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Journal Issue: Immigrant Children Volume 21 Number 1 Spring 2011

The Physical and Psychological Well-Being of Immigrant Children
Krista M. Perreira India J. Ornelas

Protecting Emotional Well-Being in Immigrant Children

While first- and second-generation children fare well on many aspects of physical well-being, this advantage relative to their native peers does not always translate into good mental health. Immigrant families experience a number of stressors that can affect the psychological well-being of all family members. These stressors affect children's emotional well-being, both directly and indirectly, by hindering parents' capacities to nurture their children's socioemotional development. 48 As examples of how immigration influences children's emotional well-being, we look specifically at patterns of substance use, internalizing behavioral problems such as anxiety and depression, and externalizing behavioral problems such as hyperactivity, aggression, and conduct disorders. According to the U.S. Surgeon General's most recent report on mental health, these are the most common mental health concerns for children and adolescents.49

Substance Use
When they first arrive in the United States, children tend to participate in fewer risky health behaviors than those born in the United States.50 However, risky behaviors among foreign-born children increase with time spent in the country, especially during adolescence. Among these behaviors, patterns of substance use are particularly well documented among foreign-born adolescents aged twelve to seventeen. According to data from the 1999 and 2000 National Household Survey on Drug Abuse (NHSDA), rates of substance use (including cigarette, alcohol, marijuana, and other illicit drug use) were lower among foreign-born adolescents (9 percent for cigarettes, 12 percent for alcohol, and 4 percent for marijuana), in particular those who had been in the United States less than five years, than among U.S.-born adolescents (15 percent for cigarettes, 17 percent for alcohol, and 8 percent for marijuana).51 Prevalence estimates for foreign-born adolescents in the United States for ten or more years were not significantly different from estimates for U.S.-born youths, with one exception. U.S.-born youth had higher rates of heavy alcohol use than foreign-born adolescents.

Several studies examining substance use among Latino adolescents aged twelve to eighteen in Add Health found that second-generation youth were more likely to smoke cigarettes and use alcohol and marijuana than first-generation youth (figure 2).52 U.S.-born Hispanic youth were more likely than foreign-born Hispanic youth to report associating with substance-using peers, and peer substance use was directly associated with increased substance use.53

Few studies have assessed the impact of acculturation on the substance use of Asian children of immigrants. Asian American adolescents tend to have lower rates of smoking, alcohol, and drug use than other racial and ethnic groups. However, despite low rates overall, there are major differences by Asian ethnic group. Pacific Islander adolescents have higher rates of substance use, including alcohol, marijuana, and illicit drug use, compared with youth of other Asian ethnic groups.54 One smaller study of Asian first- and second-generation adolescents aged fourteen and fifteen showed increases in substance use with length of time in the United States and interactions with substance-using peers.55

Depression and Suicide
Although no psychiatric epidemiological studies of children in the United States have been conducted, smaller community-based studies and studies of symptom-level psychopathology indicate that anxiety and depression are the most prevalent conditions affecting the emotional well-being of children. 56 In any given year, approximately 13 percent of children aged nine to seventeen experience symptoms of anxiety and 10–15 percent experience symptoms of depression. In addition, the vast majority of children and adolescents who commit suicide have experienced either anxiety or depression.

Although not conclusive, current research suggests that exposure to culture-related stressors and acculturation to the U.S. mainstream increases the risk of anxiety and depression among children of immigrants. In contrast, adherence to heritage cultures, a sense of belonging to their ethnic groups, and a number of family influences protect the children of immigrants from developing symptoms of anxiety and depression. Thus, mainstream integration may be problematic only when it is not coupled with the retention of one's cultural heritage, ethnic identity, and family strengths.57 For example, one study of Chinese immigrant families found that twelve- to fifteen-year-olds whose levels of acculturation were different from their fathers were more likely to report depressive symptoms.58 But another study of Chinese immigrant families found that a strong sense of family, measured by family obligations, was associated with decreased depressive symptoms among thirteen- to seventeen-year-olds.59 Similarly, data from Add Health suggest that social support from family, friends, and neighbors attenuates the risk of depressive symptoms and enhances the likelihood of positive well-being for all first- and second-generation adolescents aged twelve to eighteen.60 Parental closeness and the absence of parent-child conflict reduce the risk of poor mental health outcomes for second- and third-generation adolescents.

At its most extreme, poor mental health can lead to suicidal ideation and suicide among children of immigrants. Suicide is the third-leading cause of death among all fifteen to twenty-four-year-olds. Although the 2007 Youth Risk Behavior Survey (YRBS) does not contain information on immigrant generation or acculturation, its data indicate that Hispanic students were as likely to have seriously considered suicide in the past year as other racial and ethnic groups but that more Hispanic youth reported making a suicide plan.61 Hispanic youth (both boys and girls) were also more likely to have attempted suicide (10 percent) than non-Hispanic white (5.6 percent) or black (7.7 percent) youth. A study using YRBS data from 1991 to 1997 found that Asian and Pacific Islander youth were less likely than Hispanics and more likely than either non-Hispanic white or non-Hispanic black students to have made at least one suicide attempt.62

Those studies with specific data on immigrant generation or acculturation have found that acculturative stress is positively associated with suicidal ideation among Latino youth.63 In addition, the risk of attempted suicide among Latino adolescents doubles between the first and second generations (see figure 2). Research among Asian immigrant youth is much more limited, but results support acculturative stress theory. Under conditions of high parental-child conflict, less acculturated Asian adolescents report higher levels of suicidal behavior than do more acculturated youth.64

Attention-Deficit/Hyperactivity Disorder
Whereas internalizing behavioral problems such as depression tend to be most prevalent among females, externalizing symptoms associated with hyperactivity and conduct disorders are most prevalent among males.65 Furthermore, rates of attention-deficit/hyperactivity disorder (ADHD) and conduct disorders are increasing among children and adolescents in the United States.

Although no national studies have assessed patterns of ADHD and conduct disorder among immigrant families, the prevalence varies significantly by racial and ethnic group. Data from the 2008 National Health Interview Survey showed that among three- to seventeen-year-olds, Hispanics were roughly half as likely as non-Hispanic whites or blacks to have been diagnosed with ADHD.66 Only Asians reported fewer cases of ADHD than Hispanics, but the data are too imprecise to report. Once again, however, ethnic differences in diagnosed cases may reflect access to regular sources of medical care rather than true differences in prevalence rates. Even after receiving a diagnosis, both Hispanic and Asian children (aged three to eighteen) receive fewer medical care services than non-Hispanic whites.67