Children of Immigrants Health, Adjustment, and Public Assistance (1999) / Chapter Skim
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6 The Health Status and Risk Behaviors of Adolescents in Immigrant Families
6 The Health Status and Risk Behaviors of Adolescents in Immigrant Families
Pages 286-347
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From page 286... ...
This chapter examines the physical and emotional health status and health risk behaviors of immigrant adolescents and native-born adolescents with immigrant parents relative to adolescent health in native-born families. Generational differences are assessed by country of origin and ethnic group background, and the extent to which family and neighborhood context explains the within and across ethnic group differences in health outcomes is analyzed.
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From page 287... ...
More specific to immigrant youth, the age at which children arrive in the United States may affect their process of adaptation. Children who arrive in their preschool years can more easily adapt to the American educational system, learn the English language, and be less stigmatized without a noticeable accent than children who arrive in this country during their adolescence.
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From page 288... ...
If, however, greater exposure to American society has primarily been in inner-city environments, where many new immigrants settle and where the social environment and economic opportunities have been declining, immigrant children with longer U.S. residence (and a younger age at arrival)
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From page 289... ...
Moreover, the country-of-origin composition of immigrants to the United States between 1980 and 1990 shows that 90 percent of immigrants were from Asia, Latin America, and Africa. This chapter examines the health status and health risk behaviors of a population of adolescents who represent this "new immigration." Using data from a nationally representative study of adolescents in American schools in grades 7 through 12, the study includes immigrant youth who arrived in the United States between 1975 and 1994 and native-born youth of immigrant parents.
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From page 290... ...
As youth increasingly value peer friendships and peer relationships, concurrent distancing from the family origin constitutes a central task of adolescence (Perry et al., 1993~. This normal developmental process of waning family involvement and increasing peer influence during adolescence may be especially alien to the cultural practices and models of respect in immigrant families and may create family tensions and divided loyalties for immigrant adolescents.
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From page 291... ...
ANALYSIS STRATEGY This analysis examines how ethnic background and immigrant status influence physical and emotional health status and health risk behaviors and whether family and neighborhood context explains any of the observed differences in health outcomes. Data are from the National Longitudinal Study of Adolescent Health (Add Health)
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From page 292... ...
Finally, the assimilation process for immigrant children is examined by contrasting health outcomes by age at entry into the United States and length of time here. Stage two of the analysis explores whether differences in health status and risky behaviors by immigrant status persist within country of origin and ethnic background.
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From page 293... ...
This perspective is addressed in Table 6A-1, which examines physical health status, emotional health, and health risk behaviors of immigrant adolescents and native-born adolescents with immigrant parents in comparison to adolescents in native-born families, who are further subgrouped into native populations of non-Hispanic whites, non-Hispanic blacks, non-Hispanic other
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From page 294... ...
For nearly all of the outcomes examined, native-born youth with immigrant parents have poorer physical health and a greater propensity to engage in risky behaviors than foreign-born youth. The children of immigrants are more likely than immigrant youth to have fair or poor health (10.7 versus 9.2 percent)
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From page 295... ...
native population to which immigrant youth assimilate. If we contrast the health status and risky behaviors of foreign-born youth and native-born youth with foreign-born parents with the native populations of non-Hispanic Asian and American Indian and Hispanic adolescents, a fairly linear pattern is observed.
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From page 296... ...
The findings on health status and health risk behavior are summarized in Figures 6-1 and 6-2, which show the percentage distributions on the physical health problems index (Figure 6-1) and the risky behaviors index (Figure 6-2)
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From page 297... ...
Figure 6-2 displays a similar pattern for the risky behaviors index, showing the percentage distribution of involvement in zero, one, and two or more risky behaviors by immigrant status. The linear pattern is less striking than in Figure 6-1 but is still evident in the percentage of youth involved in zero or one risky behavior (the second level of bars)
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From page 298... ...
Demographic Composition of Immigrant Families The health differentials documented in Table 6A-1 and Figures 6-1 and 6-2 are dramatic and fairly consistent but may be a consequence of differences in the demographic characteristics of immigrant families. Immigrant children as a group are older on average than the children of immigrant or native-born parents.
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From page 299... ...
A remarkably linear and statistically significant pattern is evident, indicating that with more years of exposure and assimilation into American culture, physical health problems increase, as do risky behaviors. Health Differentials by Immigrant Status and Ethnic Background The aggregate differences by immigrant status documented thus far mask likely variations in the relationships between immigrant status and health by country of origin and ethnic background.
