This project is an investigation of the gene by environment (GxE) interactions’ effect on substance use outcomes among refugee communities. Substance use disorders (SUDs) are a major public health concern, affecting individuals and communities worldwide. The etiology of SUDs is complex, involving a combination of genetic, environmental, and social factors. In recent years, there has been growing interest in the role of gene by environment interactions in the development of SUDs, particularly in vulnerable populations such as refugees. Refugee populations are exposed to a range of environmental stressors that may interact with genetic factors to increase their risk of SUDs. However, a number of studies describe a “refugee paradox,” where despite having been exposed to risk factors that can lead to SUDs, they are less likely to develop SUDs. Understanding these gene by environment interactions in refugee communities is crucial for not only understanding this phenomenon, but developing effective prevention and treatment strategies for this population. This thesis aims to investigate the gene by environment interactions underlying substance use in refugee communities and to analyze different methods for gene by environment analyses, ultimately determining which method is best suited for this population.

In the United States, the majority of the population suffers from some form of trauma. There are many ways that an individual can cope and accept their trauma, but two practices stand out as an inexpensive, flexible option for many. Bibliotherapy is the use of reading literature as a way to learn more about and understand one’s trauma through the perspective of others. Expressive writing is the practice of writing and reflecting about one’s own traumatic experiences, as well as the emotions that are tethered to it. In this paper, I explore the fields of bibliotherapy and expressive writing as forms of therapy by reviewing the history, use, goals, and effects of each in the context of mental and emotional well-being. Intertwined with the scholarship is my own self-guided bibliotherapy of reading memoirs and poetry collections related to my trauma and self-guided expressive writing in which I wrote a short collection of personal essays and poetry, finding that both fields, separately and used together, are effective avenues for trauma healing.

This study is a systematic review of the current literature surrounding intergenerational trauma in Southeast Asian (SEA) immigrant/refugee families. This review was guided upon using the 2020 PRISMA criteria and framework. After a parallel search across several databases, 14 articles were qualified for inclusion after reviewing exclusion criteria. Across these articles, five main aims were examined: the effect of trauma on parent mental health, the effect on child mental health, the effect on parenting, the effect on family dynamics/relationship, and an exploratory aim on current recommended interventions. The literature indicated that negative mental health outcomes were often present in parents and affected the quality of parenting. Child mental health was negatively affected through close interactions with the parent. Certain parenting behaviors and styles were associated with traumatized parents, which led to the development of attachment issues in children. Family dynamics and relationships were impacted by conflicting cultures and beliefs they were raised with in the United States and the ones taught at home by their parents. Current recommendations for interventions involve therapy, understanding culture and context of trauma, and as well as utilizing the support and influence of the community. There are many gaps in current research and more examination of intergenerational trauma amongst SEA populations is needed to better understand this complex issue in order to improve the relationship between parents, children, and overall family suffering from the effects of intergenerational trauma. Further recommendations for research, gaps in literature, and implications for this study are explored.