Adolescent Health, Development, And Assimilation

As a minority group becomes more highly assimilated into mainstream American values and customs, changes in health-related attitudes and behaviors also may occur. Acceptance of the predominant values may make such a group more amenable to the prevailing social norms of health behaviors. The pattern of diseases characterizing the group may also shift toward that experienced by the majority group (Mendoza et al., 1990).

However, behavioral changes may yield unwanted outcomes. For example, low levels of assimilation are associated with lower rates of completed suicide among Mexican Americans (Earls et al., 1990). An increasingly cited finding is that foreign-born Mexican Americans experience lower rates of infant mortality and low birthweight than other groups (Bautista-Hayes, 1990; Landale et al., this volume). Subsequent generations of Mexican Americans appear to lose this advantage, which may be a consequence of adopting the lifestyle and habits of the dominant culture.

How do assimilation theories apply to adolescents? Adolescence is often characterized as a period of turmoil and rebellion from traditional constraints associated with family, adult supervision, and institutional expectations. While much has been written about the developmental period of adolescence, how is this process of human development from a child into an adult compounded by being an immigrant or having immigrant parents? In a period where being different or "standing out" takes on crucial social significance to being accepted into peer networks and school culture, peer acceptance and blending into the current society may be even more important for immigrant adolescents, who are already different in their appearance, dress, or speech.

The main socializing agents during adolescence include the family, peers, school, community, and the larger society, which all contribute uniquely to the socialization process (Dornbusch, 1989; Perry et al., 1993). Among immigrant youth, family influence can have especially poignant effects, either coddling youth within the boundaries of their ethnic culture and traditional behaviors or turning them away from their own ethnic culture and family traditions that define their difference within American society. 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.

For adolescents in immigrant families, development and socialization overlap with assimilation into American society, such that the sometimes rocky road of adolescence may be especially rocky for immigrant children who begin the developmental process as "more different" than adolescents in native-born families. Thus, there is an inherent tension in the adjustment process of immigrant adolescents as they strive to be accepted by the majority population and at the same time cope with socializing agents in their families and neighborhoods who either wish to deter the assimilation process, which is compounded by adolescent rebellion and acting out, or facilitate it through the neighborhood influence of peers. How this tension plays out in the lives of immigrant adolescents will furthermore vary by ethnic background.

Health Differentials By Immigrant Status

If we accept the view that native-born children of immigrants have adopted the values and culture of American society more so than immigrant youth, we can observe health differentials across immigrant status as representing an assimilation process. This perspective is based on the argument that the children of immigrants represent the first members of their community to be educated and socialized in American institutions, whereas immigrant adolescents may carry with them the socialization and educational experience they received in their country of origin, depending on the age at which they entered the United States.

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 races, and Hispanics. If we view generation as representing the degree of assimilation, the results indicate a pattern of increasing adoption of the mainstream behaviors of adolescents in native-born families with increasing assimilation into American culture. 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), to have missed school because of a health or emotional problem in the past month (36.5 versus 33.5 percent), to experience learning difficulties (12.5 versus 9.3 percent), to be obese (26.7 versus 17.0 percent), to have asthma (8.1 versus 4.8 percent), to have ever had sex (33.9 versus 31.3 percent) and at a younger age (14.9 versus 15.1 percent), to engage in four or more delinquent acts (25.0 versus 15.8 percent), to be involved in three or more violent acts (21.3 versus 14.6 percent), and to use three or more controlled substances (17.4 versus 8.3 percent). Differences in the likelihood of using birth control at first intercourse and in symptoms of psychological distress or feelings of positive well-being are negligible between the two immigrant generations.

Reflecting the heterogeneity of the native-born families, health outcomes vary considerably across racial and ethnic groups in the native population. In general, non-Hispanic whites have more favorable health outcomes than the other native ethnic groups. For instance, non-Hispanic whites report the lowest levels of fair or poor general health, the highest use of birth control at first intercourse, and the fewest symptoms of psychological distress across both immigrant generations and all native populations. Certain health outcomes advantage or disadvantage particular native ethnic groups. For instance, non-Hispanic blacks are the most sexually active (55 percent), with the youngest average age at first sexual intercourse (13.8), but they are the least likely among the native groups to use three or more controlled substances (8.6 percent).

