Alcohol use and social interactions among adolescents in Sweden: Do peer effects exist within and/or between the majority population and immigrants?

Are adolescents who attend schools with a high level of alcohol use and binge drinking more likely to use alcohol and binge drink themselves? This paper analyzes peer effects in adolescent drinking based on a survey of 13,070 adolescents conducted in Sweden in 2005. The empirical analysis uses a multi-level logistic model to account for non-observable heterogeneity between the schools and the results show that attending a school with a high level of alcohol use and frequent binge drinking is a strong predictor of alcohol use and binge drinking for the individual. Hardly any significant interaction effects are detected, implying that peer influence is similar across different adolescent sub-groups. Looking at adolescents with different ethnic backgrounds, it is found that the drinking-pattern of the Swedish majority population has a significant effect on drinking by Swedish individuals and immigrants from Nordic and European countries, but no effect on drinking by immigrants from non-European countries.     

Obstetric Outcomes of First- and Second-Generation Pakistani Immigrants: A Comparison Study at a Low-Risk Maternity Ward in Norway

This population-based study compares obstetric outcomes of first- and second-generation Pakistani immigrants and ethnic Norwegians who gave birth at the low-risk maternity ward in Baerum Hospital in Norway from 2006 to 2013. We hypothesized that second-generation Pakistani immigrants are more similar to the ethnic Norwegians because of increased acculturation. Outcome measures were labor onset, epidural analgesia, labor dystocia, episiotomy, vaginal/operative delivery, postpartum hemorrhage, preterm birth, birth weight, transfer to a neonatal intensive care unit, and neonatal jaundice. Compared to first-generation Pakistani immigrants, the second-generation reported more health issues before pregnancy, and they had a higher proportion of preterm births compared to Norwegians. Newborns of first-generation immigrants were more often transferred to a neonatal intensive care compared to Norwegian newborns. Few intergenerational differences in the obstetric outcomes were found between the two generations. A high prevalence of consanguinity in second-generation immigrants suggests the maintenance of a traditional Pakistani marriage pattern.     

East-west health divide and east-west migration: Self-reported health of immigrants from Eastern Europe and the former Soviet Union in Sweden

AIM: Research on the east-west health divide has provided extensive evidence of poorer health in Eastern Europe and the former Soviet Union than in Western Europe. This study focuses on immigrants from Eastern to Western Europe and analyses whether they have an increased risk of self-reported poor health compared with the host population and what determines that. METHODS: This cross-sectional study is based on 373 immigrants from Poland, other East European countries, and the former Soviet Union, aged 25-84, who arrived in Sweden after 1944 and were interviewed during 1993-2000 along with their 35,711 Swedish counterparts. RESULTS: Age- and sex-adjusted unconditional logistic regression showed in general a 92% higher risk of reporting poor health among immigrants than among Swedish-born respondents. The risk also persisted after adjustment for several potential confounders (living singly, having a poor social network, low socioeconomic status, and smoking) and after an additional adjustment for acculturation (language at home), and years in Sweden. CONCLUSIONS: Being born in Eastern Europe or the former Soviet Union was an independent risk factor for reporting poor health. It is therefore suggested that it is important for primary and public care services to be aware of the health status and needs of immigrants from these countries.     

Eating disorders in immigrants: Two case reports

The incidence of eating disorders has been highest among Caucasian American women of middle to upper middle social classes. Observations of anorexia nervosa and bulimia in two Eastern European immigrants to the United States are described. These cases illustrate the influence of immigration and acculturation on the adolescent and highlight their particular vulnerability to acculturation pressures of the new society. The case studies illustrate the complex interaction of individual, familial, and sociocultural factors associated with the development of anorexia nervosa and bulimia in a population not previously considered to be at risk. Consideration is given to the potential susceptibility of female immigrants in the United States to the pervasive messages emphasizing slimness and attractiveness as vehicles to acceptance and success in American culture.     

Influential sources affecting Bangkok adolescent body image perceptions

The study of body image-related problems in non-Western countries is still very limited. Thus, this study aims to identify the main influential sources and show how they affect the body image perceptions of Bangkok adolescents. The researcher recruited 400 Thai male and female adolescents in Bangkok, attending high school to freshmen level, ranging from 16-19 years, to participate in this study. Survey questionnaires were distributed to every student and follow-up interviews conducted with 40 students. The findings showed that there are eight main influential sources respectively ranked from the most influential to the least influential: magazines, television, peer group, familial, fashion trend, the opposite gender, self-realization and health knowledge. Similar to those studies conducted in Western countries, more than half of the total percentage was the influence of mass media and peer groups. Bangkok adolescents also internalized Western ideal beauty through these mass media channels. Alike studies conducted in the West, there was similarities in the process of how these influential sources affect Bangkok adolescent body image perception, with the exception of familial source. In conclusion, taking the approach of identifying the main influential sources and understanding how they affect adolescent body image perceptions can help prevent adolescents from having unhealthy views and taking risky measures toward their bodies. More studies conducted in non-Western countries are needed in order to build a cultural sensitive program, catered to the body image problems occurring in adolescents within that particular society.     