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From page 300... ...
Ethnic background is defined for 11 countries or regions of origin that permit comparisons by immigrant status: Mexico, Cuba, Central and South America, Puerto Rico, China, the Philippines, Japan, Vietnam, other Asia, Africa and the Afro Caribbean, and Europe and Canada. Ethnic background classifications are
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From page 301... ...
Because the native populations of non-Hispanic blacks and non-Hispanic whites represent a more heterogeneous ethnic composition than the immigrant populations of youth with African and Afro Caribbean ancestry and European and Canadian ancestry, respectively, these comparisons are loose and may not reflect a parallel ethnic group similarity across immigrant status to the same degree as in the other ethnic group comparisons. Data in Table 6A-2 are complex and not all findings are sig 2Because youth from Africa and the Afro Caribbean are black immigrants and treated as blacks by American society, their small numbers are combined in all analyses.
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From page 302... ...
Although the physical health of foreignborn youth from Africa and the Afro Caribbean is better than that of native-born youth with parents of African or Afro Caribbean descent, foreign-born youth are more likely to have ever had sex than native-born adolescents. Another exception to the health advantage associated with foreign birth occurs for asthma and sexual behavior among youth from Europe and Canada.
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From page 303... ...
. On certain outcomes and for certain ethnic groups, the children of immigrants experience the most risk in their physical health and health risk behaviors.
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From page 304... ...
To the extent that immigrant adjustment and assimilation involve the adoption of health status and behavioral norms in the native ethnic subgroup with which immigrants are identifying, a segmented assimilation process is furthermore evident in these data. Multivariate Analysis The final stage of analysis entails testing for the significant and independent effects of immigrant status and ethnic background categories displayed in Table 6A-2 and exploring possible explanations of significant differences that are associated with variations in the family and neighborhood context of different ethnic group generations.
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From page 305... ...
Neighborhood cohesiveness and safety seem to characterize the neighborhoods of native youth and are greater among Asian ethnic groups than Hispanic ethnic groups. Note that the estimated effects of family and neighborhood context on health outcomes are not of central interest in this analysis; rather the interest is the extent to which health differentials by immigrant status and ethnic group are due to the family and neighborhood contexts of the different immigrant and ethnic groups.
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From page 306... ...
306 to Q)
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From page 307... ...
307 (D ~N ~CD XOpUI UeeW (D ~N V)
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From page 308... ...
Native-born Chinese youth with immigrant parents have better physical health and engage in fewer risky behaviors than native non-Hispanic white youth, while native-born African and Afro Caribbean youth with immigrant parents are less likely to engage in risky behaviors only. Apparently, native-born youth in Chinese immigrant families and, to a lesser extent, those in African and Afro Caribbean immigrant families are deterred from the assimilation process into mainstream U.S.
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From page 309... ...
Fourth, although descriptive analysis did not indicate significant variations in emotional health by immigrant status and ethnic group background, multivariate results show a general pattern of greater distress levels among native-born ethnic minority youth and less emotional distress among foreign-born adolescents relative to non-Hispanic white youth in native-born families.3 Greater psychological distress is found among native-born Mexican youth and mainIand-born Puerto Rican youth regardless of whether their parents were immigrants and among Chinese and African and Afro Caribbean youth in native-born families. Foreign birth apparently protects youth from psychological distress as well.
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From page 310... ...
Puerto Rican youth have the highest level of physical health problems, with nearly as high levels among Mexican, Cuban, and Central and South American youth. Figure 6-5 presents the adjusted mean risky behaviors index by immigrant status and ethnic background (predicted from the equation for mode]
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From page 311... ...
With greater time and socialization in U.S. institutions, neighborhoods, and youth culture, immigrant children increasingly adopt behavioral norms regarding health status and health risk.
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From page 312... ...
Analysis showed that this protective quality was not related to the family or neighborhood context of immigrant children. Rather for some ethnic groups, family and neighborhood factors such as poverty, single-parent households, and unsafe or isolating neighborhoods reduced the health advantage associated with immigrant status.
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From page 313... ...
Data on peer networks, social supports, school involvement and context, and parent-adolescent conflict and relationships during adolescence would provide a place to start to explore the sources of distress in the lives of ethnic minority youth who are part of the native population. REFERENCES Bautista-Hayes, D.E.