The native subpopulations of youth of non-Hispanic other races and Hispanic youth stand out, however, with the poorest physical health and the highest levels of risky behaviors. Moreover, knowing that the ethnic composition of immigrant children and the children of immigrants largely represents the "new immigration" from Latin America and Asia, the native subpopulations represented by non-Hispanic other adolescents (largely Asian Americans) and Hispanic adolescents are most similar in their ethnic background and may represent the "segment" of the U.S. 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. Non-Hispanic Asian and American Indian and Hispanic native youth are more likely to report fair or poor health (14.5 and 13.1 percent, respectively) than native-born youth with foreign-born parents (10.7 percent) and foreign-born youth (9.2 percent). Similarly, non-Hispanic Asian and American Indian and Hispanic native youth are more likely to miss school because of a health or emotional problem, to have learning difficulties, to be obese, and to have asthma than native-born youth with foreign-born parents, who have the second-highest levels of health problems, and foreign-born youth, who have the lowest levels of health problems. This pattern is further reflected in the health problems index, showing that health problems increase as the immigrant experience becomes more distant by generation.

A consistent linear pattern is also found for health risk behaviors. Non-Hispanic Asian and American Indian and Hispanic youth in native families are more likely to have ever had sex (39.2 and 45.3 percent, respectively) than native-born youth with foreign-born parents (33.9 percent) and foreign-born youth (31.3 percent) and to have had first intercourse at a younger age (14.4 and 14.2 years old, respectively) than native-born youth with foreign-born parents (14.9 years) and foreign-born youth (15.1 years). Similarly, non-Hispanic Asian and American Indian and Hispanic youth in native-born families are more likely to engage in delinquency, violence, and controlled substance use than native-born youth with foreign-born parents, who report the second-highest involvement in health risk behaviors, and foreign-born youth, who report the lowest involvement in risky behaviors. The risky behaviors index displays this linear pattern as well.

In sum, the most striking finding from Table 6A-1 is the pattern of assimilation displayed by the increasing health problems and increasing propensity to engage in health risk behaviors across immigrant generations of youth, especially comparing immigrant children and the children of immigrants to the native populations of non-Hispanic Asian and American Indian and Hispanic youth. Perhaps the most consistent finding, however, is that foreign-born adolescents have better physical health and engage in fewer risky behaviors, with the exception of the use of birth control at first intercourse. Foreign-born youth experience fewer physical health problems, have less experience with sex, are less likely to engage in delinquent and violent behavior, and are less likely to use controlled substances than native-born youth. Note that all of the differences reported in Table 6A-1 are statistically significant at the 0.01 level, with the exception of psychological distress and positive well-being.

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) for foreign-born youth, native-born youth of foreign-born parents, and the native populations of non-Hispanic whites, non-Hispanic blacks, non-Hispanic other races (Asian and American Indian), and Hispanic youth. Figure 6-1 illustrates the linear relationship in physical health problems by immigrant status and the health advantage of foreign-born adolescents. The physical health problems index counts the number of health problems out of the five measured (Table 6A-1), and Figure 6-1 displays the percentage distribution with zero, one, and two or more health problems by immigrant status. Focusing on the bottom level of bars showing the percentage with no health problems, foreign-born youth have the fewest health problems, and native-born youth with foreign-born parents have the second-fewest health problems, equal with the native population of non-Hispanic whites. Non-Hispanic blacks have the next-largest percentage of youth with no health problems, followed by non-Hispanic Asian and American Indian youth; Hispanic youth have the fewest with no health problems. This same pattern is seen at the second level of bars in the percentage of youth with zero or one health problem. Conversely, the percentage with two or more health problems grows as one moves across immigrant generations to the native populations that are most similar to the ethnic backgrounds of the majority of youth in immigrant families.

Figure 6-1

Physical health problems by generation.

Figure 6-2

Risky behaviors index by generation.

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). Again, moving across immigrant generation and native ethnic groups, the percentage engaged in zero or one risky behavior decreases, while the top shaded portions of the bars, the percentages engaged in two or more risky behaviors, increase. Less engagement in risky behaviors is again evident for immigrant children, and while the children of immigrants are less involved in risky behaviors than are youth in native-born families with a similar ethnic background, the advantage is slightly less than it was for physical health status.

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. Nearly 75 percent of foreign-born adolescents are 16 to 21 years old, whereas about 60 percent of native-born adolescents with foreign-born parents and 52 percent of youth in native-born families are among the older adolescents in this age group. The sex composition of immigrant and native-born adolescent groups is similar with even representation of female and male adolescents.

To explore the possibility that differences in the age composition of immigrant and native-born adolescent groups may explain some of the differences in health outcomes, physical health status and health risk behaviors were examined among younger (11 to 15 years old) and older (16 to 21 years old) adolescents in immigrant and native-born families. Health differentials were somewhat attenuated among the younger adolescents, but the results (not shown) were consistent with those in Table 6A-1 and the majority of differences were statistically significant.

Health Differentials Among Immigrant Youth

To further test the assimilation model from an intragenerational perspective, health outcomes by time in the United States for immigrant youth are examined. The results are dramatically consistent: the longer the time since arrival in the United States, the poorer are the physical health outcomes and the greater the likelihood of engaging in health risk behaviors.¹ Age at arrival is correlated with time in the United States, and the same results emerge when health differentials by age at arrival in the United States are examined.

Figure 6-3 summarizes these results by presenting means on the physical health problems index (top panel) and the risky behaviors index (bottom panel) by years in the United States for foreign-born youth. 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.

Figure 6-3

Mean index scores of foreign-born youth with foreign-born parents by time in the United States.

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. Differences in the ethnic composition of foreign-born youth and native-born youth with foreign-born parents and in the relationship between ethnic background and health may partially explain the aggregate patterns found in Table 6A-1. The next stage of analysis therefore controls for ethnic background and examines differences in health outcomes by immigrant status within ethnic groups. Table 6A-2 presents these results.

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 based on the adolescent's birthplace and the immigrant parent's birthplace for foreign-born youth and native-born youth with foreign-born parents, respectively. Adolescents in native-born families who indicated they were of Hispanic or Asian background were classified according to the specific ethnic group they identified in the survey (see Appendix 6A-1 for further details about this classification). Immigrant status is indicated by FB (foreign-born), NB/FB (native-born to foreign-born parents), and NB (youth in native-born families). Youth of Puerto Rican background were classified according to whether they were island-born (IB), mainland-born to island-born parents (MB/IB), or mainland-born to mainland-born parents (MB).

The generational comparisons of youth of African and Afro Caribbean background and European and Canadian background deserve a word of caution. African and Afro Caribbean background cannot be specifically determined for youth in native-born families; however, the native population of non-Hispanic blacks probably represents prior immigration from these regions. Therefore, foreign-born youth and native-born youth with foreign-born parents from Africa and the Afro Caribbean who also indicated they were non-Hispanic and of the black race are compared with the native population of non-Hispanic blacks.² In a similar manner, foreign-born youth and native-born youth with foreign-born parents from Europe and Canada who are non-Hispanic and white are compared with non-Hispanic white adolescents in native-born families. 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 significant, but the general pattern confirms the aggregate findings: foreign-born youth experience better physical health and engage in fewer risky behaviors than native-born youth with foreign-born parents. Focusing only on significant effects, the most consistent results are shown for learning difficulties, obesity, and asthma among the physical health outcomes and for all risky behaviors for nearly all of the ethnic groups. The strongest and most consistent results are found for Mexican, Central and South American, Filipino, and other Asian youth. Foreign-born Mexican youth are less likely to have missed school for a health or emotional problem in the past month and are less likely to have learning difficulties, to be obese, or to have asthma than native-born youth with foreign-born Mexican parents. Similarly, foreign-born Mexican youth are less likely than native-born youth of Mexican parents to have ever had sex, to engage in multiple delinquent or violent acts, and to use three or more controlled substances, though they are equally likely to experience psychological distress.

Exceptions to this pattern appear for the African and Afro Caribbean ethnic group. Although the physical health of foreign-born 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. Foreign-born youth have higher rates of asthma and sexual behavior than native-born youth with European or Canadian parents, though the differences are small. Finally, minor differences between Chinese immigrant children and the children of Chinese immigrants also operate in the opposite direction for the general health and ''missed school due to a health problem" outcomes.

Nevertheless, even for these exceptions, immigrant children and the children of immigrants experience fewer health problems and engage in fewer risky behaviors than youth in native families across all ethnic groups. For instance, even though foreign-born African and Afro Caribbean youth have higher rates of sexual activity than native-born youth with African or Afro Caribbean parents, they are still less likely to have ever had sex than the native population of non-Hispanic blacks. Similarly, native non-Hispanic whites have higher rates of asthma than immigrant children or the children of immigrants from Europe and Canada. Moreover, comparing across immigrant groups to the native population within ethnic background tells a story of increasing health problems and increasing risky behaviors for the majority of significant relationships. This finding is most consistent for youth of Mexican, Central and South American, Chinese, Filipino, and other Asian background.

Consistent with findings presented in Table 6A-1, use of birth control at first intercourse and emotional health outcomes do not follow this pattern. In general, there is no significant variation in the use of birth control or emotional health by immigrant status and ethnic group background. The only exception is the one significant relationship for use of birth control among youth of Mexican background. Use of birth control is more prevalent among sexually active adolescents in the native Mexican population (56.5 percent), followed by youth with immigrant parents (52.5 percent), and is least prevalent among sexually active immigrant youth from Mexico (42.5 percent).

Immigrant status does not influence symptoms of psychological distress or feelings of positive well-being among youth across the various ethnic backgrounds in these descriptive data. Previous research has produced mixed results regarding the relationship between depressive symptoms and immigrant status. Some research suggests that immigrant children experience acculturative stress as they adjust to a foreign culture, learn a new language, and try to fit into mainstream youth society (Kao, this volume; Rumbaut, 1994), while other studies find immigrants to experience fewer depressive symptoms than the native population such that becoming "Americanized" increases levels of distress among youth (Rumbaut, 1997a, 1997b).

On certain outcomes and for certain ethnic groups, the children of immigrants experience the most risk in their physical health and health risk behaviors. For instance, native-born youth with Mexican immigrant parents are more likely to miss school because of a health or emotional problem and to be obese than both the native population (differences are slight) and immigrant children from Mexico. Native-born youth with Cuban immigrant parents are more likely to engage in multiple acts of delinquency than either immigrant or native Cuban youth. Finally, mainland-born Puerto Rican youth of island-born parents are much more likely to be obese than island-born youth and mainland-born youth of mainland-born Puerto Rican parents.

Nevertheless, the dominant finding in Table 6A-2 is the prevalence of a health advantage associated with immigrant status among the major ethnic groups in America. As the immigrant experience becomes more distant across generations, youth become more similar to the native population in their health status and health risk behaviors. 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. Multivariate regression analysis is used to model each of the health outcomes as a function of immigrant status and ethnic group category (essentially an interaction effect) relative to the baseline effect (reference category) of native non-Hispanic whites, the majority native ethnic group of youth in America.

Table 6A-3 displays the results of the multivariate analysis of the five physical health outcomes, the psychological distress outcome, the four health risk behavior outcomes, the physical health problems index, and the risky behaviors index. For each outcome, three models are estimated. The first model estimates the effects of immigrant status and ethnic group categories relative to the baseline effect for native non-Hispanic whites, controlling for the age and sex of the adolescent. Model 2 controls for family context effects, and model 3 explores the influence of neighborhood differences.

Table 6A-3

Parameter Estimates of Ethnic Group and Generation on Adolescents' Physical Health and Health Behavior Outcomes.

There are important structural differences in family context by immigrant status and ethnic background that might explain the health differentials found in the descriptive analysis. For instance, native-born youth of foreign-born parents are more likely to live with their biological parents (67 percent) and less likely to live in a step-or other family form (16 percent). Youth in native-born families are the least likely to live with both of their biological parents (47 percent) and the most likely to live with a single parent (27 percent). Foreign-born adolescents lie between these extremes with 55 percent living with two biological parents, 24 percent living in a stepfamily or other family form, and 21 percent living with a single parent. Nevertheless, immigrant children experience the highest poverty rates. More than a third of immigrant youth live in poverty (38 percent), compared to 22 percent of youth with immigrant parents and 20 percent of youth in native-born families. Average family income further reflects this differential in economic status, with mean family income ranging from $33,976, $44,185, and $47,090 for foreign-born youth, native-born youth with foreign-born parents, and youth in native-born families, respectively.

The main sources of neighborhood context differences are geographic location and neighborhood familiarity and cohesive-ness. Increasing familiarity and association with people in the neighborhood occurs with native birth, with the least neighborhood familiarity evident among Asian ethnic groups and the most familiarity among African and Afro Caribbean ethnic groups. 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.

Table 6A-3 contains a massive amount of data analysis, and here only the most important and general results are highlighted. The main findings are summarized in Figures 6-4 and 6-5 and discussed below. First, there are consistently beneficial and significant effects (shown in bold) of foreign birth on health problems and health risk behaviors for all ethnic groups, controlling for demographic composition and family and neighborhood context (i.e., in model 3). Because the negative coefficients indicate that immigrant children experience fewer health problems and risky behaviors than native-born non-Hispanic white youth, foreign birth is a health advantage. Health outcomes for which the beneficial effects of foreign birth are most prevalent across all ethnic groups are learning difficulties, obesity, asthma, and the risky behaviors of sexual activity, delinquency, violence, and use of controlled substances. Across all measures of health outcomes, the most consistent beneficial effects of foreign birth are found for Mexican, Central and South American, Chinese, Filipino, and other Asian youth.

Figure 6-4

Mean physical health problems index by ethnic group and immigrant status.

Figure 6-5

Mean risky behaviors index by ethnic group and immigrant status.

Results for the physical health problems and risky behaviors indexes show that foreign-born Mexican, Cuban, Central and South American, Chinese, Filipino, other Asian, African and Afro Caribbean, and European and Canadian youth have significantly fewer health problems and engage in fewer risky behaviors than native non-Hispanic white youth. Island-born Puerto Rican youth do not enjoy these beneficial effects, suggesting a commonality with U.S. native youth culture. Nor is this protective quality conferred to native-born youth with immigrant parents, with the exception of Chinese and African and Afro Caribbean ethnicity. 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. youth culture that we observed for other ethnic groups.

A second major finding is that controlling for family and neighborhood context does not diminish the beneficial effects on physical health and risky behavior outcomes for foreign-born youth. Thus, the protective quality of immigrant status for adolescents is not related to family and neighborhood context. Rather, controlling for family and neighborhood context increases the beneficial effects of foreign birth on physical health problems for Mexican, Cuban, Central and South American, Filipino, and African and Afro Caribbean youth and on risky behaviors for African and Afro Caribbean youth. This suggests that differences in family and neighborhood contexts operate to increase health risks for immigrant youth from these regions, and when these factors are controlled, the beneficial influence of foreign birth increases. Here poverty status plays an important role in increasing health risks for immigrant youth and, once its effect is held constant, immigrant status becomes even more important in reducing health problems and risky behaviors.

Third, family and neighborhood context matter most for native minority youth, who experience greater health problems and risky behaviors than native non-Hispanic white youth. Among Mexican, Central and South American, Puerto Rican, Filipino, and African and Afro Caribbean youth in native-born families, when family and neighborhood contexts are controlled, the adverse effects of native birth and ethnic group on health status and risky behaviors diminish or become insignificant. This result indicates that family and neighborhood factors, particularly family poverty status, among these ethnic groups in the native population explain their poorer health outcomes and greater risky behaviors relative to non-Hispanic whites.

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 mainland-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. Foreign-born youth from Cuba, Europe, and Canada enjoy better emotional health than non-Hispanic white youth in native-born families. The one exception is that foreign-born youth and native-born youth of immigrant parents from the Philippines—the most Americanized of immigrant groups with a common language and exposure to America—experience more depressive symptoms than native non-Hispanic white youth.

Figures 6-4 and 6-5 summarize the multivariate results of the effects of immigrant status and ethnic group categories on health. Figure 6-4 presents the predicted mean physical health problems index by immigrant status and ethnic background, adjusted for demographic characteristics, family context, and neighborhood context of the youth (i.e., based on model 3). The graph shows that, for all ethnic groups except Cuba, Puerto Rico, and China, there is a consistent relationship between immigrant status and physical health problems: physical health problems increase with greater exposure to American society across native birth of generations. Note further the varying levels of physical health problems by ethnic group. Chinese youth have the lowest levels of physical health problems, followed by youth of European or Canadian and other Asian backgrounds. 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 model 3). Again, with the exception of Africa and the Afro Caribbean, the relationship between immigrant status and risky behaviors is remarkably consistent for all ethnic groups: engagement in risky behaviors increases with greater exposure and socialization in American society, as represented by native birth of generations. For certain ethnic groups (Cuba, Central and South America, Europe, and Canada) the relationship is linear. For other groups (Mexico, other Asia) the main difference is between foreign-born youth and native-born youth regardless of whether their parents were immigrants. Finally, among Puerto Rican, Chinese, and African and Afro Caribbean youth, both immigrant children and the children of immigrants display much lower involvement in risky behaviors than youth in native-born families.

The extent to which certain ethnic groups experience segmented assimilation can be clearly seen in Figure 6-5, where the risky behaviors of native-born children of immigrant parents have surpassed those of the mainstream youth population of non-Hispanic whites and approach those of their native-born ethnic group. In particular, native-born Mexican, Central and South American, Filipino, and other Asian youth with immigrant parents and mainland-born Puerto Rican youth with island-born parents are more involved in risky behaviors than non-Hispanic youth in native-born families.

Note finally that Chinese youth stand out as the ethnic group least engaged in risky behaviors. Because of intense familial and ethnic pressure to maintain the family reputation and focus only on achievement goals in American society, it is possible that Chinese youth may have under-reported their engagement in risky behaviors in this survey; however, this potential bias cannot be explored with the data at hand. Youth of Hispanic origin, on the other hand, display the greatest involvement in risky behaviors, followed by Asian youth, where native-born Filipino and other Asian youth with foreign-born parents are especially involved in risky behaviors.

Health Outcome Measures

Physical health outcomes are measured as dichotomous variables and include (1) fair or poor general health, (2) whether the adolescent ever missed school for a health or emotional problem, (3) learning difficulties, (4) obesity, and (5) asthma. A physical health problems index was then constructed using these five physical health outcomes for graphical illustration of results. (See Table 6A-1, Total column, for overall sample mean.)

Both the adolescent and his or her parent were asked to rate the adolescent's general health. If the adolescent or the parent indicated that the adolescent's health was fair or poor, this outcome was coded one (9.7 percent), whereas if both the parent and the adolescent rated the adolescent's health as good, very good, or excellent, the outcome was coded 0. Adolescents were asked how often they missed school in the past month because of a health or emotional problem. The majority indicated that they never missed school for these reasons (65 percent) and only a small minority missed school once a week or every day. Therefore, those who ever missed school in the past month for health or emotional reasons were coded 1 (35.3 percent).

Learning difficulties were coded 1 if the parent reported that the adolescent had a specific learning disability (i.e., difficulties with attention, dyslexia) or received any type of special education service in the past 12 months (15.4 percent). Obesity is measured by computing the body mass index (BMI or weight in kilograms divided by height in meters squared), using the adolescent's self-reported weight and height. Using age-and sex-specific standard distributions for BMI based on data from the NHANES I (National Health and Examination Survey; WHO, 1995), adolescents who fell above the standard BMI for the 85th percentile were considered extremely overweight and obese (25.3 percent).

Finally; whether the adolescent had asthma was reported by the parent, resulting in a sample mean of nearly 12 percent of adolescents with asthma. 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.

Emotional health is measured by constructing two indexes based on items from the CES-D Scale (Radloff, 1977) and some from the Beck Inventory (Beck, 1978). Psychological distress includes 15 items that measure depressive symptoms such as feeling depressed, bothered by things, fearful, and sad. Responses range from 1 (never) to 4 (all the time), and the index represents the mean item score across the 15 items with a reliability (Cronbach's alpha) of 0.86. The positive well-being index includes four items that measure positive feelings such as feeling hopeful about the future, feeling happy, and enjoying life. Items also range from 1 to 4, and the index again represents the mean item score with a reliability of 0.71. Sample means are 1.49 for psychological distress and 2.99 for positive well-being.

Health risk behaviors are self-reported by the adolescent and include the following: (1) ever having had sexual intercourse, (2) age at first intercourse, (3) use of birth control at first intercourse, (4) delinquency, (5) violent behavior, and (6) use of controlled substances. A risky behaviors index based on sexual activity, delinquency, violence, and use of controlled substances also is presented. For the entire sample of adolescents ages 11 to 21, 40 percent reported ever having had sexual intercourse (see Table 6A-1 for sample means). Among those who have had sex, the average age at first intercourse was 14.5, and 64 percent used birth control at first intercourse.

Delinquency is measured by constructing an index of 11 delinquent or illegal behaviors in which the youth engaged such as painting graffiti, damaging property, shoplifting, running away from home, stealing a car, selling drugs, and burglary. In descriptive analysis a dichotomous measure indicating whether the youth engaged in four or more delinquent acts is used (21.6 percent), and in multivariate analysis the count of delinquent acts expressed as a proportion of all possible and nonmissing responses is used. The reliability (Cronbach's alpha) of the index is 0.80.

Violence is measured as an index based on nine items in which the youth reports violent behavior and use of weapons, including such items as fighting, having pulled a knife or gun on someone, having shot or stabbed someone, and having used a weapon in a fight. The dichotomous measure used in descriptive analysis identifies youth who engaged in three or more acts of violence (21.9 percent), and the multivariate analysis uses the proportionate measure with a reliability of 0.80.

Controlled substance use is measured by an index containing five items that indicate ever having used any of the following controlled substances: cigarettes, alcohol, chewing tobacco, marijuana, and hard drugs (inhalants, cocaine, other illegal drugs, or injected illegal drugs).⁵ Descriptive analysis identifies youth who used three or more substances (19.4 percent), 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 0 for having been involved in no risky behaviors to 4 for having been involved in all four risky behaviors. The sample index average is 1.03 risky behaviors.

Youth Characteristics And Ethnic Background

Demographic characteristics include the youth's age and gender and serve as control variables in multivariate models. The gender distribution is even, and the average age of the sample is 15.5. Parallel country-of-origin classifications are used for immigrant children and for the children of immigrants (if both parents are immigrants, the country of origin of the father was chosen unless it was missing; if so, the mother's country of origin was selected).⁶ Race/ethnicity is defined for all adolescents, but the measure is used to classify youth in native-born families in aggregate comparisons to youth in immigrant families. Four racial/ ethnic categories are formed: non-Hispanic whites, non-Hispanic black, non-Hispanic other (American Indian, Asian, or other race), and Hispanic.

Add Health provides data on the ethnic background of youth in native-born families for adolescents of Hispanic or Asian background. Moreover, adolescents are permitted to check multiple ethnic group backgrounds. A small minority (7 to 8 percent) reported multiple ethnic group backgrounds. While there is substantive significance potentially related to the identity of multiple ethnic backgrounds among youth (see Rumbaut, 1994), 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. Some youth (N = 34) indicated both Hispanic and Asian backgrounds. Because a randomization procedure did not seem appropriate for the Asian Hispanic biethnic youth and to capture the potential influence of both of the ethnic group backgrounds these youth indicated, these cases were doublecounted in the analysis.⁷

Family Context

Family context represents both the structural and the supportive features of the family environment as indicated by family income, family structure, mother's education, and parental supervision in the home. Family income is measured as a set of dummy variables: (1) less than $16,000, or below poverty for a family of four in 1995; (2) $16,000 to $29,999; (3) $30,000 to $49,999; (4) $50,000 or more (reference); and (5) a dummy variable for missing income data. Family structure is measured as a five-category variable, operationalized as a set of dummy variables that identify youth who live with (1) two biological parents (reference); (2) stepparents (step, adopted, or foster); (3) mother only; (4) father only; and (5) other family forms (with grandparents, aunts, uncles, or other relatives or in group homes). Mother's education is measured as four dummy variables: (1) less than high school (reference), (2) high school diploma or GED, (3) some college, and (4) college or postgraduate schooling.

Parental supervision is a count variable ranging from 0 to 4 indicating whether a parent is present in the home most or all of the time the adolescent (1) goes to school in the morning, (2) comes home from school in the afternoon, (3) eats the evening meal (five to seven dinners a week), and (4) goes to bed at night. The sample mean is 3.0.

Neighborhood Context

Geographical context includes the region (West, South, Northeast, and the reference Midwest) and urbanicity of residence (urban, suburban, and reference rural) because immigrant groups are concentrated in a handful of states in the United States and are overrepresented in metropolitan areas (Farley, 1996). Youth's familiarity and association with neighbors are measured by two items. Neighborhood familiarity is coded 1 if the youth knows most of the people in the neighborhood and has stopped on the street to talk with someone who lives in the neighborhood and is coded 0 otherwise. Neighborhood cohesiveness is coded 1 if the adolescent reports that people in his or her neighborhood look out for each other and is coded 0 otherwise. Finally, neighborhood safety is coded 1 if the adolescent reports usually feeling safe in his or her neighborhood.

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. Multivariate analyses rely on three forms of regression: (1) logit models to estimate the dichotomous physical health outcomes; (2) a hazard model to estimate the risk of first sexual intercourse, accounting for exposure time (i.e., age); (3) and ordinary least squares models to estimate the linear proportionate indexes of risky behaviors.

Table 6A-1

Health Outcomes by Immigrant Status and Race/Ethnicity of Adolescents in Native-Born Families (means).

Table 6A-2

Health Outcomes of Adolescents by Immigrant Status and Ethnic Background.