From Generation to Generation The Health and Well-Being of Children in Immigrant Families (1998) / Chapter Skim
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3 Health Status and Adjustment
3 Health Status and Adjustment
Pages 59-110
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From page 59... ...
This relative advantage tends to deteriorate with length of time in the United States and from one generation to the next. Moreover, as we discuss in this chapter, children in immigrant families may be at particular risk for certain health conditions.
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From page 60... ...
Although it is well documented that prenatal care contributes to positive birth outcomes, the more favorable health outcomes of immigrants often occur in the context of lower utilization of pre iAmong the hypotheses that might explain the epidemiological paradox are several that point to possible data limitations. Some have argued, for example, that the unexpectedly low rate of infant mortality among Mexican-origin women, especially immigrants, may be due to underreporting of infant deaths or ethnic misclassifications on birth and/or death certificates.
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From page 61... ...
More detailed studies of previously unmeasured lifestyle differences, such as nutrition and stress, that compare immigrants and natives, coupled with greater attention to alternative sources of information for pregnant immigrant women, could shed light on the precise role of formal medicine in protecting the health of children in immigrant families during infancy. Consistent with the pattern for low birthweight, infant mortality rates are also lower for children of immigrants than for U.S.born children of U.S.-born women, although sometimes the differences are slight.
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From page 62... ...
The infant mortality rates for non-Hispanic whites and blacks are also lower for foreign-born than for U.S.-born mothers (4.6 and 5.8 percent for whites, and 10.5 and 12.9 percent for blacks) (Figure 3-2)
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From page 63... ...
Along these lines, immigrant women of Mexican origin are less likely to use alcohol and drugs and may have a healthier diet than U.S.born women (Cabral et al., 1990; Guendelman and Abrams, 1995~. These healthful behaviors may be reinforced by strong family bonds among immigrant groups and communities that sustain cultural orientations that lead to healthful behavior, factors that become diluted with duration of residence in the United States.
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From page 64... ...
; the responses to both surveys reflect parental awareness of conditions rather than medically confirmed diagnoses; immigrant parents may be more hesitant than U.S.-born parents to reveal the existence of health problems to an interviewer, or they may have health expectations that differ from native-born parents, because they come from different cultures; and only the NHANES III has standardized translations of the survey instruments into Spanish and uses bilingual, bicultural interviews. For all these reasons, inconsistencies between parental reports of general health and of the prevalence of specific conditions should be treated as preliminary, and subject to additional study.
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From page 65... ...
Third- and later-generation Mexican-origin children had similar rates as third- and later-generation black children, and both were twice as likely to be rated in fair or poor health compared with third- and later-generation white children. Mexican-origin children in all generations are therefore 2 to 9 times more likely to have parents who express concerns about their health than third- and latergeneration white parents.
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From page 66... ...
13.3 (2.05) aParental reported condition from Household Youth Questionnaire NHANES ill.
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From page 67... ...
HEALTH STATUS AND ADJUSTMENT 67 Non-Hispanic Non-Hispanic Non-Hispanic Black White Other 4.9 (0.73)
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From page 68... ...
Moreover, inappropriate generalization could obscure significant health problems in specific subpopulations of migrant farmworkers. CHRONIC HEALTH CONDITIONS An accurate assessment of the prevalence of chronic health conditions and disability among children in immigrant families does not exist for the most part.
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From page 69... ...
For example, studies in the Puerto Rican community have demonstrated that the degree of acculturation is directly related to the likelihood of compliance with medically prescribed asthma therapy for children (Pachter and Weller, 1993~. New analyses conducted for the committee from NHANES III indicate that, among Mexican-origin children, the prevalence of asthma as reported by parents increased between the first, second, and third and later generations (Mendoza and Dixon, 1998)
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From page 70... ...
Comprehensive and culturally sensitive care may be particularly important in the care of asthma, because access appears to be problematic for immigrant and minority populations. In one study, black and Hispanic children were less likely than white children to leave the hospital with appropriate home nebulization services, a cornerstone of chronic asthma therapy (Finkelstein et al., 1995~.
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From page 71... ...
. A diagnosis of tuberculosis infection in a child is a sentinel event, because it represents recent transmission in the community and therefore merits intensive investigation by public health authorities to identify the source.
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From page 72... ...
One of the few measures of children's physical health status in the NHANES III that is determined by physician report is the assessment of a possible active infection in the child at the time of the survey. As seen in Table 3-1, comparisons between all generations of Mexican-origin children and third- and later-generation white children show no significant differences in the frequency of active infections (Mendoza and Dixon, 1998~.
