Assimilation and Emerging Health Disparities Among New Generations of U.S. Children

Background: Although children of immigrants are expected to make up one-third of all children by 2050, our knowledge about their health and their health assimilation to U.S. society is limited. It is well-documented that children of immigrants are born with relatively good health compared to their children-of-U.S.-natives counterparts despite significant socioeconomic disadvantage. Known as the epidemiological paradox, this pattern is observed across major immigrant groups in the United States (Frisbie and Song 2003). The purpose of this study was to extend this research by developing a comprehensive account of the health of children of immigrants (first generation) in comparison to second and third-plus generation children in four major U.S. racial/ethnic groups. Methods: Using data from 2007 National Survey of Child Health, we analyzed a sample of 64,509 Hispanic, Asian, black, and white children between the ages of 3-17 (excluded from the analysis were 1,350 children, 1.7%, whose race/ethnicity and 53 children, <1%, whose immigrant generation was missing). Seven, non-rare physical and developmental health measures were examined, including asthma, allergies, developmental problems, ear infections, learning disabilities, headaches, and overweight. Health conditions were reported by the child's parent or caretaker and were based on questions that ask whether these conditions were identified or diagnosed by a doctor or other health care professional, or in the case of learning disabilities, by a teacher or school counselor. Results: For nearly all groups, first generation children from early childhood through adolescence have the lowest prevalence of three health conditions, allergies, developmental problems, and learning disabilities. A less consistent generational pattern is observed for ear infections, headaches, and overweight status, and for Hispanics, the reverse pattern in overweight is observed. By the third-plus generation, black and Hispanic children, groups who are significantly more disadvantaged, have higher rates of nearly all conditions than do white or Asian children. For asthma, the prevalence increases for black children, from about 10% of first generation children to more than 30% in third-plus generation children. For Hispanic children with allergies, the proportion increases from 16.3% for first and 17.3% for second generation to 26.2% for third-plus generation. Multivariate logistic regression models tested the influence of access to and use of health care, socioeconomic status and family structure, parents' and home health, social support, and neighborhood conditions in explaining generational and racial/ethnic differences in each child health outcome. Although these factors play a significant role in predicting health, they do not explain the deterioration in health status across generation. By controlling for health care access and use, we rule out the possibility of under-diagnosis as an explanation for lower rates of health conditions. Obesity is a significant exception: immigrant children have higher rates of obesity compared to subsequent generations. Discussion: A pattern of generational health decline is consistent with several explanations of health assimilation, including, selective migration, protective culture, changing health response and reporting. These explanations have implications for where and how social and public health policy might best be focused to address the health needs of children and disparities between them.