Influence of acculturation on self-perceived oral health among Japanese-Brazilian elderly

Utilizing a qualitative methodology, this study aimed to evaluate the influence of acculturation on the elderly population and self-perception of their oral health. The target population included 40 individuals, divided into two groups: first- and second-generation Japanese immigrants. Through recorded interviews, acculturation level was assessed for each group, as was its influence on attention to oral health and self-evaluation of oral health status and time elapsed since the last dental appointment. Acculturation affected both groups, although to a greater degree in second-generation Japanese-Brazilians. However, it does not interfere in self-perception of oral health by this population. The main individual care with their oral health included brushing, flossing, and soaking dentures in antiseptic solutions. In self-assessed oral health, the main complaints related to wearing dentures, and the time elapsed since the last dental appointment was 1.4 years for the non-edentulous and 6.3 years for the edentulous.     

The Role of Risk and Protective Factors in Substance Use Across Adolescence

PURPOSE: To compare the relative influence of risk and protective factors across several domains on adolescent substance use in a large sample of youth. METHODS: Cross-sectional survey data were collected from students in grades 6, 8, 10, and 12 in Pennsylvania (N = 91,778). Generalized linear mixed models were estimated for each grade level to examine associations among indices of three risk factors (individual, peer, and family) and three protective factors (family, school, and community) and both recent and lifetime substance use. RESULTS: The risk factors were stronger predictors of substance use outcomes compared with the protective factors, regardless of grade level or substance use type. In particular, the individual and peer risk factors were strongly related to lifetime and recent use of cigarettes, alcohol, and marijuana. Among the protective factors, the strongest associations with substance use were found in the community domain. Several age-related differences in the associations were also found, suggesting that family and community factors were more salient among younger adolescents whereas peer and school factors were stronger among older adolescents. CONCLUSIONS: These findings provide support for the social development model (SDM), which proposes that adolescent substance use is associated with factors across multiple spheres of influence. Age-related differences in these associations suggest that effective interventions to reduce adolescent substance use may need to emphasize different domains of risk and protective factors at different stages of adolescent development.     

The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe

BACKGROUND: The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries. METHODS: Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status. RESULTS: In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable. CONCLUSION: The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.     

Trans-cultural comparison of disordered eating in Korean women

OBJECTIVE: The presence of eating disorders in non-Western cultures is often attributed to the export of Western ideals. This study examines this hypothesis by comparing disordered eating attitudes and behaviors in Korean women with differing levels of exposure to Western culture. METHOD: Second-generation Korean-Americans (n=167) and Korean immigrants (n=37) completed the Eating Attitudes Test (EAT-26), and data from native Koreans (n=937) were obtained from a previous epidemiological study, using a Korean-translated version of the EAT-26 (K-EAT-26). Korean-American and immigrant women completed the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA). RESULTS: Korean-American women scored significantly lower on the EAT-26 than Korean immigrants and native Koreans, who did not differ from each other. Korean-Americans were more Western-oriented than Korean immigrants, and acculturation levels were not correlated with EAT-26 scores in either group. CONCLUSION: This study supports the importance of native cultural factors in the development of eating disorders in non-Western contexts.     

Influence of known psychosocial smoking risk factors on Egyptian adolescents' cigarette smoking behavior

The morbidity and mortality associated with cigarette smoking is shifting from the developed world to developing countries, especially developing Arab countries. One such country is Egypt, which has the highest rate of tobacco consumption in the Arab world. To curb the rising smoking epidemic in Egypt, appropriate adolescent smoking prevention programs need to be developed. Most of the effective adolescent smoking prevention programs are based on the social influence approach, which targets the proximal psychosocial variables believed to promote adolescent smoking. However, most of our understanding of adolescents' psychosocial smoking risk factors is based mainly on Western studies. Whether these factors have the same influence on Egyptian adolescents' smoking behavior has not been investigated to date. An understanding of the psychosocial correlates of smoking behavior among Egyptian adolescents may help in designing the appropriate smoking prevention program aimed at this population. This study reports the results of a cross-sectional survey administered to a random sample of 1930 students in grades 7, 9 and 12 in the city of Alexandria, Egypt, in May 2003. Adolescent smoking behavior was positively associated with positive beliefs about smoking, sibling, parent and peer smoking, and social smoking norms, with sibling smoking and perceived adult smoking norms having a stronger influence on adolescents' smoking behavior than peer smoking and perceived peer smoking norms. Refusal self-efficacy was protective against smoking behavior, while knowledge of the short-term negative consequences of smoking was protective against susceptibility to future smoking among females only. The results suggest that adolescents from collective cultures, like Egypt, are more influenced by their family's smoking behavior and perceived adult smoking norms than their peers' smoking behavior and perceived peer smoking norms. Smoking prevention programs aimed at Egyptian adolescents should be accompanied by smoking cessation programs for the family and adult community members.     

