1. Acculturation and the Health and Well-Being of U.S. Immigrant Adolescents Yu SM, ScD, MPH Huang ZJ, MB, PhD, MPH Schwalberg R, MPH Overpeck MD, DrPH Kogan MD, PhD

2. Background n Nearly 14 million immigrant children in U.S. n Growth of immigrant students in K-12 from 6% in 1970 to 19% in 1997 n IOM report found first generation immigrant adolescents in better health and have lower risk behaviors; but adjustment problems and acculturative stress in LEP population n Language at home is a measure of acculturation

3. Study Objective n To estimate prevalence of health, psychosocial and parental risk factors by race/ethnicity and language groups n To examine association of the degree of acculturation and race/ethnicity and risk factors

4. Methods n 1997-98 WHO Study of Health Behavior in School Children (HBSC) n National representative sample of grades 6-10 in U.S. schools n Black and Hispanic youths oversampled n 83 percent participation rate in 386 schools n Anonymous standardized questionnaires

5. Study Population Total N=15,220 n N-H White=8,915 n N-H Black=2,667 n Hispanic=2,942 n N-H Asian=696

6. Variables n Independent variable ä Language spoken at home n Outcome variables ä Health factors ä Psychosocial school factors ä Parental factors n Control variables ä Gender, maternal education, age

7. Language at Home and Nativity Status Within Race/Ethnicity Groups (Percents) N-H WhiteN-H BlackHispanicAsian Language at Home Only/mostly another language 1.22.526.624.6 Mixed language4.45.445.444.1 Only/mostly English94.492.128.131.3 Nativity U.S. born97.596.780.269.6 Foreign born2.53.319.830.4

8. Odds Ratios of Selected Outcomes Based on Language at Home Among N-H Whites 2.82.1 Bullied at school 2.41.2 (NS) Parents expect too much 2.51.2 (NS) Parents not ready to help 1.6 (NS)1.5 Students do not feel safe at school 2.21.4 (NS) Students in class do not enjoy being together Only other language N=123 Mixed language N=395

9. Odds Ratios of Selected Outcomes Based on Language at Home Among N-H Blacks English N=2,426 Mixed language N=161 Only other language N=65 Stomachache (>=once/week) 2.02.21.2(NS) Not feel confident 2.72.61.3 Parents not ready to help 2.34.11.4 Feel not belong to school 2.8 1.7 Feel helpless 2.63.81.2

10. Odds Ratios of Selected Outcomes Based on Language at Home Among Hispanics English N=795 Mixed language N=1,329 Only other language N=787 Do not always wear bicycle helmet 1.4 (NS)1.62.0 Teachers expect too much 1.2 (NS)1.6 Bullied at school 1.81.51.8 Parents expect too much 1.1 (NS)1.62.1 Not feel confident 1.41.51.8

11. Odds Ratios of Selected Outcomes Based on Language at Home Among Asians English N=190 Mixed language N=332 Only other language N=181 Do not spend any evenings with friends 1.1 (NS)2.71.9 Bullied at school 3.63.54.3 Parents not willing to talk to teacher 0.6 (NS)1.93.6 Difficult to talk to mother 0.61.2(NS)1.9

12. Odds Ratios of Parents Not Ready to Help Among Students Who Speak Only Another Language at Home Reference group=English only N-H White

13. Odds Ratios of Parents Expecting Too Much of Student at School Among Students Who Speak Only Another Language at Home Reference group=English only N-H White

14. Odds Ratios of Parent Not Willing to Talk to Teacher Among Students Who Speak Another Language Reference group=English only N-H White

15. Odds Ratios of Being Bullied at School Among Students Who Speak Another Language Reference group=English only N-H White

16. Odds Ratios of Not Feeling Safe at School Among Students Who Speak Another Language Reference group=English only N-H White

17. Conclusions n Complex interaction among immigration, race/ethnicity, and linguistic assimilation n All non-White youths at higher risk of being bullied n All ‘other language’ youths experience elevated psychosocial and parental risks n Level of acculturation associated with risk in each race/ethnicity

18. Limitations n Underestimate of risk due to in-school population n Absenteeism n Lack of citizenship information n Lack of info. on length of time in U.S.

19. Implications n Risk reduction intervention should be targeted towards new immigrants of all races and ethnic groups n Diversity within race/ethnic group should be recognized n Outreach programs needed for parents of immigrant children