Journal Issue: Immigrant Children Volume 21 Number 1 Spring 2011
Promoting Physical Well-Being in Immigrant Children
Pre-migration, migration, and post-migration stressors have the potential to harm the well-being of children of immigrants. Yet for a number of health indicators, foreign-born children experience better outcomes than do children in U.S.-born families. Foreign-born immigrant children typically have lower mortality and morbidity risks than both U.S.-born children of immigrants and U.S.-born children of natives within their same racial-ethnic group;29 they have fewer specific acute and chronic health problems; and they have a lower prevalence of accidents and injuries than U.S.-born children.30
Over time and across generations, however, the health advantage of immigrant children fades. In this section, we summarize prevalence data on two key physical health indicators— obesity and asthma. These are two leading childhood health conditions in the United States with increasing prevalence among children of immigrants and long-term consequences for adult well-being. Because of the paucity of research on European and African children of immigrants, this summary focuses on Asian and Hispanic populations. To the extent that data are available, we highlight differences across immigrant generation and country of origin. In general, much of the research on Asian populations focuses either on Southeast Asians such as Vietnamese and Cambodians, Chinese, or Filipinos. Research on Hispanics focuses on Mexicans and Puerto Ricans.
Overweight and Obesity
Over the past three decades, the prevalence of excessive weight among children (aged six to nineteen) has increased from 5–7 percent to 17–18 percent.31 Likely to become overweight adults, overweight children are at increased risk of developing serious health conditions, including diabetes and cardiovascular disease.
Studies comparing foreign-born and U.S.-born adolescents (aged twelve to twenty-six) have found that the share of adolescents who are overweight or obese is lowest for foreign-born youth, but these shares grow larger for each generation and increase rapidly as youth transition into adulthood.32 Among children aged ten to seventeen whose parents or grandparents are immigrants, Hispanics are most at risk of being overweight or obese, whereas non-Hispanic whites and Asians are the least at risk. Among all youth, third- generation blacks have the highest rates of excessive weight (figure 1).33 These findings parallel those identified in studies of younger children (aged five to ten).34 As with adolescents, second-generation Hispanic boys are at greater risk of being overweight or obese than second-generation children of any other racial or ethnic background.
Diet significantly contributes to excessive weight among children and adolescents. As immigrants become more acculturated to U.S. society, they adopt American diets, which typically include greater amounts of fat, processed meats, snack foods, and fast foods than the diets in their countries of origin.35 Although these changes in dietary intake among immigrant adults are well documented, studies among youth are more limited.36 One study using the National Longitudinal Study of Adolescent Health (also known as Add Health) found that foreign-born Hispanic youth aged twelve to eighteen had generally healthier diets than Hispanic youth born in the United States.37 A second study using the 2001 California Health Interview Survey found that Asian and Latino foreign-born youth aged twelve to seventeen drank fewer sodas and ate more fruits and vegetables than non-Hispanic white U.S.-born children.38 But Latinos' fruit and vegetable consumption decreased and their soda consumption increased over time, while Asians' fruit, vegetable, and soda consumption stayed constant. Thus Asian children tended to maintain a lower risk of being overweight or obese than Latino children.
Low levels of physical activity further contribute to overweight and obesity among children. Rates of physical inactivity are high among foreign-born children.39 Eighteen percent of foreign-born immigrant children aged six to seventeen do not get any vigorous exercise in a typical week, and 56 percent do not take part in any team sports or games. By comparison 11 percent of U.S.-born children with U.S.-born parents do not exercise regularly, and 41 percent do not participate in organized sports. Compared with foreign-born Asian children, Hispanic foreign-born children had triple the rates of physical inactivity (22.5 percent to 7.4 percent); two-thirds of the Hispanic children did not participate in sports, compared with slightly more than one-third of the Asian children (66.6 percent to 37.6 percent). Asian children's higher rates of physical activity may also contribute to their reduced risk of obesity. Immigrant families may not be fully aware of the physical and mental health benefits of physical activity, may place a higher value on family or school activities, or may discourage participation in physical activities and sports. Most importantly, the structure of their daily lives (such as parents' work schedules) and their living conditions (neighborhood environments and access to recreational facilities, for example) may limit immigrant children's ability to engage in physical activities.40
In 2008, nearly one of every ten U.S. children up to age seventeen had asthma, a leading chronic childhood disease, and rates of asthma are increasing worldwide. Patterns of asthma prevalence vary considerably by racial and ethnic group, with Asians having the lowest prevalence (4 percent), followed by Hispanics (7 percent), whites (9 percent), and blacks (16 percent).41
Although few studies have disaggregated the prevalence of asthma by country of origin or nativity, evidence suggests that across all racial and ethnic groups the children of immigrants have a lower lifetime prevalence of asthma than native children.42 Among Hispanic groups, Puerto Rican children have one of the highest rates of childhood asthma (19.2 percent in 2007), whereas Mexican children, whether immigrant or not, have one of the lowest rates (6.0 percent in 2008).43 Prevalence rates among Asian children aged two to seventeen vary from 4 percent for Asian Indians, to 5 percent for Chinese, to 11 percent for Filipinos.44
Because a diagnosis of asthma requires a visit to a health care provider, and because immigrants have less access to the health care system than nonimmigrants, rates among these groups may be underreported. Moreover, barriers to accessing health care can contribute to higher rates of hospitalization for asthma and poor asthma management among Hispanic children, immigrants, and other minority groups.45 In a recent study of Hispanic children aged five to twelve in New York City, asthmatic children from Spanish-speaking families were less likely to have an asthma diagnosis than children from English-speaking families but were twice as likely to be hospitalized for asthma (9.4 percent to. 4.4 percent).46 Another study of families in California found that asthmatic children of immigrants aged one to eleven were more likely to lack a usual source of care, report a delay in medical care, and report fair or poor health status than asthmatic children in nonimmigrant families.47