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From page 314... ...
Baisden, and R Martorelli 1990 Selected measures of health status for Mexican-American, mainland Puerto Rican, and Cuban-American children.
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From page 315... ...
1997b Ties that bind: Immigration and immigrant families in the United States.
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From page 316... ...
Add Health was designed to help explain the causes of adolescent health and health risk behaviors with special emphasis on the effects of multiple contexts of adolescent life. The study used a school-based design to sample high schools and their feeder middle or junior high schools.4 From the school sample (using school rosters)
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From page 317... ...
The physical health problems index was constructed by summing the incidence of each of the five physical health outcomes and ranges from 0 for adolescents who have none of these physical health problems to 5 for adolescents who have all of the physical health problems indicated by each of the outcome measures. The sample average index is 0.97 physical health problems.
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From page 318... ...
Health risk behaviors are self-reported by the adolescent and include the following: (1) ever having had sexual intercourse, (2)
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From page 319... ...
, and multivariate analysis uses the proportionate measure (Cronbach's alpha = 0.68~. The risky behaviors index sums the dichotomous indicators of ever having had sex, having engaged in four or more delinquent acts, having engaged in three or more acts of violence, and having used three or more controlled substances and ranges from O for having been involved in no risky behaviors to 4 for having been involved in all four risky behaviors.
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From page 320... ...
, these cases are too few to explore in any meaningful way within the analytical framework of this chapter. Therefore, a randomization procedure was used to assign youth with multiple ethnic backgrounds to one ethnic group within Hispanic and Asian ethnic backgrounds.
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From page 321... ...
Analytic Methods Descriptive analyses present the mean scores of emotional health indexes and the dichotomous measures of physical health and risky behavior outcomes (percentage with a particular physical health problem or engaging in a risky behavior) by immigrant status and ethnic group background.
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From page 322... ...
322 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-1 Health Outcomes by Immigrant Status and Race/Ethnicity of Aclolescents in Native-Born Families (means) Natives Native-Born/ Non-His Foreign-BornForeign-Born Parents White Physical Health General health is fair or poor9.210.7 8.1 Missed school due to a health or emotional problem33.536.5 33.6 Learning difficulties9.312.5 16.9 Obesity17.026.7 23.4 Asthma4.88.1 12.2 Health Problems.74.94 .93 Emotional Health Psychological distress1.541.52 1.45 Positive well-being2.852.87 3.06 Health Risk Behaviors Ever had sex31.333.9 36.7 Age at first intercoursea15.114.9 14.8 Birth control used at first intercoursea56.257.3 67.1 Four or more delinquent acts15.825.0 21.9 Three or more acts of violence14.621.3 19.4 Use of three or more controlled substances8.317.4 25.1 Risky behaviors index.70.98 1.03 N1,6512,526 10,248 aThese outcomes are based on the sample of adolescents who reported ever having had sex (N= 8,226)
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From page 323... ...
KATHLEEN MULLAN HARRIS icity of 323 Native-Born with Native-Born Parents rn/ Non-Hispanic Non-Hispanic Non-Hispanic orn Parents White Black Other Hispanic Total 8.1 11.5 14.3 13.1 9.7 33.6 37.1 40.2 41.1 35.4 16.9 14.3 15.6 18.3 15.4 23.4 29.9 31.5 31.0 25.3 12.2 13.5 14.9 15.7 11.8 .93 1.05 1.17 1.20 .97 1.45 1.52 1.54 1.54 1.49 3.06 2.99 2.89 2.89 2.99 36.7 54.8 39.2 45.3 40.4 14.8 13.8 14.4 14.2 14.5 67.1 64.2 60.5 58.3 63.8 21.9 18.0 26.3 29.6 21.6 19.4 27.2 26.4 31.5 21.9 25.1 8.6 24.3 25.3 19.4 1.03 1.09 1.17 1.32 1.03 10,248 4,312 456 1,429 20,622 NOTE: With the exception of age at first intercourse and emotional health, all differences are statistically significant at the 0.001 level.
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From page 324... ...
.85* Emotional Health Psychological distress1.54 1.58 1.541.46 Positive well-being2.67 2.71 2.892.97 Health Risk Behaviors Ever had sex35.1*
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From page 325... ...
KATHLEEN MULLAN HARRIS and 325 Cuba Central/South America Puerto Rico FB NB/FB NB FB NB/FB NB IB MB/IB MB 7.6 9.1 5.6 12.2 11.2 10.5 11.8 16.9 12.9 .3*
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From page 326... ...