Acculturation and drinking patterns among U.S. Anglos, blacks, and Mexican Americans.

The relationship between acculturation, generational status/nativity and drinking patterns is examined using data from a 1988 community survey of 1286 adult regular drinkers (at least two drinks/month) in San Antonio, Texas. This sample includes 412 Anglo, 239 Black, and 635 Mexican American respondents, with Mexican Americans further classified into high, medium, and low acculturation groups using a language-use-based acculturation measure. This data set allows comparisons between racial/ethnic majority and minority groups with further comparisons between Black and Mexican American subgroups. These racial/ethnic and acculturation level comparisons highlight the effects of minority status and cultural differences between groups with regard to drinking patterns. Overall, the analyses indicate little evidence to support an 'acculturation stress' model of alcohol use, wherein the stresses of acculturation produce higher levels of alcohol consumption among moderately or higher acculturation groups. Generally, in our data, quantity and frequency consumption was somewhat higher among the least acculturated males and moderately acculturated females. Further analyses by generational status indicate heavier consumption patterns among second-generation individuals, especially among the less acculturated, though those differences were eliminated by controls. The findings highlight inadequacies of using generational status/nativity measures alone to assess acculturation level. Further, joint effects of acculturation level and generational status suggest the viability of a cultural marginality model of acculturation, though many of the effects of acculturation and generational status are explained by demographic and psychosocial factors.     

Changing patterns of migration to Australia and their influence on the health of migrants

Whilst before World War II migration to Australia was almost entirely from the British Isles, over 60% of post-War II migrants came from other countries other than Britain. They arrived in Australia in distinct waves: Eastern European refugees were followed by migrants from Western Europe, who were later replaced by migrants from the Mediterranean Basin and finally by Asians, initially from the Indian subcontinent, afterwards from Lebanon and most recently from Indo-China. These patterns of migration were changing the numerical size, age distribution and length of residence in Australia of the different ethnic groups. The paper describes the influence of these changes on physical and mental health of the migrants. Physical morbidity was related to 'imported diseases', to the different physical and social environment and to differences and changes in eating and other habits. Psychiatric disorders were associated with traumatic experiences encountered prior to migration, and with stresses of migration and adjustment to the new country. Thus, in evaluating the health of immigrants, one has to take into account the sources from which the migrants were drawn, their situation in the host society, their numerical growth and age distribution, as well as acculturation to the country settlement.     

Measuring acculturation among male Arab immigrants in the United States: an exploratory study

Given the absence of empirical measures that assess acculturation patterns among male Arab immigrants, a new acculturation instrument was developed and evaluated. One hundred and fifteen adult male Arab immigrants were administered the Male Arab Acculturation Scale (MAAS), and psychometrically established measures of ethnic identity and self-esteem. Satisfactory reliability is reported for the two acculturation scales, separation/assimilation and integration/marginalization. Ethnic identity, self-construal, personal self-esteem, and collective self-esteem appear to be differentially associated with acculturation patterns among male Arab immigrants.     

The Impact of Perceived Need and Relational Factors on Mental Health Service Use Among Generations of Asian Americans

The present study examined generational differences in the patterns and predictors of formal and informal mental health service utilization among a nationally representative sample of 1850 Asian Americans from the National Latino and Asian American Study. We focused on the effects of perceived need and relational factors on service utilization among 1st-, 1.5-, and 2nd-generation Asian Americans. Results of hierarchical logistic regression showed significant intergenerational differences. Specifically, 1.5-generation Asian Americans exhibited distinctive pattern of service use, with perceived need being associated with a higher likelihood of using formal mental health services, but only for those with high level of social support. First- and second-generation Asian Americans, on the other hand, perceived need was independently associated with formal service use, and a significant predictor of informal service use for first generation. Greater family conflict was also associated with greater use of formal and informal services for both first- and second generations. However, family cohesion was associated with only informal service use among first -generation Asian Americans. Implications for mental health service policy were discussed.     