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From page 73... ...
found elevated blood lead levels among Mexicanorigin children, and a study of Mexican-born children in Santa Clara Valley, California, found lead levels above 10,ug/dL among 20 percent of the children, compared with 7 percent of third- and later-generation children (Snyder et al., 1995~. Although few countries sending large numbers of immigrants to the United States gather data from nationally representative samples, mean blood lead values from selected studies of children in those countries are considerably higher than the current U.S.
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From page 74... ...
of Hispanic immigrants, compared with elevated levels in less than 10 percent of children in census tracts with few immigrants (Sargent, 1997~. For migrant farmworkers, pesticides are an ever-present danger, with 1.2 billion pounds of pesticides used in U.S.
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From page 75... ...
Although these children appear to have their stature affected by poverty, suggesting stunting due to poor nutrition and health, the increase in obesity would suggest the counterargument of adequate or overnutrition. Similar findings have been reported for some Asian children in immigrant families as well (Himes et al., 1992~.
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From page 76... ...
For children less than age 5, there were no significant differences between firstgeneration Mexican-origin and third- and later-generation white children; there were also no significant differences between firstand either later-generation Mexican-origin children or third- and later-generation black children in this age group. Data about the nutritional status of Asian children in immigrant families are limited and complicated by the diversity of Asian countries that send children to the United States.
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From page 77... ...
The limited data on the dietary intake of Asian children in immigrant families indicate that they initially consume traditional diets, but then make a transition to American foods (Story and Harris, 1988, 1989; Thuy et al., 1983~. Southeast Asian mothers have been observed to reduce the practice of breastfeeding, apparently as a result of the need to work, the desire for convenience, and the sense that baby formula is superior (Serdula et al., 1991; Tuttle and Dewey, 1994~.
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From page 78... ...
Given higher rates of these conditions among children living in poverty, one might expect higher rates among children in immigrant families. However, parental report information from the NHANES III seen in Table 3-1 shows that the prevalence of accidents, injury, and poisoning among all ages of Mexican-origin children is significantly lower than that of third- and later-generation white children of similar ages (Mendoza and Dixon, 1998~.
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From page 79... ...
As shown in Table 3-2 and Figure 3-3, overall and for most specific countries of origin, first-generation adolescents were less likely than second or third and later generations to consider themselves in poor health (specifically with neurological impairment, obesity, or asthma) or to have school absence due to health or emotional problems.
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From page 80... ...
80 FROM GENERATION TO GENERATION TABLE 3-2 Health Indicators for First- and Seconcl-Generation Aclolescents by Generation and for Thircl- and Later-Generation Aclolescents by Race and Ethnicity: 1995 (means) First Second Generation Generation Non-Hispanic White, Third and Later Generations Physical Health General health fair or poor 9.2 10.7 8.1 Missed school due to a health or emotional problem 33.5 36.5 33.6 Learning difficulties 9.3 12.5 16.9 Obesity 17.0 26.7 23.4 Asthma 4.8 8.1 12.2 Health and school problems index 0.74 0.94 0.93 Emotional Health Psychological distress 1.54 1.52 1.45 Positive well-being 2.85 2.87 3.06 Health Risk Behavior Ever had sex 31.3 33.9 36.7 Age at first intercoursea 15.1 14.9 14.8 Birth control/first intercoursea 56.2 57.3 67.1 Four or more delinquent acts 15.8 25.0 21.9 Three or more acts of violence 14.6 21.3 19.4 Use of three or more substances 8.3 17.4 25.1 Risk behavior index 0.7 0.98 1.03 N 1,651 2,526 1 O,248 NOTE: With the exception of age at first intercourse and emotional health, all differences are statistically significant at the .001 level.
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From page 81... ...
HEALTH STATUS AND ADJUSTMENT 81 Non-Hispanic Non-Hispanic Hispanic, Black, Third Other, Third Third and and Later and Later Later Generations Generations Generations Total 11.5 37.1 14.3 29.9 13.5 1.05 1.52 2.99 54.8 13.8 64.2 18.0 27.2 8.6 1.09 14.3 40.2 15.6 31.5 14.9 1.17 1.54 2.89 39.2 14.4 60.5 26.3 26.4 24.3 1.17 13.1 41.1 18.3 31.0 15.7 1.2 1.54 2.89 45.3 14.2 58.3 29.6 31.5 25.3 1.32 4,312 456 1,429 20,622 9.7 35.4 15.4 25.3 11.8 0.97 1.49 2.99 40.4 14.5 63.8 21.6 21.9 19.4 1.03
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From page 82... ...