.73* Emotional Health Psychological distress1.53 1.451.531.64 Positive well-being2.90 2.992.912.78 Health Risk Behaviors Ever had sex9.5*
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From page 327... ...
KATHLEEN MULLAN HARRIS 327 Philippines Japan Vietnam FB NB/FB NB FB NB/FB NB FB NB/FB NB .9*
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From page 328... ...
* Emotional Health Psychological distress1.551.56 1.591.49 Positive well-being2.832.86 2.833.07 Health Risk Behaviors Ever had sex14.2*
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From page 329... ...
KATHLEEN MULLAN HARRIS 329 Africa/Afro-Cari bbean Europe/Canada FB NB/FB NB FB NB/FB NB 1 .4*
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From page 330... ...
330 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-3 Parameter Estimates of Ethnic Group and Generation on Aclolescents' Physical Health and Health Behavior Outcomes Substance Use 3 Psycholc Constant -0.33 -0.16 -0.13 1.0$ (0.02)
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From page 331... ...
KATHLEEN MULLAN HARRIS 331 Psychological Distress Health Problems Index Risky Behaviors Index 2 3 1 2 3 1 2 3 1.08 1.32 1.52 0.98 1.07 1.20 -1.28 -0.53 -0.41 (0.03)
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From page 332... ...
332 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-3 Continuecl Substance Use 3 Psycholc PHIL-FB -0.14 -0.13 -0.13 0.14 (0.02)
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From page 333... ...
KATHLEEN MULLAN HARRIS 333 Psychological Distress Health Problems Index Risky Behaviors Index 2 3 1 2 3 1 2 3 0.14 0.15 0.11 -0.21 -0.18 -0.30 -0.36 -0.31 -0.34 (0.03)
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From page 334... ...
334 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-3 Continuecl Substance Use 3 Psycholc HS 0 00 (0.01 )
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From page 335... ...
KATHLEEN MULLAN HARRIS 335 Psychological Distress 2 3 Health Problems Index Risky Behaviors Index 2 3 1 2 3 -0.05 -0.05 (0.01)
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From page 336... ...
336 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-3 Continuecl Asthma Ever Had Sex Delinque 2 3 1 2 Constant -1.27 -1.56 -1.5$ -$.31 -7.73 -7.71 0.14 (0.21)
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From page 337... ...
KATHLEEN MULLAN HARRIS 337 Delinquency 2 Violence 3 7.71 D.17)
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From page 338... ...
338 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-3 Continuecl Asthma Ever Had Sex Delinque 2 3 1 2 PH 1 L-FB -0.67 -0.61 -0.80 -0.58 -0.46 -0.37 0.01 (0.29)
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From page 339... ...
KATHLEEN MULLAN HARRIS 339 Delinquency 2 Violence 3 1.37 1.15)
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From page 340... ...
340 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-3 Continuecl Asthma Ever Had Sex Delinque 2 3 2 HS 0.00 -0.03 -0.04 -0.04 (0.08)
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From page 341... ...
KATHLEEN MULLAN HARRIS 341 Delinquency 2 Violence 2 3 D.04 -0.01 -0.01 -0.02 -0.02 3.04)
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From page 342... ...
342 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-3 Continuecl General Health Fair/Poor Missed School 2 3 1 2 Learning Constant -3.27 -2.62 -2.04 -0.71 -0.51 -0.41 -2.29 (0.24)
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From page 343... ...
KATHLEEN MULLAN HARRIS 343 Learning Difficulties 2 Obesity 3 D.41 1.20)
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From page 344... ...
344 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-3 Continuecl General Health Fair/Poor Missed School 2 3 1 2 Learning PHIL-FB -0.14 0.08 -0.18 0.42 0.44 0.17 -1.21 (0.26)
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From page 345... ...
KATHLEEN MULLAN HARRIS 345 Learning Difficulties 2 Obesity 2 3 )
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From page 346... ...
346 HEALTH STATUS AND RISK BEHAVIORS OF ADOLESCENTS TABLE 6A-3 Continuecl General Health Fair/Poor Missed School 2 3 2 Learning OTHER 0.27 0.23 0.29 0.26 (0.13)
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From page 347... ...
KATHLEEN MULLAN HARRIS 347 Learning Difficulties 2 Obesity 2 3 D.26 D.09)
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