Asians who immigrated to the United States as children have higher rates of suicidal ideation and suicide attempts than U.S. born Asians. Asians who came as adolescents and adults have lower rates than either of those groups.In addition, more Asian female students reported suicidal thoughts and behaviors than Asian male, White female, or White male students. In a survey of students attending high schools in Hawaii, Native Hawaiians had a significantly higher lifetime prevalence rate for suicide attempt (12.9%) than non-native Hawaiian students (9.6%).11 In another survey of Hawaiian high school students, Native Hawaiians (11.5%) and Filipinos (13.6%) had more than twice the rate of suicide attempts in the past 12 months than Caucasians (5.6%). Cultural identification: Among Asians, higher levels of identification with Asian culture, such as a sense of belonging and affiliation with spiritual, material, intellectual, and emotional features of Asian culture, have been associated with a 69% reduction in the risk of suicide attempt. Family relationship: Among Native Hawaiian and Other Pacific Islander youth, strong and supportive family relationships and higher levels of family cohesion, family organization, and parental bonding have been related to lower risk of lifetime suicide attempt.Acculturation: A study of Native Hawaiian youth found a small but statistically significant risk for attempting suicide in adolescents who had greater affiliation with Hawaiian culture. This may be due to increased cultural conflict and stress of being culturally Hawaiian in a Western environment.Native Hawaiians have had to deal with colonialism similar to other native peoples, which has led to a significant change in values and a negative effect on family structure, health, and wellbeing.29