Among adolescents in grades 7 through 12 in 1995, health risk behaviors involving early sexual activity, nonuse of birth control,
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From page 83... ...
For most of these behaviors, the thirdand later-generation rates approach and even exceed those of third- and later-generation white children. MENTAL HEALTH AND ADJUSTMENT In general, the mental health and adjustment of children and youth in immigrant families appears to be similar to, if not better, than that of U.S.-born children and youth in U.S.-born families, in
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From page 84... ...
Acculturative Stress A key factor in understanding psychosocial distress among children and youth in immigrant families is acculturative stress (Aronowitz, 1984; Gil et al., 1994; Gi! and Vega, 1996; Zambrana and Silva-Palacios, 1989~.
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From page 85... ...
For first-generation adolescents, higher levels of acculturation corresponded with increased family conflict and decreased family pride. Bicultural individuals born in the United States experienced less acculturation stress, more family pride, and the most positive outcomes (Gil et al., 1994~.
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From page 86... ...
Vietnamese community and did not receive it had the highest depressive symptoms when they were assessed several months after arrival. The investigators also discovered other factors that may have contributed to the worsening mental health of the Amerasian youth following immigration, including traveling alone or with only partial family support, close identification with other youths from whom they were separated upon arrival in this country, limited education, and little or no knowledge of English.
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From page 87... ...
However, the second year tends to be the most stressful, as the impact of acculturative stress is completely experienced. The third and subsequent years vary
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From page 88... ...
and the 1995 National Longitudinal Study of Adolescent Health (Add Health) for adolescents in grades 7 through 12 in 1995 with origins in Mexico, Cuba, Central and South America, China, the Philippines, Japan, Vietnam, Africa and the Caribbean, and Europe and Canada (Harris, 1998~.
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From page 89... ...
Taken together, these results may suggest that immigrant youth are able to maintain positive feelings about themselves and their general well-being, despite perceiving that they have relatively less control over their lives and are less well accepted by their school peers. After the effects of socioeconomic status are statistically excluded, the NELS data continue to show relatively lower self-efficacy among first- and second-generation youth who are Hispanic and Asian compared with third- and later-generation white youth (see Figures 3-7 and 3-8~.
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From page 90... ...
. 0.4 0.3 0.1 o -0.1 -0.2 -0.3 -0.4 -0.5 Asian Hispanic Bl k ac White Native-born of native-born parents Native-born of immigrant parents Immigrant generation FIGURE 3-8 Estimates of adolescent alienation at school.
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From page 91... ...
The Children of Immigrants Longitudinal Study, conducted in Southern California (San Diego) and South Florida (Miami and Fort Lauderdale)
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From page 92... ...
The study found lower self-esteem and higher depressive symptoms among youth in immigrant families for girls and for children experiencing high parent-child conflict, low family cohesion, recent serious illness or disability in the family, a high proportion of English-only spoken in the neighborhood, a school perceived as unsafe, dissatisfaction with physical looks, and lack of popularity with the opposite sex.3 Also associated with low self-esteem were being of Filipino or Vietnamese origin, a recent family move to another home, low grades and educational aspirations, current limited English proficiency, and limited English proficiency in 1991 (see Table 3-3~. Subsequent analyses of the Children of Immigrants Longitudinal Study (Rumbaut, 1998b)
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From page 93... ...
Despite the potential importance of these factors for enhancing or reducing self-esteem and depression among children in immigrant families, national estimates of the prevalence of their experience with most of these factors are not available (exceptions are educational aspirations and achievements, as measured by NELS, and language proficiency, as measured by the decennial census)
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From page 95... ...
95 ~C ~C ~C CO o CD CD CD CD ~ ~c Z Z Z Z _ _ ~ CO oo CO oo CO - 1 00 (D ~ o · 1 ~C ~C o ~ oo .
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From page 96... ...
As Table 3-4 shows, Mexican-origin children in every generation have similar grades and math test scores, although later generations have better reading test scores. Mexican-origin children in every generation also have substantially lower educational achievements than third- and later-generation white children; most of the difference for each generation is explained by lower parental education and family income among the Mexican-origin children (Kao, 1998~.
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From page 97... ...
For seven different activities of this type in 1996, among third- and later-generation white children, the proportion of children with parents engaged in such activities during the past week ranged from 75 to 93 percent; the proportions for children in immigrant families were about the same to no more than 11 percentage points smaller. Among children in immigrant families, the proportions were usually higher for second-generation children than for the first generation, and the proportions tended to be 10 to 15 percentage points lower for Hispanic children than for Asians (Nord and Griffin, 1998~.
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From page 98... ...
98 FROM GENERATION TO GENERATION TABLE 3-4 Descriptive Characteristics of lath Oracle Youth CHINESE Nativeborn of Foreignlmmigrant born Generation Parents FILIPINOS Native born of Native born Immigrant Parents Generation Native- Native born of born of Foreign- Native born born Parents Parents Self-efficacy, or locus of control -0.241 c 0.011 0.073 -0.156 0.011 -0.006 -0.591 -0.567 -0.757 -0.631 -0.553 -0.806 Self-concept -0.115 -0.021 -0.058 -0.043 0.023 -0.33 -0.644 -0.709 -0.659 -0.578 -0.641 -0.561 Alienation, or unpopularity 0.349c 0.283b 0.192 0.207 0.198 0.312 -0~479 -0.453 -0.402 -0.407 -0.4 -0.479 Middle school grade point average 3.356c 3.447c 2.992 3.203b 3.247c 3.013 -0.654 -0.568 -0.957 -0.687 -0.689 -0.74 Math test scores 56.802C 61.363C 53.077 50.736 56.085C 53.651 -9.35 -8.531 -13.564 -9.6 -9.888 -11 .786 Reading test scores 49.480b 58.204C 49.797 49.181 b 54.587a 55.297 -10.1 66 -7.887 -10.538 -9.219 -9.239 -9.983 Parents' education 14.045a 15.944c 14.923 15.426C 15.896C 13.875 -2.758 -3.252 -2.607 -1 .973 -2.214 -1 .147 Family income 3.353c 6.160C 4.708 3.912 5.558a 3.797 (in $10,000) -3.49 -4.481 -4.247 -3.044 -4.165 -1.382 Home language use Non-English language only 0.201 c -0.403 0.111 c 0.038 0.1 39c 0.21 7c 0 -0.316 -0.196 -0.347 -0.414 0
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From page 99... ...
HEALTH STATUS AND ADJUSTMENT 99 MEXICAN OTHERHISPANICS WHITES Native- Native- Native- Native- Native born of born of born of born of born of Foreign- Native- Foreign- Native- Native lmmigrant born born Immigrant born born born Generation Parents Parents Generation Parents Parents Parents -0.282C -0.151 C -0.113C -0.086b _0.049a -0.068b 0.056 -0.619 -0.626 -0.633 -0.62 -0.684 -0.685 -0.605 -0.148b _0.098b -0.025 0.012 0.003 -0.025 -0.016 -0.62 -0.649 -0.663 -0.656 -0.642 -0.683 -0.662 0.288c 0.263c 0.140a 0.219 0.166 0.206 0.17 -0.454 -0.441 -0.348 -0.416 -0.373 -0.405 -0.376 2.707C -0.734 2.760C -0.7 2.743C -0.743 2.853 -0.746 2.796b -0.681 2.803b -0.747 2.959 -0.751 45.393c 45.639c 46.383C 46.970C 48.547c 46.674C 52.547 -8.721 -7.891 -8.903 -10.121 -9.844 -9.103 -9.837 43.420C 45.772c 47.671 C 47.662C 48.484C 47.613C 52.355 -8.59 -8.575 -9.1 93 -9.732 -9.591 -9.658 -9.717 11.200C 11.887C 13.066C 13.512C 14.000b 14.033b 14.546 -2.071 -2.1 65 -1.997 -2.968 -2.984 -2.4 -2.433 1.796c 2.239c 2.773c 2.990c 3.783b 3.290c 4.648 -1.869 -2.037 -2.103 -3.324 -4.008 -2.446 -3.9 0.251 C 0.169C 0.112C 0.187C -0.435 -0.375 -0.315 -0.391 0.218C 0.045C 0.007 -0.414 -0.208 -0.085
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From page 100... ...
Among children in immigrant families, the proportion with parents highly involved in school was 57 percent, although most of the difference between these children and third- and later-generation white children was accounted for by the higher proportion with a moderate level of parental involvement. Parental involvement was greater for the second generation than the first (58 versus 50 percent highly involved)
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From page 101... ...
In parental ratings of children's schools along 10 dimensions, the proportion with favorable or very favorable parental responses was 45 to 67 percent for third- and later-generation white children. The proportions with favorable ratings were 2 to 10 percentage points lower along most dimensions for third- and later-generation blacks and Hispanics.
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From page 102... ...
102 FROM GENERATION TO GENERATION TABLE 3-5 Percent with Parents Reporting Selected Family Eclucational and School Experiences for Chilclren Ages 3 to ~ by Generation and for Thircl- and Later-Generation Chilclren by Race and Ethnicity: 1996 First and Second Generations Characteristic Children First 3-8 Years Total Generation Total (thousands) Family Involvement at Home In the past week, someone in family: 22,959 3,213 430 Taught child letters, words, or numbered93% 92% 86 Taught child songs or musics76 73 68 Took child along while doing errandsa95 91 97 Number of times read to child:b Notatall7 11 13 Once ortwice20 26 34 3 or more times28 25 23 Every day44 37 31 Told child a story77 76 74 Worked on arts and crafts project with child72 65 59 Played a game, sport, or exercised with child92 86 82 Involved child in household chores95 86 83 Worked on a project with child like building, making orfixing somethingC67 56 51 In the past month, someone in the family: Visited the library with child44 38 32 Went to a play, concert, or other live show with the child30 26 21 Visited an art gallery, museum, or historical attraction with child20 20 1' Visited a zoo or aquarium with child17 23 21 Talked with child about family history or ethnic heritage52 55 60 Attended an event with child sponsored by a community, ethnic, or religious group50 41 39 Attended an athletic or sporting event in which child was not a player33 22 1`
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From page 103... ...
HEALTH STATUS AND ADJUSTMENT 103 Third and Later Generations Second Generation Hispanic Asian White Total White Black Hispanic 2,782 1,734 239 83719,74614,166 3,326 1,652 93% 90% 97% 94%94%93% 96% 91% 73 70 72 787676 83 69 90 88 79 999596 94 94 11 14 6 776 8 8 25 32 18 171917 25 24 26 25 25 242928 30 29 38 29 51 514548 37 39 77 71 83 847778 73 79 66 59 74 747375 66 72 87 81 92 949394 92 87 86 84 74 909697 95 92 58 47 59 696870 63 67 38 27 54 514547 40 39 27 21 34 333029 36 27 20 15 24 272019 22 20 23 20 32 261614 23 21 54 52 50 615147 65 54 41 35 38 515152 52 4~ 24 18 19 303536 33 21 (Table continued on next page)
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From page 104... ...
second-generation children and for Hispanic and Asian children in immigrant families (Nord and Griffin, 1998~. Educational Aspirations and School Problems Analyses conducted for the committee based on the National Education Longitudinal Survey of 1988 (Kao, 1998)
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From page 105... ...
It is difficult to assess from the literature whether these higher rates of behavioral problems and learning difficulties that teachers report are due to their misinterpretation of normatively different behavior or the effects of acculturative stresses, such as language difficulties and perceived discrimination at school. It is likely that both of these factors not only are present, but also interact in the school setting.
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From page 106... ...
in Montreal illustrated that the school's perceptions of different immigrant groups may also interact with student motivation to produce worse outcomes for some groups of children than others. In this study, although the school performance of first-generation Southeast Asian and Central American immigrant children did not vary significantly, teachers identified more learning problems in the Central American children.
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From page 107... ...
For children of Mexican origin, parents in immigrant families report fewer acute injuries and poisonings and fewer limitations on major activities than U.S.-born parents in U.S.-born families. First-generation immigrant adolescents also report lower levels of neurological impairment, obesity, and asthma, and fewer health risk behaviors such as early sexual activity; use of cigarettes, alcohol, marijuana, or hard drugs; delinquency; and use of violence.
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From page 108... ...
They are also more likely to exhibit elevated blood lead levels. In addition, parents in immigrant families are, paradoxically, somewhat less likely than those in U.S.-born families to report their child's health as excellent or very good, despite the fact that they report their children to have fewer specific acute and chronic health problems.
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From page 109... ...
Children do not differ systematically along most of these dimensions, with the exception that children in immigrant families are much less likely to be enrolled in early childhood programs or attend Head Start if they are eligible. Children in immigrant families nationally have somewhat higher middle school grade point averages and math test scores than do U.S.-born children in U.S.-born families, although reading test scores among the first generation are lower than for later generations.
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From page 110... ...
110 FROM GENERATION TO GENERATION scores that are similar to each other, but that are much lower than for third- and later-generation white children. Corresponding to the declines in educational aspirations across generations, however, there is evidence that, among Chinese-origin and Filipinoorigin children, the especially strong achievement records of the second generation are not sustained.
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