A Social Determinants Analysis of Southeast Asian Adolescents' Behavioral Health

Background and Purpose: Inequities in health are well-documented, with research indicating that racial/ethnic minority status and socioeconomic disadvantage contribute to disproportionate rates of morbidity and mortality in the U.S. (Kawachi, et al., 2008). In response to health inequities, the WHO and other public health entities have called attention to the social determinants of health (SDOH), referring to the social, economic, and environmental conditions that shape structures at individual, family, community, and societal levels to affect the health of individuals and populations (Viner et al., 2012). The U.S. Surgeon General’s Healthy People 2020 initiative provides a conceptual framework highlighting five key SDOH areas: economic stability, education, social and community context, health and health care, and neighborhood and built environment.

While SDOH research exists on adults and to some extent young children, less research attends to modifiable SDOH affecting the health of adolescents. Nonetheless, adolescence is a critical developmental period that affects health behaviors and outcomes that emerge in adulthood.

This study examines the association between SDOH indicators and behavioral health outcomes for Vietnamese and Cambodian American adolescents. Compared to more established Asian immigrant communities, Vietnamese and Cambodian American families are more likely to be characterized by recent migration as refugees and pre-migration trauma, and have faced greater constraints to social and economic mobility (Choi et al., 2008).

Using data reported from adolescents and their mothers, the aims of the current study are to: (a) describe the prevalence of characteristics within Healthy People 2020’s five key SDOH areas, (b) examine the association between SDOH indicators and adolescent depression, problem behaviors, and substance use.   

Methods:

Data/sample: Data come from the final wave of a 5-year longitudinal study of Vietnamese and Cambodian mothers and their adolescent children (n=285). Participants were divided evenly by ethnicity. Among adolescents, 53% were female and 60% were U.S.-born, with an average age of 16.20 (SD=1.22). All mothers had migrated from Vietnam or Cambodia. Their mean age was 46 (SD=7.7) and mean years in the U.S. was 17.39 (SD=5.28).

Measures: Adolescent outcomes included measures assessing depression, problem behaviors, and substance use (alcohol and cigarette use). SDOH indicators included mother-reported personal and family characteristics (age, years in U.S., number of people in household, marital status), employment status/occupation, education level, health status and health insurance status, ethnic social capital, and neighborhood safety.

Analysis: Descriptive statistics described all measures. Multiple and logistic regression analyses examined the associations between SDOH indicators and adolescent outcomes; all analyses controlled for adolescent gender, ethnicity, age, and nativity status.

Results: After controlling for child demographics, mothers’ education level and employment status/occupation were significantly associated with adolescents’ behavioral health and substance use. Mothers’ age, marital status, and years in the U.S. predicted several adolescent outcomes. Finally, mothers’ health status was associated with adolescents’ depression while lack of health insurance was inversely associated with adolescents’ cigarette use.

Implications: Understanding the SDOH can inform policies that positively influence the social and economic conditions that support the health of adolescents and inform effective intervention and prevention efforts in diverse populations.