065-1072. doi:
Wagner, J., Kong, S., Kuoch, T., Scully, M. F., Tan, H. K., & Bermudez-Millan, A. (2015). Patient reported outcomes of 'eat, walk, sleep': A cardiometabolic lifestyle program for Cambodian Americans delivered by community health workers. Journal of Health Care for the Poor and Underserved, 26(2), 441-452. doi:
Yoshida, H., Henkin, N., & Lehrman, P. (2013). Strengthening intergenerational bonds in immigrant and refugee communities. Philadelphia, PA: The Intergenerational Center at Temple University. Retrieved from
Zahn, D., Matos, S., Findley, S., & Hicks, A. (2012). Making the connection: The role of community health workers in health homes. Retrieved from New York State Health Foundation:
Zelikowsky, M., Hui, M., Karigo, T., Choe, A., Yang, B., Blanco, M. R., . . . Anderson, D. J. (2018). The neuropeptide Tac2 controls a distributed brain state induced by chronic social isolation stress. Cell, 173(5), 1265-1279. doi: