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Acculturation and the health and well-being of U.S. immigrant adolescents
JOURNAL OF ADOLESCENT HEALTH 2003;33:479 – 488
ORIGINAL ARTICLE
Acculturation and the Health and Well-being of U.S. Immigrant Adolescents STELLA M. YU, Sc.D., M.P.H., ZHIHUAN J. HUANG, M.B., Ph.D., M.P.H., RENEE H. SCHWALBERG, M.P.H., MARY OVERPECK, Dr.P.H., AND MICHAEL D. KOGAN, Ph.D.
Purpose: To examine the association of acculturation, as measured by language spoken at home, with the health, psychosocial, school, and parental risk factors of adolescents of various racial/ethnic groups. Methods: Using the U.S. component of the 1997–98 World Health Organization Study of Health Behavior in School Children, bivariate and multiple logistic regression analyses were conducted of records for adolescents in four racial/ethnic groups to explore the relationship between the language spoken at home and outcome variables regarding health status and risks, psychosocial and school risk factors, and parental factors. Data were analyzed using Software for the Statistical Analysis of Correlated Data (SUDAAN). Results: Adolescents of all racial and ethnic groups who primarily speak a language other than English at home are at elevated risk for psychosocial risk factors such as alienation from classmates and being bullied, and parental risk factors such as feeling that their parents are not able or willing to help them. Those who speak a combination of languages are also at risk for being bullied and for high parental expectations. Language spoken at home is generally not associated with health and safety measures for adolescents across racial/ethnic groups. Conclusions: Adolescents whose primary language at home is not English experience higher psychosocial,
From the Maternal and Child Health Bureau Office of Data and Information Management, Rockville, Maryland (S.M.Y., Z.J.H., M.O., M.D.K.); Children’s National Medical Center, Washington, DC (Z.J.H.); and Maternal and Child Health Information Resource Center, Washington, DC (R.H.S.). Address correspondence to: Stella Yu, Sc.D., M.P.H., Maternal and Child Health Bureau, Office of Data and Information Management, 5600 Fishers Lane, 18-41, Rockville, MD 20857. E-mail: [email protected] Manuscript accepted March 7, 2003.
Published by Elsevier Inc., 360 Park Avenue South, New York, NY 10010
school, and parental risks than non-Hispanic white English-speakers. New immigrant youths of all races and ethnic groups would potentially benefit from preventive and risk-reduction services.
KEY WORDS:
Adolescents Ethnicity Health behavior Immigrants Psychosocial risk factors
Nearly 14 million children in the United States are immigrants or had immigrant parents in 2000, and almost 1 in 6 children under 18 live with a foreignborn householder (1). More than 30 million Americans were estimated to be foreign-born in 2000 (2). The population of children in immigrant families has grown by almost 50% over the course of the 1990s, nearly 7 times faster than the population of children of U.S.-born parents (3). Although the majority of children in immigrant families are of Hispanic or Asian origin, the growing population of immigrant children also includes significant numbers of recently arrived refugees from Eastern Europe and Africa (4). The total population of foreignborn Blacks remains small, but this group faces particular acculturation challenges in their interactions with the larger African-American community (5). Children in immigrant families are more likely than native-born children to be poor, to live in crowded housing, to be uninsured, to lack a usual 1054-139X/03/$–see front matter doi:10.1016/S1054-139X(03)00210-6
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source of health care, and to be in fair or poor health (6). For adolescents, being foreign-born or residing in a foreign-born household produces stresses that may be reflected in health behaviors and risk factors that are associated with adverse outcomes. Studies of the effect of immigration status on adolescent health risks have generally found that foreign-born youth are at lower risk of health problems and risk behaviors than those born in the United States, but that this protective effect diminishes over three generations (7,8). A recent Canadian study concluded that poverty has less effect on emotional health among immigrant children than it does on native-born children (9). However, several studies of the effect of immigration status on adolescents’ emotional health have found the opposite. Youth born outside the United States, and those born in the United States to immigrant parents, have been found to be more likely to feel peer pressure to engage in substance use, sexual activity, and violence, and to experience less parental support to resist these pressures (8). Another national study found that immigrant youth of all racial and ethnic groups experience higher rates of depression and alienation and lower feelings of “self efficacy” than do native-born children of native-born parents (10). In a small study of Mexican-American immigrant youth, those who rated higher levels of “acculturative stress” showed higher risk for depression and suicidal ideation (11), whereas another study found higher numbers of risk behaviors among Latino immigrants than among native-born Latino or native non-Hispanic white adolescents (12). Because of the paucity of research on the effects of immigration on children’s health, the Committee on the Health and Adjustment of Immigrant Children and Families, convened by the National Research Council and the Institute of Medicine, has recommended that further research be conducted on the physical health, mental health, and school adjustment of immigrant children (13). This study directly addresses this research need by assessing the influence of adolescents’ level of acculturation on their health and psychosocial risks. Acculturation has been identified throughout the literature as a critical mediating factor in adolescents’ adaptation to their environment and their adoption of the health behaviors and risks of their peers, and one that comprises multiple dimensions and facets (14 –18). In this article, we distinguish those who have adopted the behaviors of the non-Hispanic white majority and those who have not through language spoken in the home environment. Lan-
JOURNAL OF ADOLESCENT HEALTH Vol. 33, No. 6
guage has long been used as a proxy measure for the degree of acculturation (19). For immigrant youth, linguistic acculturation, that is, the ability to speak English proficiently, may be an indicator of overall level of cultural acclimation. Findings on the effect of linguistic acculturation on educational and psychological outcomes are mixed as well: whereas bilingual students with full English proficiency often exceed native English-speakers academically, those with limited English proficiency are at highest risk of school dropout (20 –22) Another study found that, among Hispanics, linguistic acculturation was associated with greater risk of smoking among adolescent girls (23). A recent review of the literature by the Institute of Medicine found that first-generation immigrant adolescents were in better health and had lower rates of many risk behaviors than native-born youth and later generations of immigrants. However, the psychological adjustment problems and acculturative stresses were most likely to be seen in youth with limited English proficiency or those who were not fully bicultural (3). In response to these needs, the American Academy of Pediatrics in 1997 recommended that pediatricians be sensitive to the needs of immigrant children and that training programs provide information about the stresses associated with immigration (24). Owing to their different cultural backgrounds and countries of origin, the effect of acculturation on adolescents’ risk status is likely to vary by race and ethnicity. The objectives of this study are: (a) to estimate the prevalence of the health, psychosocial, and parental risk factors by race/ethnicity and language groups; and (b) to examine the association of the degree of acculturation and race/ethnicity and health, psychosocial, and parental outcome measures. We hypothesize that the use of English in the home environment may protect against psychosocial risk factors, but may not necessarily be protective against health or parental risks.
Methods The data used in this study are drawn from the 1997–1998 World Health Organization Study of Health Behavior in School Children (HBSC), a crossnational research study focusing on the health, health behaviors, and lifestyles of young people (25,26). This is a nationally representative survey sample of youth in grades 6 to 10 in U.S. schools. The subjects included students who answered anonymous standardized questionnaires during the spring
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ADOLESCENT HEALTH AND PRIMARY LANGUAGE
of 1998 in 386 schools in the United States. The participation rate was 83%. Unlike other major data sources on adolescent health behaviors, the HBSC allows for examination of the association of outcome measures with the degree of acculturation, as measured by the language spoken in the home environment (exclusively or mostly English, exclusively or mostly another language, or a mixture of the two). Although the proportion of non-exclusive English-speakers varies considerably among racial/ethnic groups, we have included all groups in our analysis. This analysis includes four major racial and ethnic categories: non-Hispanic white, non-Hispanic black, Hispanic, and non-Hispanic Asian. A total of 15,220 records were analyzed. This study compares adolescents’ self-reported health and psychosocial risk factors for those of all racial and ethnic groups who do not report speaking English at home with those of the majority population of white non-Hispanic Englishspeakers. The outcome measure of well-being included questions about health behavior (including seatbelt and helmet use, frequency of adverse health events such as headaches and stomachaches, and overall health assessment), psychosocial and school risk factors (such as acceptance from other students and support from teachers) and parental influence (such as perception of parental willingness to help and difficulty talking to parents about problems) from the self-reported survey. Questions about seatbelt use when riding in a car and helmet use when biking, were limited to those who said they traveled in a car and rode bicycles. For ease of interpretation, response categories were combined to create dichotomized outcomes for logistic regression analysis. The independent variable is the language the child reports being spoken at home all or most of the time. The question is “What languages do your parents or other people who are raising you speak at home?” The students were classified in three groups based on the language they reported being spoken at home: “English (English),” “a language other than English (other language),” and “English and another language about equally (mixed languages).” Adjustment variables from the questionnaire include selfreported age, gender, and mother’s education. Maternal education is used as a proxy measure of the household’s socioeconomic status, as income information is not available directly from the survey. In the multivariate analysis, responses from all groups were compared with that of the English-speaking
white population to create odds ratios that may be compared across racial/ethnic groups. All analyses were conducted using Software for the Statistical Analysis of Correlated Data (SUDAAN) (27), which applies statistical sample weights to adjust for oversampling, and uses the Taylor series linearization method to adjust variance estimates to account for sample design and intracluster correlation, producing conservative estimates. To adjust for the problem multiple comparisons, Chisquare p values of .01 and 99% confidence intervals for odds ratios were used to identify significance (28).
481
Results The demographic distribution of the study population is displayed in Table 1. In three of the racial/ ethnic groups, females represented just over half of the study population, although males were the majority among Asian respondents. In all four groups, the respondents were concentrated in the mid-adolescent age group (aged 12–15 years). Among all of the non-Hispanic groups, more than half of respondents’ mothers had more than a high-school education, but this percentage was lower among Hispanics. Non-Hispanic black and Hispanic respondents were most likely to live in urban areas, whereas most of non-Hispanic white and Asian respondents live in towns or suburban areas. More than 30% of Asian and nearly 20% of Hispanic respondents were foreign-born, compared with 2.5% of non-Hispanic Whites and 3.3% of nonHispanic Blacks. Asians and Hispanics were also the most likely to speak a language other than English at home: one-quarter of Hispanic and Asian respondents reported that English is not usually spoken at home, and about 45% of respondents in each group reported that two languages were spoken equally. Among non-Hispanic Blacks, 2.5% report that a language other than English is primarily spoken at home, and 5.4% report that a mixture of languages is spoken. These percentages are even lower among non-Hispanic Whites. Language spoken in the home is generally not significantly associated with any health and safety measures for adolescents across the racial/ethnic groups, with the exceptions of seat belt and helmet use among black and Hispanic youths in non-English home environments (data not shown). Table 2 shows the results of bivariate analyses of psychosocial and school relationship characteristics by language spo-
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Table 1. Characteristic of Study Population Non-Hispanic White
Gender Male Female Age (yrs) 11 12 13 14 15 16 17 Maternal education ⬍ High school High school graduate Some college College graduate Not stated Area of residence Urban Suburban Town Rural Nativity U.S.-born Foreign-born Language at home Only/mostly English Mixed languages Only/mostly another language Residing with parent Lives with mother Lives with father Total
Non-Hispanic Black
Hispanic
Asian
n
Weighted %
SE
n
Weighted %
SE
n
Weighted %
SE
n
Weighted %
SE
4263 4652
47.7 52.4
1.2 1.2
1129 1538
42.6 57.4
1.3 1.3
1342 1600
45.0 55.0
1.4 1.4
365 331
53.3 45.1
3.7 3.7
430 1500 1477 1861 2008 1480 155
5.1 20.2 19.7 19.5 19.6 14.4 1.5
0.7 1.7 1.7 1.7 1.3 1.1 0.2
186 471 546 517 529 343 72
6.2 15.8 20 18.8 21.5 15 2.6
1.2 1.3 2 1.2 1.6 1.8 0.4
202 508 660 664 506 325 70
5.7 16.8 22.6 19.4 19.1 13.3 3.2
0.8 1.4 1.9 1.6 1.3 1.2 0.7
51 115 159 155 132 73 11
8.9 17.8 20.8 18.7 21.6 9.8 2.4
1.9 3.1 4.4 2.0 4.8 1.8 0.8
447 1788 1857 3838 948
5.3 21.2 20.7 40.1 12.7
0.7 0.9 0.6 1.5 0.7
216 535 558 897 440
7.8 20.7 22 31.3 18.2
0.8 1.3 1.3 1.6 1.3
681 499 490 508 744
23.2 17.6 16.6 17.3 25.2
1.3 1.1 1.2 1.2 1.2
46 78 88 336 148
7 13.2 13 41.6 25.2
1.6 1.4 2.5 3.9 4.8
1132 3031 2929 1762
14.2 31.8 34.6 19.5
2.1 2.7 2.4 1.9
1078 569 561 389
39.6 25 21.5 14
4.8 5.1 2.5 1.9
1222 723 646 271
39.4 25.1 26.3 9.2
4.2 2.8 2.6 1.3
229 315 96 50
32.7 45.5 15.1 6.7
6.2 6.5 1.7 1.6
8681 210
97.5 2.5
0.3 0.3
2567 84
96.7 3.3
0.6 0.6
2337 566
80.2 19.8
1.6 1.6
440 253
69.6 30.4
4.0 4.0
8376 395 123
94.4 4.4 1.2
0.4 0.4 0.2
2426 161 65
92.1 5.4 2.5
0.7 0.6 0.4
795 1329 787
28.1 45.4 26.6
1.6 1.7 2
190 322 181
31.3 44.1 24.6
6.9 3.0 4.7
8278 6644 8915
93.2 73.6
0.5 0.9
2384 1044 2667
91.3 38.4
1 1.6
2738 1923 2942
93.5 64.6
0.6 1.2
647 584 696
95.5 84
0.8 1.8
ken at home. Results are based on the associations within each racial/ethnic group; that is, those who do not speak English at home are compared with English-speakers for each variable. For all racial/ ethnic groups, those associations that are significant demonstrate increased risk within the populations that do not report that English is spoken at home. Among non-Hispanic Whites, the other language group had a higher risk of feeling low; non-Hispanic Blacks in the other language and mixed language groups were more likely to report feeling helpless and not feeling confident; Hispanics were more likely to report difficulty making new friends if Spanish was spoken at home; and Asians were more likely to feel that their teachers’ expectations were too high if they were not English-speakers. In all of these cases, the risk among the mixed-language
group fell between those of the English and the non-English groups. Table 3 shows the relationship of parental support characteristics and language spoken at home within each racial/ethnic group. Hispanics, followed by Asians, report the highest number of parental risk factors significantly associated with the language spoken at home. Although none of the associations were significant at the p ⬍ .01 level for non-Hispanic Whites, non-Hispanic Blacks were more likely to report that their parents did not encourage them in school; Hispanics were more likely to report that their parents were not willing to come to school to talk to teachers; and Asians were more likely to report that their parents were not ready to help with school problems or to talk to teachers if English was not spoken at home.
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ADOLESCENT HEALTH AND PRIMARY LANGUAGE
483
Table 2. Selected Adolescent Psychosocial and School Relationship Characteristics by Language Spoken at Home and Race/ethnicity Non-Hispanic White Language
Feeling low more than once a week Irritability and bad temper more than once a week “Often” or “always” feel left out of things “Often” or “always” feel helpless “Rarely” or “never” feel confident in self “Don’t like school” Agree that teachers’ expectations too high Students in my class “rarely” or “never” enjoy being together Other students “rarely” or “never” accept me as I am Difficult to make new friends “Often” or “always” bullied because of religion or race
Non-Hispanic Black Language
Hispanic Language
Asian Language
English
Mixed
Other
English
Mixed
Other
English
Mixed
Other
English
Mixed
Other
*21.9
34.0
29.4
23.9
28.8
38.7
25.4
23.2
21.8
22.4
25.6
17.5
29.2
33.1
30.7
40.1
32.5
19.3
34.1
33.3
30.7
33.2
33.3
22.6
14.8
16.4
17.6
15.0
22.5
32.6
13.0
13.6
13.0
12.1
7.3
15.0
10.7
9.9
13.7
*12.8
26.2
33.9
13.3
12.6
13.4
10.1
12.4
11.9
15.8
17.9
24.5
*20.4
34.5
35.2
21.4
23.3
29.8
10.5
16.7
15.8
32.2 32.3
33.9 42.1
29.8 38.1
25.0 42.3
35.4 52.1
34.0 44.9
35.1 37.9
26.0 45.8
27.9 46.5
19.1 *26.8
26.1 29.6
28.9 39.6
12.7
17.0
24.7
20.5
29.2
32.6
12.2
15.1
21.6
16.0
9.2
16.7
15.3
17.7
15.9
18.6
25.6
28.3
14.1
13.7
15.1
11.5
9.3
21.8
16.7
15.6
21.9
13.6
20.2
22.6
*12.1
14.8
20.5
15.5
18.1
32.4
3.9
7.7
13.8
11.0
16.3
16.0
6.8
6.6
8.8
5.5
7.6
11.9
* Chi-square value ⬍ 0.01.
Table 4 shows the results of multivariate analyses that compare the level of risk in each racial/ethnic and language group with that of the reference group of English-speaking non-Hispanic Whites, controlling for the effects of age, gender, and maternal education. Among non-Hispanic Whites, those in the mixed language group showed elevated risk of feeling low, whereas those who spoke another language at home showed higher risks of being bullied because of their religion or race, reporting that their parents were not willing to talk to their teachers and that students in their class do not enjoy being together, and feeling that their parents expect too much of them at school. Among non-Hispanic black respondents, elevated risks were seen for most health, psychosocial, and parental risk factors when compared with the reference group. However, these risks were frequently high for all three language groups. That is, black adolescents are at significantly higher risk for psychosocial and school risks (such as feeling helpless, feeling unconfident in themselves, and being bullied); and parental risks (such as not feeling that their
parents are ready to help them and feeling that their parents expect too much of them at school), regardless of the language they speak at home. The odds ratios for these risk factors are usually highest among those adolescents who speak another language exclusively at home and lowest among those for whom English is spoken in the home environment. Among Hispanic respondents, those in the English-speaking group did not show any significant difference in psychosocial, school, or parental risk compared with non-Hispanic white English-speakers. Those who spoke Spanish at home, either exclusively or in combination with other languages, were more likely to report not feeling confident, to feel that their teachers’ expectations were too high, to be bullied at school because of race or religion, to report that their parents were unwilling to come to school to talk to their teachers, and to feel excessive parental expectation. In general, the odds ratios within the other language group are higher than those in the mixed language group, although the two groups tend to show significant results for the same outcome measures.
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Table 3. Selected Parental Characteristics by Language Spoken at Home and Race/Ethnicity Non-Hispanic White Language
Parents “never” or “rarely” ready to help with school problems Parents “never” or “rarely” willing to come to school to talk to teachers Parents “never” or “rarely” encourage me to do well at school “Strongly agree” or “agree” that my parents expect too much of me at school “Very difficult” or “difficult” to talk to mother
Non-Hispanic Black Language
English
Mixed
Other
English
Mixed
Other
12.6
12.2
21.3
20.1
30.7
35.8
13.3
13.5
30.1
20.1
20.7
5.6
9.1
14.2
*12.7
33.0
37.1
54.5
25.5
27.0
30.6
Hispanic Language English
Asian Language
Mixed
Other
English
Mixed
Other
16
19.5
23.1
*12.6
19.3
22.9
28.5
*15.6
19.4
27.0
*11.9
22.6
30.3
26.3
17.4
7.4
7.5
9.3
5.0
7.5
7.8
44.0
51.2
52.8
*35.4
45.3
53.0
38.6
49.9
52.4
30.5
22.6
29.5
24.6
29.2
32.0
17.3
29.7
40.2
* Chi-square value ⬍ 0.01.
The pattern among Asian respondents was similar. Those who speak another language exclusively at home had significantly higher rates of several risk factors, including difficulty making new friends, being bullied, feeling that their parents were not often willing to talk to their teachers about problems at school, and finding it difficult to talk to their mothers about problems. Those who speak a mixture of languages had significantly elevated risks of only two risk factors: feeling that parents were not willing to talk to their teachers, and feeling that parents expect too much of them at school.
Discussion This analysis demonstrates the complex relationships among immigration, race/ethnicity, and linguistic assimilation. Adolescents of all racial and ethnic groups from a non-English home environment are at higher risk of a range of psychosocial and parental risk factors than the majority population of non-Hispanic white English-speakers. Adolescents who speak other languages at home, exclusively, or in combination with English, are particularly likely to report feelings of vulnerability, exclusion, and lack of confidence. This confirms that earlier findings among Asian-American youth are also evident in other racial and ethnic groups (29). In addition, it is notable that many groups of nonwhite youth, regardless of language, and white adolescents who do not speak English at home were at significantly higher risk for being bullied because of their race or religion. That is, many youth who are different from
the majority population are at high risk of experiencing bullying. The relationship between being a victim of bullying and having other psychosocial risk factors confirms that found in other research (26). For most racial/ethnic groups, these risks are more pronounced for those who speak another language exclusively. Non-Hispanic black youths, however, are at significantly elevated risk of reporting feelings of alienation, vulnerability, lack of confidence, and helplessness regardless of the language they speak at home compared with non-Hispanic white English-speakers. This finding suggests a broad divergence in the experience of white and African-American youth and indicates the need for further research on the relative effect of race and the level of acculturation on the health and mental health of minority adolescents. Several limitations of this analysis should be noted. First, because the survey was conducted in school, the study population excludes such high-risk populations as those who have dropped out of school or who are in the juvenile justice system. Students in special education classes were also less likely to be interviewed. Thus, the levels of risk reported here might be lower than those of the adolescent population as a whole. Absenteeism may also tend to bias risk levels downward, if those who do not attend school regularly have higher levels of risk, although this has been shown not to be a serious problem in school-based surveys (30). We also do not have information on the response rates by race/ ethnicity. In addition, the risk factors are analyzed here as they are reported by the survey’s respon-
Non-Hispanic White Other Language
Other Language
1.9 (1.3–2.7)
1.5 (0.6 –3.3)
1.1 (0.9 –1.3) 1.5 (0.7–2.9)
2.1 (0.9 – 4.9)
1.2 (0.8 –1.8)
1.1 (0.5–2.2)
1.6 (1.3–1.9) 1.1 (0.5–2.7)
1.1 (0.6 –2.2)
1.2 (0.4 –3.0)
0.9 (0.5–1.8)
Hispanic
Other Language
1.2 (0.8 –1.6) 1.0 (0.8 –1.3) 0.9 (0.6 –1.3) 1.1 (0.5–2.2)
1.2 (0.5–2.7)
0.7 (0.3–1.7)
0.5 (0.2–1.5)
1.2 (0.9 –1.5) 1.1 (0.8 –1.4) 0.9 (0.7–1.2) 1.3 (0.8 –2.0)
1.2 (0.7–1.9)
0.6 (0.3–1.5)
1 (0.8 –1.3) 1.6 (0.9 –3.0)
2.6 (1.2–5.6)
0.8 (0.6 –1.3) 0.8 (0.6 –1.1) 0.8 (0.5–1.1) 0.8 (0.4 –1.7)
0.4 (0.2– 0.8)
0.9 (0.4 –1.9)
1.2 (0.5–3.2)
1.2 (0.9 –1.5) 2.7 (1.5–5.1)
3.9 (1.6 –9.3)
1.2 (0.8 –1.9) 1.0 (0.7–1.5) 1.0 (0.7–1.4) 1.0 (0.6 –1.7)
1.1 (0.5–2.7)
1.0 (0.5–1.8)
1.2 (0.7–1.9)
1.7 (0.8 –3.6)
1.3 (1.0 –1.8) 2.7 (1.3–5.6)
2.6 (1.0 – 6.8)
1.4 (0.9 –2.2) 1.4 (1.2–1.8) 1.9 (1.4 –2.5) 0.6 (0.3–1.6)
1.1 (0.6 –2.0)
0.8 (0.3–2.3)
1.1 (0.6 –1.9)
0.9 (0.4 –1.7)
0.7 (0.5– 0.9) 1.1 (0.5–2.2)
1.0 (0.5–2.3)
0.7 (0.5– 0.9) 0.7 (0.5– 0.9) 0.7 (0.5–1.0) 0.5 (0.2– 0.9)
0.7 (0.5–1.1)
0.7 (0.3–1.4)
1.5 (0.9 –2.5)
1.3 (0.6 –2.7)
1.5 (1.2–1.8) 2.2 (1.2–3.9)
1.6 (0.8 –3.2)
1.2 (0.9 –1.6) 1.6 (1.3–2.0) 1.6 (1.1–2.2) 0.8 (0.5–1.4)
0.9 (0.5–1.4)
1.2 (0.7–1.9)
1.4 (0.8 –2.6)
2.2 (1.0 –5.0)
1.7 (1.4 –2.2) 2.6 (1.4 –5.1)
3.0 (1.0 –9.2)
0.9 (0.5–1.5) 1.1 (0.8 –1.5) 1.5 (0.9 –2.4) 1.3 (0.5–3.1)
0.7 (0.3–1.3)
1.0 (0.4 –2.6)
1.2 (0.6 –2.3)
1.0 (0.5–2.1)
1.3 (1.0 –1.7) 1.8 (0.9 –3.6)
2.1 (0.8 –5.7)
0.9 (0.6 –1.4) 0.8 (0.6 –1.1) 0.8 (0.6 –1.3) 0.7 (0.3–1.6)
0.6 (0.3–1.2)
1.2 (0.8 –1.8)
0.9 (0.5–1.6)
1.3 (0.6 –3.1)
0.8 (0.5–1.1) 1.2 (0.5–2.6)
1.3 (0.4 – 4.0)
0.7 (0.4 –1.0) 0.8 (0.5–1.1) 1.0 (0.7–1.5) 0.9 (0.5–1.7)
1.1 (0.5–2.2)
1.9 (1.0 –3.4)
2.1 (0.9 – 4.8)
3.9 (1.2–12.6)
3.1 (2.1– 4.5) 4.4 (2.1– 8.9)
4.5 (1.2–16.4)
1.7 (0.9 –3.5) 1.6 (1.0 –2.7) 2.0 (1.2–3.4) 1.4 (0.4 –5.0)
2.0 (0.6 – 6.7)
2.7 (1.0 –7.4)
English
Mixed Language
Asian Mixed Language
English
Mixed Language
Other Language
English
ADOLESCENT HEALTH AND PRIMARY LANGUAGE
Feeling low more than once a week Irritability and bad temper more than once a week “Often” or “always” feel left out of things “Often” or “always” feel helpless “Rarely” or “never” feel confident in self “Don’t like school” “Agree” that teachers’ expectations too high Students in my class “rarely” or “never” enjoy being together Other students “rarely” or “never” accept me as I am Difficult to make new friends “Often” or “always” bullied because of religion or race
Non-Hispanic Black
Mixed Language
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Table 4. Adjusted Odds Ratios and Their 99% Confident Intervals of Selected Outcomes Based on Language at Home by Race/ethnicity
485
486
Table 4. continued Non-Hispanic White Other Language
1.0 (0.5–2.1)
Non-Hispanic Black Other Language
1.9 (0.7–5.0)
1.7 (1.3–2.2)
2.8 (1.5–5.0)
1.0 (0.6 –1.8)
2.8 (1.2– 6.4)
1.6 (1.2–2.1)
1.7 (0.8 –3.4)
2.7 (0.9 – 8.3)
1.2 (0.7–1.9)
1.1 (0.7–1.6)
Hispanic
Asian
English
Mixed Language
Other Language
3.5 (1.5– 8.2)
1.2 (0.8 –1.9)
1.4 (1.1–1.9)
1.5 (0.8 –2.9)
2.3 (0.8 – 6.5)
1.1 (0.7–1.7)
2.4 (1.8 –3.2)
5.4 (3.1–9.5)
3.1 (0.9 –11.0)
2.4 (1.2– 4.6)
1.6 (1.3–1.9)
2.0 (1.1–3.7)
1.3 (0.6 –2.7)
1.3 (1.1–1.5)
0.8 (0.5–1.5)
Reference group ⫽ Non-Hispanic white speaks English only. Controlled for gender, age, and maternal education.
English
Mixed Language
Other Language
1.6 (1.2–2.2)
1.0 (0.6 –1.8)
1.7 (0.8 –3.3)
1.6 (0.6 – 4.4)
1.2 (1.0 –1.6)
1.7 (1.3–2.3)
0.9 (0.5–1.7)
1.9 (1.0 –3.7)
2.2 (1.1– 4.5)
1.2 (0.7–2.2)
1.1 (0.7–1.8)
1.3 (0.8 –2.0)
0.9 (0.4 –2.2)
1.3 (0.6 –3.2)
1.0 (0.3–3.1)
2.2 (1.0 –5.1)
1.1 (0.8 –1.5)
1.6 (1.2–2.0)
2.1 (1.4 –3.1)
1.3 (0.7–2.4)
2.0 (1.2–3.2)
2.1 (0.8 –5.6)
1.2 (0.4 –3.7)
0.9 (0.7–1.2)
1.1 (0.9 –1.4)
1.3 (0.9 –1.7)
0.6 (0.4 –1.1)
1.2 (0.7–2.2)
1.9 (1.0 –3.6)
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English
Mixed Language
YU ET AL
Parents “never” or “rarely” ready to help with school problems Parents “never” or “rarely” willing to come to school to talk to teachers Parents “never” or “rarely” encourage me to do well at school “Agree”/ “strongly agree” my parents expect too much of me at school “Difficult”/ “very difficult” to talk to mother
Mixed Language
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ADOLESCENT HEALTH AND PRIMARY LANGUAGE
dents; that is, this study describes perceived risk rather than objectively measured risk. Finally, the survey does not provide information on respondents’ citizenship or the length of time they have been in the United States. Citizenship may affect adolescents’ access to programs, such as Medicaid, the State Children’s Health Insurance Program, and Supplemental Nutrition for Women, Infants, and Children (WIC), which may help to ameliorate their health and mental health risks; indeed, low-income children who are not U.S. citizens have been found to use health and mental health services at levels below those of citizen children (31). Length of time in the United States is of course an important factor in acculturation, but one about which we have no information in this sample. This study reinforces the conclusion that neither acculturation nor race and ethnicity alone determine the risks faced by immigrant youth. The great and growing diversity of American culture, particularly youth culture, does not necessarily protect adolescents whose families are new to the United States from feeling alienated from their schools and their classmates. In addition, parents may provide a particularly weak support system for these children, as they are often even less acculturated than their children and often rely on them for support (21). Immigrant parents may experience both linguistic and cultural barriers in communicating with children who grew up in the United States, and their children, in turn, may experience conflicts if they are surrounded by different cultures and expectations at home and in the wider world. In addition, parents may have difficulty communicating with teachers and school officials, for both linguistic and cultural reasons (32). New immigrants may have less flexible work schedules, especially if they are employed in secondary labor markets, and may not be able to make time for school conferences. Thus, targeted outreach efforts may be needed to assure that foreign-born parents can participate in the children’s school experience. The area of parent– children interactions in immigrant families is one that requires further research. This article provides an overview of the many issues and challenges faced by adolescents from varying levels of acculturation in the United States, a nation that prides itself in its diversity and its legacy of immigration. As demonstrated by the subgroup analysis, some general patterns about children who live in foreign-born households emerge, but further research is needed to examine the details of the health, psychosocial, and parental support domains
in specific ethnic groups to ensure that all youths have the potential for optimal physical and mental health in their adolescent years. Moreover, these findings emphasize the need to design risk-reduction interventions for adolescents that take the vulnerabilities of immigrant youth into account, and to implement preventive mental health services for youth that are targeted toward new immigrants of all races and ethnic groups.
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The opinions expressed in this paper are the authors’ and do not necessarily reflect the views or policies of the institutions with which the authors are affiliated.
References 1. Schmidley AD. U.S. Census Bureau, Current Population Reports, Series P23-206, Profile of the Foreign-Born Population in the United States: 2000. Washington, DC: U.S. Government Printing Office, 2001. 2. U.S. Census Bureau. Table QT-02: Profile of Selected Social Characteristics: 2000. Census 2000 Supplementary Summary Tables. Washington, DC: U.S. Census Bureau, 2002. 3. Hernandez DJ, Charney E (eds). From Generation to Generation: The Health and Well-Being of Children in Immigrant Families. Washington, DC: National Academy Press, 1998. 4. Immigration and Naturalization Service. Refugees, Fiscal Year 1997. Washington, DC: Immigration and Naturalization Service, 1999. 5. Fears D. “As foreign-born population grows, nationality trumps skin color.” The Washington Post, February 24, 2002, page A1. 6. Capps R. Hardship among Children of Immigrants: Findings from the 1999 National Survey of America’s Families. New Federalism: National Survey of America’s Families, Series B, No. B-29. Washington, DC: The Urban Institute, 2001. 7. Harris KM. The health status and risk behaviors of adolescents in immigrant families. In: Hernandez DJ (ed). Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: National Academy Press, 2000:286 –347. 8. Blake SM, Ledsky R, Goodenow C, O’Donnell L. Recency of immigration, substance use, and sexual behavior among Massachusetts adolescents. Am J Public Health 2001;91:794 –8. 9. Beiser M, Hou F, Hyman I, Tousignant M. Poverty, family process, and the mental health of immigrant children in Canada. Am J Public Health 2002;92:220 –7. 10. Kao G. Psychological well-being and educational achievement among immigrant youth. In: Hernandez DJ (ed). Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: National Academy Press, 2000:410 –77. 11. Hovey J. Acculturative stress, depression, and suicidal ideation among Mexican-American adolescents: Implications for the development of suicide prevention programs in schools. Psychol Rep 1998;83:249 –50. 12. Brindis C, Wolfe AL, McCarter V, et al. The associations between immigrant status and risk-behavior patterns in Latino adolescents. J Adolesc Health 1996;19:378 –80. 13. Research Forum on Children, Families, and the New Federalism. Lack of appropriate research leads to gaps in knowledge about children in immigrant families. The Forum 2002;5(1).
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14. Vega WA, Gil AG, Warheig GJ, et al. Acculturation and delinquent behavior among Cuban American adolescents: Toward an empirical model. Am J Community Psychol 1993; 21:113–25. 15. Browner-Elhanan KJ. Acculturation issues in adolescent immigrants: How are they related to health? Adolesc Med 1997;8:397–401. 16. Ebin VJ, Sneed CD, Morisky DE, et al. Acculturation and interrelationships between problem and health-promoting behaviors among Latino adolescents. J Adolesc Health 2001;29: 62–72. 17. Birman D, Trickett EJ, Vinokurov A. Acculturation and adaptation of Soviet Jewish refugee adolescents: Predictors of adjustment across life domains. Am J Community Psychol 2002;30:585–607. 18. Dinh KT, Roosa MW, Tein JY, Lopez VA. The relationship between acculturation and problem behavior proneness in a Hispanic youth sample: A longitudinal mediation model. J Abnorm Child Psychol 2002;30:295–309. 19. English PB, Kharrazi M, Guendelman S. Pregnancy outcomes and risk factors in Mexican Americans: The effect of language use and mother’s birth place. Ethn Dis 1997;7:229 –40. 20. Bhattacharya G. The school adjustment of south Asian immigrant children in the United States. Adolescence 2000;35:77– 85. 21. Zhou M. Growing up American: The challenge confronting immigrant children and children of immigrants. Annu Rev Sociol 1997;23:63–95. 22. Buron L, Beecroft E, Bell S, et al. PROSPECTS: The Congressionally Mandated Study of Educational Growth and Opportunity, Final Report on LEP Students. Prepared for the U.S. Department of Education. Washington, DC: Abt Associates, 1998.
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23. Epstein JA, Botvin GJ, Diaz T. Linguistic acculturation and gender effects on smoking among Hispanic youth. Prev Med 1998;27:583–9. 24. American Academy of Pediatrics Committee on Community Health Services. Health care for children of immigrant families. Pediatrics 1997;100:153–6. 25. Currie C, Hurrelman K, Settertobulte W, et al. Health and health behavior among young people. WHO policy series: Health policy for children and adolescents, Issue 1. Copenhagen, Denmark: World Health Organization Regional Office for Europe, 2000. 26. Nansel TR, Overpeck M, Pilla RS, et al. Bullying behaviors among US youth: Prevalence and association with psychosocial adjustment. JAMA 2001;285:2094 –100. 27. Shah BV, Barnwell BG, Bieler GS. SUDAAN User’s Manual, Release 7.5. Research Triangle Park, NC: Research Triangle Institute, 1997. 28. Lengendre P, Lengendre L. Numerical Ecology, 2nd English Edition. Amsterdam: Elsevier, 1998. 29. Yu SM, Huang Z J, Schwalberg RH, et al. Association of language spoken at home with health and school issues among US Asian adolescents. J School Health 2002;72:192–8. 30. Guttmacher S, Weitzman BC, Kapadia F, Weinberg SL. Classroom-based surveys of adolescent risk-taking behaviors: Reducing the bias of absenteeism. Am J Public Health 2002;92: 235–7. 31. Kaiser Commission on Medicaid and the Uninsured. Immigrants’ Health Care: Coverage and Access. Washington, DC: The Henry J. Kaiser Family Foundation, 2000. 32. Ruiz de Velasco J, Fix M, Clewell BC. Overlooked and Underserved: Immigrant Students in U.S. Secondary Schools. Washington, DC: Urban Institute, 2000.
ORIGINAL ARTICLE
Acculturation and the Health and Well-being of U.S. Immigrant Adolescents STELLA M. YU, Sc.D., M.P.H., ZHIHUAN J. HUANG, M.B., Ph.D., M.P.H., RENEE H. SCHWALBERG, M.P.H., MARY OVERPECK, Dr.P.H., AND MICHAEL D. KOGAN, Ph.D.
Purpose: To examine the association of acculturation, as measured by language spoken at home, with the health, psychosocial, school, and parental risk factors of adolescents of various racial/ethnic groups. Methods: Using the U.S. component of the 1997–98 World Health Organization Study of Health Behavior in School Children, bivariate and multiple logistic regression analyses were conducted of records for adolescents in four racial/ethnic groups to explore the relationship between the language spoken at home and outcome variables regarding health status and risks, psychosocial and school risk factors, and parental factors. Data were analyzed using Software for the Statistical Analysis of Correlated Data (SUDAAN). Results: Adolescents of all racial and ethnic groups who primarily speak a language other than English at home are at elevated risk for psychosocial risk factors such as alienation from classmates and being bullied, and parental risk factors such as feeling that their parents are not able or willing to help them. Those who speak a combination of languages are also at risk for being bullied and for high parental expectations. Language spoken at home is generally not associated with health and safety measures for adolescents across racial/ethnic groups. Conclusions: Adolescents whose primary language at home is not English experience higher psychosocial,
From the Maternal and Child Health Bureau Office of Data and Information Management, Rockville, Maryland (S.M.Y., Z.J.H., M.O., M.D.K.); Children’s National Medical Center, Washington, DC (Z.J.H.); and Maternal and Child Health Information Resource Center, Washington, DC (R.H.S.). Address correspondence to: Stella Yu, Sc.D., M.P.H., Maternal and Child Health Bureau, Office of Data and Information Management, 5600 Fishers Lane, 18-41, Rockville, MD 20857. E-mail: [email protected] Manuscript accepted March 7, 2003.
Published by Elsevier Inc., 360 Park Avenue South, New York, NY 10010
school, and parental risks than non-Hispanic white English-speakers. New immigrant youths of all races and ethnic groups would potentially benefit from preventive and risk-reduction services.
KEY WORDS:
Adolescents Ethnicity Health behavior Immigrants Psychosocial risk factors
Nearly 14 million children in the United States are immigrants or had immigrant parents in 2000, and almost 1 in 6 children under 18 live with a foreignborn householder (1). More than 30 million Americans were estimated to be foreign-born in 2000 (2). The population of children in immigrant families has grown by almost 50% over the course of the 1990s, nearly 7 times faster than the population of children of U.S.-born parents (3). Although the majority of children in immigrant families are of Hispanic or Asian origin, the growing population of immigrant children also includes significant numbers of recently arrived refugees from Eastern Europe and Africa (4). The total population of foreignborn Blacks remains small, but this group faces particular acculturation challenges in their interactions with the larger African-American community (5). Children in immigrant families are more likely than native-born children to be poor, to live in crowded housing, to be uninsured, to lack a usual 1054-139X/03/$–see front matter doi:10.1016/S1054-139X(03)00210-6
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source of health care, and to be in fair or poor health (6). For adolescents, being foreign-born or residing in a foreign-born household produces stresses that may be reflected in health behaviors and risk factors that are associated with adverse outcomes. Studies of the effect of immigration status on adolescent health risks have generally found that foreign-born youth are at lower risk of health problems and risk behaviors than those born in the United States, but that this protective effect diminishes over three generations (7,8). A recent Canadian study concluded that poverty has less effect on emotional health among immigrant children than it does on native-born children (9). However, several studies of the effect of immigration status on adolescents’ emotional health have found the opposite. Youth born outside the United States, and those born in the United States to immigrant parents, have been found to be more likely to feel peer pressure to engage in substance use, sexual activity, and violence, and to experience less parental support to resist these pressures (8). Another national study found that immigrant youth of all racial and ethnic groups experience higher rates of depression and alienation and lower feelings of “self efficacy” than do native-born children of native-born parents (10). In a small study of Mexican-American immigrant youth, those who rated higher levels of “acculturative stress” showed higher risk for depression and suicidal ideation (11), whereas another study found higher numbers of risk behaviors among Latino immigrants than among native-born Latino or native non-Hispanic white adolescents (12). Because of the paucity of research on the effects of immigration on children’s health, the Committee on the Health and Adjustment of Immigrant Children and Families, convened by the National Research Council and the Institute of Medicine, has recommended that further research be conducted on the physical health, mental health, and school adjustment of immigrant children (13). This study directly addresses this research need by assessing the influence of adolescents’ level of acculturation on their health and psychosocial risks. Acculturation has been identified throughout the literature as a critical mediating factor in adolescents’ adaptation to their environment and their adoption of the health behaviors and risks of their peers, and one that comprises multiple dimensions and facets (14 –18). In this article, we distinguish those who have adopted the behaviors of the non-Hispanic white majority and those who have not through language spoken in the home environment. Lan-
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guage has long been used as a proxy measure for the degree of acculturation (19). For immigrant youth, linguistic acculturation, that is, the ability to speak English proficiently, may be an indicator of overall level of cultural acclimation. Findings on the effect of linguistic acculturation on educational and psychological outcomes are mixed as well: whereas bilingual students with full English proficiency often exceed native English-speakers academically, those with limited English proficiency are at highest risk of school dropout (20 –22) Another study found that, among Hispanics, linguistic acculturation was associated with greater risk of smoking among adolescent girls (23). A recent review of the literature by the Institute of Medicine found that first-generation immigrant adolescents were in better health and had lower rates of many risk behaviors than native-born youth and later generations of immigrants. However, the psychological adjustment problems and acculturative stresses were most likely to be seen in youth with limited English proficiency or those who were not fully bicultural (3). In response to these needs, the American Academy of Pediatrics in 1997 recommended that pediatricians be sensitive to the needs of immigrant children and that training programs provide information about the stresses associated with immigration (24). Owing to their different cultural backgrounds and countries of origin, the effect of acculturation on adolescents’ risk status is likely to vary by race and ethnicity. The objectives of this study are: (a) to estimate the prevalence of the health, psychosocial, and parental risk factors by race/ethnicity and language groups; and (b) to examine the association of the degree of acculturation and race/ethnicity and health, psychosocial, and parental outcome measures. We hypothesize that the use of English in the home environment may protect against psychosocial risk factors, but may not necessarily be protective against health or parental risks.
Methods The data used in this study are drawn from the 1997–1998 World Health Organization Study of Health Behavior in School Children (HBSC), a crossnational research study focusing on the health, health behaviors, and lifestyles of young people (25,26). This is a nationally representative survey sample of youth in grades 6 to 10 in U.S. schools. The subjects included students who answered anonymous standardized questionnaires during the spring
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ADOLESCENT HEALTH AND PRIMARY LANGUAGE
of 1998 in 386 schools in the United States. The participation rate was 83%. Unlike other major data sources on adolescent health behaviors, the HBSC allows for examination of the association of outcome measures with the degree of acculturation, as measured by the language spoken in the home environment (exclusively or mostly English, exclusively or mostly another language, or a mixture of the two). Although the proportion of non-exclusive English-speakers varies considerably among racial/ethnic groups, we have included all groups in our analysis. This analysis includes four major racial and ethnic categories: non-Hispanic white, non-Hispanic black, Hispanic, and non-Hispanic Asian. A total of 15,220 records were analyzed. This study compares adolescents’ self-reported health and psychosocial risk factors for those of all racial and ethnic groups who do not report speaking English at home with those of the majority population of white non-Hispanic Englishspeakers. The outcome measure of well-being included questions about health behavior (including seatbelt and helmet use, frequency of adverse health events such as headaches and stomachaches, and overall health assessment), psychosocial and school risk factors (such as acceptance from other students and support from teachers) and parental influence (such as perception of parental willingness to help and difficulty talking to parents about problems) from the self-reported survey. Questions about seatbelt use when riding in a car and helmet use when biking, were limited to those who said they traveled in a car and rode bicycles. For ease of interpretation, response categories were combined to create dichotomized outcomes for logistic regression analysis. The independent variable is the language the child reports being spoken at home all or most of the time. The question is “What languages do your parents or other people who are raising you speak at home?” The students were classified in three groups based on the language they reported being spoken at home: “English (English),” “a language other than English (other language),” and “English and another language about equally (mixed languages).” Adjustment variables from the questionnaire include selfreported age, gender, and mother’s education. Maternal education is used as a proxy measure of the household’s socioeconomic status, as income information is not available directly from the survey. In the multivariate analysis, responses from all groups were compared with that of the English-speaking
white population to create odds ratios that may be compared across racial/ethnic groups. All analyses were conducted using Software for the Statistical Analysis of Correlated Data (SUDAAN) (27), which applies statistical sample weights to adjust for oversampling, and uses the Taylor series linearization method to adjust variance estimates to account for sample design and intracluster correlation, producing conservative estimates. To adjust for the problem multiple comparisons, Chisquare p values of .01 and 99% confidence intervals for odds ratios were used to identify significance (28).
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Results The demographic distribution of the study population is displayed in Table 1. In three of the racial/ ethnic groups, females represented just over half of the study population, although males were the majority among Asian respondents. In all four groups, the respondents were concentrated in the mid-adolescent age group (aged 12–15 years). Among all of the non-Hispanic groups, more than half of respondents’ mothers had more than a high-school education, but this percentage was lower among Hispanics. Non-Hispanic black and Hispanic respondents were most likely to live in urban areas, whereas most of non-Hispanic white and Asian respondents live in towns or suburban areas. More than 30% of Asian and nearly 20% of Hispanic respondents were foreign-born, compared with 2.5% of non-Hispanic Whites and 3.3% of nonHispanic Blacks. Asians and Hispanics were also the most likely to speak a language other than English at home: one-quarter of Hispanic and Asian respondents reported that English is not usually spoken at home, and about 45% of respondents in each group reported that two languages were spoken equally. Among non-Hispanic Blacks, 2.5% report that a language other than English is primarily spoken at home, and 5.4% report that a mixture of languages is spoken. These percentages are even lower among non-Hispanic Whites. Language spoken in the home is generally not significantly associated with any health and safety measures for adolescents across the racial/ethnic groups, with the exceptions of seat belt and helmet use among black and Hispanic youths in non-English home environments (data not shown). Table 2 shows the results of bivariate analyses of psychosocial and school relationship characteristics by language spo-
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Table 1. Characteristic of Study Population Non-Hispanic White
Gender Male Female Age (yrs) 11 12 13 14 15 16 17 Maternal education ⬍ High school High school graduate Some college College graduate Not stated Area of residence Urban Suburban Town Rural Nativity U.S.-born Foreign-born Language at home Only/mostly English Mixed languages Only/mostly another language Residing with parent Lives with mother Lives with father Total
Non-Hispanic Black
Hispanic
Asian
n
Weighted %
SE
n
Weighted %
SE
n
Weighted %
SE
n
Weighted %
SE
4263 4652
47.7 52.4
1.2 1.2
1129 1538
42.6 57.4
1.3 1.3
1342 1600
45.0 55.0
1.4 1.4
365 331
53.3 45.1
3.7 3.7
430 1500 1477 1861 2008 1480 155
5.1 20.2 19.7 19.5 19.6 14.4 1.5
0.7 1.7 1.7 1.7 1.3 1.1 0.2
186 471 546 517 529 343 72
6.2 15.8 20 18.8 21.5 15 2.6
1.2 1.3 2 1.2 1.6 1.8 0.4
202 508 660 664 506 325 70
5.7 16.8 22.6 19.4 19.1 13.3 3.2
0.8 1.4 1.9 1.6 1.3 1.2 0.7
51 115 159 155 132 73 11
8.9 17.8 20.8 18.7 21.6 9.8 2.4
1.9 3.1 4.4 2.0 4.8 1.8 0.8
447 1788 1857 3838 948
5.3 21.2 20.7 40.1 12.7
0.7 0.9 0.6 1.5 0.7
216 535 558 897 440
7.8 20.7 22 31.3 18.2
0.8 1.3 1.3 1.6 1.3
681 499 490 508 744
23.2 17.6 16.6 17.3 25.2
1.3 1.1 1.2 1.2 1.2
46 78 88 336 148
7 13.2 13 41.6 25.2
1.6 1.4 2.5 3.9 4.8
1132 3031 2929 1762
14.2 31.8 34.6 19.5
2.1 2.7 2.4 1.9
1078 569 561 389
39.6 25 21.5 14
4.8 5.1 2.5 1.9
1222 723 646 271
39.4 25.1 26.3 9.2
4.2 2.8 2.6 1.3
229 315 96 50
32.7 45.5 15.1 6.7
6.2 6.5 1.7 1.6
8681 210
97.5 2.5
0.3 0.3
2567 84
96.7 3.3
0.6 0.6
2337 566
80.2 19.8
1.6 1.6
440 253
69.6 30.4
4.0 4.0
8376 395 123
94.4 4.4 1.2
0.4 0.4 0.2
2426 161 65
92.1 5.4 2.5
0.7 0.6 0.4
795 1329 787
28.1 45.4 26.6
1.6 1.7 2
190 322 181
31.3 44.1 24.6
6.9 3.0 4.7
8278 6644 8915
93.2 73.6
0.5 0.9
2384 1044 2667
91.3 38.4
1 1.6
2738 1923 2942
93.5 64.6
0.6 1.2
647 584 696
95.5 84
0.8 1.8
ken at home. Results are based on the associations within each racial/ethnic group; that is, those who do not speak English at home are compared with English-speakers for each variable. For all racial/ ethnic groups, those associations that are significant demonstrate increased risk within the populations that do not report that English is spoken at home. Among non-Hispanic Whites, the other language group had a higher risk of feeling low; non-Hispanic Blacks in the other language and mixed language groups were more likely to report feeling helpless and not feeling confident; Hispanics were more likely to report difficulty making new friends if Spanish was spoken at home; and Asians were more likely to feel that their teachers’ expectations were too high if they were not English-speakers. In all of these cases, the risk among the mixed-language
group fell between those of the English and the non-English groups. Table 3 shows the relationship of parental support characteristics and language spoken at home within each racial/ethnic group. Hispanics, followed by Asians, report the highest number of parental risk factors significantly associated with the language spoken at home. Although none of the associations were significant at the p ⬍ .01 level for non-Hispanic Whites, non-Hispanic Blacks were more likely to report that their parents did not encourage them in school; Hispanics were more likely to report that their parents were not willing to come to school to talk to teachers; and Asians were more likely to report that their parents were not ready to help with school problems or to talk to teachers if English was not spoken at home.
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483
Table 2. Selected Adolescent Psychosocial and School Relationship Characteristics by Language Spoken at Home and Race/ethnicity Non-Hispanic White Language
Feeling low more than once a week Irritability and bad temper more than once a week “Often” or “always” feel left out of things “Often” or “always” feel helpless “Rarely” or “never” feel confident in self “Don’t like school” Agree that teachers’ expectations too high Students in my class “rarely” or “never” enjoy being together Other students “rarely” or “never” accept me as I am Difficult to make new friends “Often” or “always” bullied because of religion or race
Non-Hispanic Black Language
Hispanic Language
Asian Language
English
Mixed
Other
English
Mixed
Other
English
Mixed
Other
English
Mixed
Other
*21.9
34.0
29.4
23.9
28.8
38.7
25.4
23.2
21.8
22.4
25.6
17.5
29.2
33.1
30.7
40.1
32.5
19.3
34.1
33.3
30.7
33.2
33.3
22.6
14.8
16.4
17.6
15.0
22.5
32.6
13.0
13.6
13.0
12.1
7.3
15.0
10.7
9.9
13.7
*12.8
26.2
33.9
13.3
12.6
13.4
10.1
12.4
11.9
15.8
17.9
24.5
*20.4
34.5
35.2
21.4
23.3
29.8
10.5
16.7
15.8
32.2 32.3
33.9 42.1
29.8 38.1
25.0 42.3
35.4 52.1
34.0 44.9
35.1 37.9
26.0 45.8
27.9 46.5
19.1 *26.8
26.1 29.6
28.9 39.6
12.7
17.0
24.7
20.5
29.2
32.6
12.2
15.1
21.6
16.0
9.2
16.7
15.3
17.7
15.9
18.6
25.6
28.3
14.1
13.7
15.1
11.5
9.3
21.8
16.7
15.6
21.9
13.6
20.2
22.6
*12.1
14.8
20.5
15.5
18.1
32.4
3.9
7.7
13.8
11.0
16.3
16.0
6.8
6.6
8.8
5.5
7.6
11.9
* Chi-square value ⬍ 0.01.
Table 4 shows the results of multivariate analyses that compare the level of risk in each racial/ethnic and language group with that of the reference group of English-speaking non-Hispanic Whites, controlling for the effects of age, gender, and maternal education. Among non-Hispanic Whites, those in the mixed language group showed elevated risk of feeling low, whereas those who spoke another language at home showed higher risks of being bullied because of their religion or race, reporting that their parents were not willing to talk to their teachers and that students in their class do not enjoy being together, and feeling that their parents expect too much of them at school. Among non-Hispanic black respondents, elevated risks were seen for most health, psychosocial, and parental risk factors when compared with the reference group. However, these risks were frequently high for all three language groups. That is, black adolescents are at significantly higher risk for psychosocial and school risks (such as feeling helpless, feeling unconfident in themselves, and being bullied); and parental risks (such as not feeling that their
parents are ready to help them and feeling that their parents expect too much of them at school), regardless of the language they speak at home. The odds ratios for these risk factors are usually highest among those adolescents who speak another language exclusively at home and lowest among those for whom English is spoken in the home environment. Among Hispanic respondents, those in the English-speaking group did not show any significant difference in psychosocial, school, or parental risk compared with non-Hispanic white English-speakers. Those who spoke Spanish at home, either exclusively or in combination with other languages, were more likely to report not feeling confident, to feel that their teachers’ expectations were too high, to be bullied at school because of race or religion, to report that their parents were unwilling to come to school to talk to their teachers, and to feel excessive parental expectation. In general, the odds ratios within the other language group are higher than those in the mixed language group, although the two groups tend to show significant results for the same outcome measures.
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Table 3. Selected Parental Characteristics by Language Spoken at Home and Race/Ethnicity Non-Hispanic White Language
Parents “never” or “rarely” ready to help with school problems Parents “never” or “rarely” willing to come to school to talk to teachers Parents “never” or “rarely” encourage me to do well at school “Strongly agree” or “agree” that my parents expect too much of me at school “Very difficult” or “difficult” to talk to mother
Non-Hispanic Black Language
English
Mixed
Other
English
Mixed
Other
12.6
12.2
21.3
20.1
30.7
35.8
13.3
13.5
30.1
20.1
20.7
5.6
9.1
14.2
*12.7
33.0
37.1
54.5
25.5
27.0
30.6
Hispanic Language English
Asian Language
Mixed
Other
English
Mixed
Other
16
19.5
23.1
*12.6
19.3
22.9
28.5
*15.6
19.4
27.0
*11.9
22.6
30.3
26.3
17.4
7.4
7.5
9.3
5.0
7.5
7.8
44.0
51.2
52.8
*35.4
45.3
53.0
38.6
49.9
52.4
30.5
22.6
29.5
24.6
29.2
32.0
17.3
29.7
40.2
* Chi-square value ⬍ 0.01.
The pattern among Asian respondents was similar. Those who speak another language exclusively at home had significantly higher rates of several risk factors, including difficulty making new friends, being bullied, feeling that their parents were not often willing to talk to their teachers about problems at school, and finding it difficult to talk to their mothers about problems. Those who speak a mixture of languages had significantly elevated risks of only two risk factors: feeling that parents were not willing to talk to their teachers, and feeling that parents expect too much of them at school.
Discussion This analysis demonstrates the complex relationships among immigration, race/ethnicity, and linguistic assimilation. Adolescents of all racial and ethnic groups from a non-English home environment are at higher risk of a range of psychosocial and parental risk factors than the majority population of non-Hispanic white English-speakers. Adolescents who speak other languages at home, exclusively, or in combination with English, are particularly likely to report feelings of vulnerability, exclusion, and lack of confidence. This confirms that earlier findings among Asian-American youth are also evident in other racial and ethnic groups (29). In addition, it is notable that many groups of nonwhite youth, regardless of language, and white adolescents who do not speak English at home were at significantly higher risk for being bullied because of their race or religion. That is, many youth who are different from
the majority population are at high risk of experiencing bullying. The relationship between being a victim of bullying and having other psychosocial risk factors confirms that found in other research (26). For most racial/ethnic groups, these risks are more pronounced for those who speak another language exclusively. Non-Hispanic black youths, however, are at significantly elevated risk of reporting feelings of alienation, vulnerability, lack of confidence, and helplessness regardless of the language they speak at home compared with non-Hispanic white English-speakers. This finding suggests a broad divergence in the experience of white and African-American youth and indicates the need for further research on the relative effect of race and the level of acculturation on the health and mental health of minority adolescents. Several limitations of this analysis should be noted. First, because the survey was conducted in school, the study population excludes such high-risk populations as those who have dropped out of school or who are in the juvenile justice system. Students in special education classes were also less likely to be interviewed. Thus, the levels of risk reported here might be lower than those of the adolescent population as a whole. Absenteeism may also tend to bias risk levels downward, if those who do not attend school regularly have higher levels of risk, although this has been shown not to be a serious problem in school-based surveys (30). We also do not have information on the response rates by race/ ethnicity. In addition, the risk factors are analyzed here as they are reported by the survey’s respon-
Non-Hispanic White Other Language
Other Language
1.9 (1.3–2.7)
1.5 (0.6 –3.3)
1.1 (0.9 –1.3) 1.5 (0.7–2.9)
2.1 (0.9 – 4.9)
1.2 (0.8 –1.8)
1.1 (0.5–2.2)
1.6 (1.3–1.9) 1.1 (0.5–2.7)
1.1 (0.6 –2.2)
1.2 (0.4 –3.0)
0.9 (0.5–1.8)
Hispanic
Other Language
1.2 (0.8 –1.6) 1.0 (0.8 –1.3) 0.9 (0.6 –1.3) 1.1 (0.5–2.2)
1.2 (0.5–2.7)
0.7 (0.3–1.7)
0.5 (0.2–1.5)
1.2 (0.9 –1.5) 1.1 (0.8 –1.4) 0.9 (0.7–1.2) 1.3 (0.8 –2.0)
1.2 (0.7–1.9)
0.6 (0.3–1.5)
1 (0.8 –1.3) 1.6 (0.9 –3.0)
2.6 (1.2–5.6)
0.8 (0.6 –1.3) 0.8 (0.6 –1.1) 0.8 (0.5–1.1) 0.8 (0.4 –1.7)
0.4 (0.2– 0.8)
0.9 (0.4 –1.9)
1.2 (0.5–3.2)
1.2 (0.9 –1.5) 2.7 (1.5–5.1)
3.9 (1.6 –9.3)
1.2 (0.8 –1.9) 1.0 (0.7–1.5) 1.0 (0.7–1.4) 1.0 (0.6 –1.7)
1.1 (0.5–2.7)
1.0 (0.5–1.8)
1.2 (0.7–1.9)
1.7 (0.8 –3.6)
1.3 (1.0 –1.8) 2.7 (1.3–5.6)
2.6 (1.0 – 6.8)
1.4 (0.9 –2.2) 1.4 (1.2–1.8) 1.9 (1.4 –2.5) 0.6 (0.3–1.6)
1.1 (0.6 –2.0)
0.8 (0.3–2.3)
1.1 (0.6 –1.9)
0.9 (0.4 –1.7)
0.7 (0.5– 0.9) 1.1 (0.5–2.2)
1.0 (0.5–2.3)
0.7 (0.5– 0.9) 0.7 (0.5– 0.9) 0.7 (0.5–1.0) 0.5 (0.2– 0.9)
0.7 (0.5–1.1)
0.7 (0.3–1.4)
1.5 (0.9 –2.5)
1.3 (0.6 –2.7)
1.5 (1.2–1.8) 2.2 (1.2–3.9)
1.6 (0.8 –3.2)
1.2 (0.9 –1.6) 1.6 (1.3–2.0) 1.6 (1.1–2.2) 0.8 (0.5–1.4)
0.9 (0.5–1.4)
1.2 (0.7–1.9)
1.4 (0.8 –2.6)
2.2 (1.0 –5.0)
1.7 (1.4 –2.2) 2.6 (1.4 –5.1)
3.0 (1.0 –9.2)
0.9 (0.5–1.5) 1.1 (0.8 –1.5) 1.5 (0.9 –2.4) 1.3 (0.5–3.1)
0.7 (0.3–1.3)
1.0 (0.4 –2.6)
1.2 (0.6 –2.3)
1.0 (0.5–2.1)
1.3 (1.0 –1.7) 1.8 (0.9 –3.6)
2.1 (0.8 –5.7)
0.9 (0.6 –1.4) 0.8 (0.6 –1.1) 0.8 (0.6 –1.3) 0.7 (0.3–1.6)
0.6 (0.3–1.2)
1.2 (0.8 –1.8)
0.9 (0.5–1.6)
1.3 (0.6 –3.1)
0.8 (0.5–1.1) 1.2 (0.5–2.6)
1.3 (0.4 – 4.0)
0.7 (0.4 –1.0) 0.8 (0.5–1.1) 1.0 (0.7–1.5) 0.9 (0.5–1.7)
1.1 (0.5–2.2)
1.9 (1.0 –3.4)
2.1 (0.9 – 4.8)
3.9 (1.2–12.6)
3.1 (2.1– 4.5) 4.4 (2.1– 8.9)
4.5 (1.2–16.4)
1.7 (0.9 –3.5) 1.6 (1.0 –2.7) 2.0 (1.2–3.4) 1.4 (0.4 –5.0)
2.0 (0.6 – 6.7)
2.7 (1.0 –7.4)
English
Mixed Language
Asian Mixed Language
English
Mixed Language
Other Language
English
ADOLESCENT HEALTH AND PRIMARY LANGUAGE
Feeling low more than once a week Irritability and bad temper more than once a week “Often” or “always” feel left out of things “Often” or “always” feel helpless “Rarely” or “never” feel confident in self “Don’t like school” “Agree” that teachers’ expectations too high Students in my class “rarely” or “never” enjoy being together Other students “rarely” or “never” accept me as I am Difficult to make new friends “Often” or “always” bullied because of religion or race
Non-Hispanic Black
Mixed Language
December 2003
Table 4. Adjusted Odds Ratios and Their 99% Confident Intervals of Selected Outcomes Based on Language at Home by Race/ethnicity
485
486
Table 4. continued Non-Hispanic White Other Language
1.0 (0.5–2.1)
Non-Hispanic Black Other Language
1.9 (0.7–5.0)
1.7 (1.3–2.2)
2.8 (1.5–5.0)
1.0 (0.6 –1.8)
2.8 (1.2– 6.4)
1.6 (1.2–2.1)
1.7 (0.8 –3.4)
2.7 (0.9 – 8.3)
1.2 (0.7–1.9)
1.1 (0.7–1.6)
Hispanic
Asian
English
Mixed Language
Other Language
3.5 (1.5– 8.2)
1.2 (0.8 –1.9)
1.4 (1.1–1.9)
1.5 (0.8 –2.9)
2.3 (0.8 – 6.5)
1.1 (0.7–1.7)
2.4 (1.8 –3.2)
5.4 (3.1–9.5)
3.1 (0.9 –11.0)
2.4 (1.2– 4.6)
1.6 (1.3–1.9)
2.0 (1.1–3.7)
1.3 (0.6 –2.7)
1.3 (1.1–1.5)
0.8 (0.5–1.5)
Reference group ⫽ Non-Hispanic white speaks English only. Controlled for gender, age, and maternal education.
English
Mixed Language
Other Language
1.6 (1.2–2.2)
1.0 (0.6 –1.8)
1.7 (0.8 –3.3)
1.6 (0.6 – 4.4)
1.2 (1.0 –1.6)
1.7 (1.3–2.3)
0.9 (0.5–1.7)
1.9 (1.0 –3.7)
2.2 (1.1– 4.5)
1.2 (0.7–2.2)
1.1 (0.7–1.8)
1.3 (0.8 –2.0)
0.9 (0.4 –2.2)
1.3 (0.6 –3.2)
1.0 (0.3–3.1)
2.2 (1.0 –5.1)
1.1 (0.8 –1.5)
1.6 (1.2–2.0)
2.1 (1.4 –3.1)
1.3 (0.7–2.4)
2.0 (1.2–3.2)
2.1 (0.8 –5.6)
1.2 (0.4 –3.7)
0.9 (0.7–1.2)
1.1 (0.9 –1.4)
1.3 (0.9 –1.7)
0.6 (0.4 –1.1)
1.2 (0.7–2.2)
1.9 (1.0 –3.6)
JOURNAL OF ADOLESCENT HEALTH Vol. 33, No. 6
English
Mixed Language
YU ET AL
Parents “never” or “rarely” ready to help with school problems Parents “never” or “rarely” willing to come to school to talk to teachers Parents “never” or “rarely” encourage me to do well at school “Agree”/ “strongly agree” my parents expect too much of me at school “Difficult”/ “very difficult” to talk to mother
Mixed Language
December 2003
ADOLESCENT HEALTH AND PRIMARY LANGUAGE
dents; that is, this study describes perceived risk rather than objectively measured risk. Finally, the survey does not provide information on respondents’ citizenship or the length of time they have been in the United States. Citizenship may affect adolescents’ access to programs, such as Medicaid, the State Children’s Health Insurance Program, and Supplemental Nutrition for Women, Infants, and Children (WIC), which may help to ameliorate their health and mental health risks; indeed, low-income children who are not U.S. citizens have been found to use health and mental health services at levels below those of citizen children (31). Length of time in the United States is of course an important factor in acculturation, but one about which we have no information in this sample. This study reinforces the conclusion that neither acculturation nor race and ethnicity alone determine the risks faced by immigrant youth. The great and growing diversity of American culture, particularly youth culture, does not necessarily protect adolescents whose families are new to the United States from feeling alienated from their schools and their classmates. In addition, parents may provide a particularly weak support system for these children, as they are often even less acculturated than their children and often rely on them for support (21). Immigrant parents may experience both linguistic and cultural barriers in communicating with children who grew up in the United States, and their children, in turn, may experience conflicts if they are surrounded by different cultures and expectations at home and in the wider world. In addition, parents may have difficulty communicating with teachers and school officials, for both linguistic and cultural reasons (32). New immigrants may have less flexible work schedules, especially if they are employed in secondary labor markets, and may not be able to make time for school conferences. Thus, targeted outreach efforts may be needed to assure that foreign-born parents can participate in the children’s school experience. The area of parent– children interactions in immigrant families is one that requires further research. This article provides an overview of the many issues and challenges faced by adolescents from varying levels of acculturation in the United States, a nation that prides itself in its diversity and its legacy of immigration. As demonstrated by the subgroup analysis, some general patterns about children who live in foreign-born households emerge, but further research is needed to examine the details of the health, psychosocial, and parental support domains
in specific ethnic groups to ensure that all youths have the potential for optimal physical and mental health in their adolescent years. Moreover, these findings emphasize the need to design risk-reduction interventions for adolescents that take the vulnerabilities of immigrant youth into account, and to implement preventive mental health services for youth that are targeted toward new immigrants of all races and ethnic groups.
487
The opinions expressed in this paper are the authors’ and do not necessarily reflect the views or policies of the institutions with which the authors are affiliated.
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