Socio-demographic Differences in Acculturation and Mental Health for a Sample of 2nd Generation/Early Immigrant Arab Americans

This study examined socio-demographic differences in acculturation patterns among early immigrant and second-generation Arab Americans, using data from 120 participants who completed a Web-based study. Although sex, age, education, and income did not significantly relate to the acculturation process, respondents who were female and those who were married reported greater Arab ethnic identity and religiosity. Striking differences were found based on religious affiliation. Christian patterns of acculturation and mental health were consistent with acculturation theory. For Muslims, however, integration was not associated with better mental health, and religiosity was predictive of better family functioning and less depression. The results of this study suggest unique acculturation patterns for Christian and Muslim subgroups that can better inform future research and mental health service.     

Acculturation and overweight-related behaviors among Hispanic immigrants to the US: the National Longitudinal Study of Adolescent Health

Little is known about the factors underlying the striking increase in overweight occurring between first and second generation US immigrants. Using data from the National Longitudinal Study of Adolescent Health, this study addressed two goals. First, we determined which measures of acculturation (defined as the acquisition of dominant cultural norms by members of a non-dominant group) were important. Second, we determined how the acculturation process affected differences in overweight and its proximate determinants (e.g., physical activity, diet, and smoking) as immigrants acculturated to American society. In addition, we sought to elucidate the role of underlying structural factors (e.g., family income and crime) and acculturation factors (e.g., language spoken at home and proportion of foreign-born neighbors) in generation differences in overweight. Results showed clear structural and acculturation differences between foreign and US-born immigrants to the US. Foreign-born immigrants were more likely to have lower family income and maternal education, and to live in areas of higher immigrant density and greater linguistic isolation. In addition, results suggested rapid acculturation of overweight-related behaviors, such as diet, smoking, and inactivity, in US-born relative to foreign-born immigrants. Multivariate analysis indicated that longer US residence was associated with increased overweight among Puerto Ricans and Cubans. Predicted probabilities showed that controlling for acculturation and proximate factors increased overweight among foreign-born adolescents, but had minimal impact for US-born adolescents. Thus, without the beneficial pattern of: acculturation factors, diet, and physical activity, first generation Hispanic adolescents would have higher overweight prevalence. We found important generation differences in structural, acculturation, and proximate overweight determinants. These lifestyle differences between foreign- and US-born Hispanic adolescent immigrants are likely to underlie the striking increase in overweight prevalence between first and subsequent generation of US residence.     

Limited Socioeconomic Opportunities and Latina Teen Childbearing: A Qualitative Study of Family and Structural Factors Affecting Future Expectations

The decrease in adolescent birth rates in the United States has been slower among Latinas than among other ethnic/racial groups. Limited research has explored how socioeconomic opportunities influence childbearing among Latina adolescents. We conducted in-depth interviews with 65 pregnant foreign- and US-born Latina women (31 adolescents; 34 adults) in two California counties. We assessed perceived socioeconomic opportunities and examined how family, immigration and acculturation affected the relationships between socioeconomic opportunities and adolescent childbearing. Compared with women who delayed childbearing into adulthood, pregnant adolescents described having few resources for educational and career development and experiencing numerous socioeconomic and social barriers to achieving their goals. Socioeconomic instability and policies limiting access to education influenced childbearing for immigrant adolescents. In contrast, family disintegration tied to poverty figured prominently in US-born adolescents’ childbearing. Limited socioeconomic opportunities may play a large role in persistently high pregnancy rates among Latina adolescents.     

Variation in Sexual Behaviors in a Cohort of Adolescent Females: The Role of Personal,Perceived Peer,and Perceived Family Attitudes

PurposeLittle is known about how adolescent sexual behaviors develop and the influence of personal or perceived social attitudes. We sought to describe how personal, perceived peer, and perceived family attitudes toward adolescent sexual activity influence sexual behaviors of adolescent females' over time.MethodsBetween the years of 1999 and 2006, 358 English-speaking female adolescents, aged 14–17 years, were recruited from three urban adolescent clinics. Participants completed quarterly and annual questionnaires over a span of 4 years. Primary outcomes included engagement in any of the following eight sexual behaviors: kissing, having breasts touched, having genitals touched, touching partners' genitals, oral giving, oral receiving, anal, or vaginal sex. Three attitudinal scales assessed personal importance of abstinence, perceived peer beliefs about when to have sex, and perceived family beliefs that adolescent sex is negative. We used generalized estimating equations to identify predictors of each sexual behavior and compared whether personal, perceived peer, or perceived family attitudes predicted sexual behaviors over time.ResultsThe odds of reporting each sexual behavior increased with age but were lower among those whose personal or perceived family attitudes were less positive. Participants' personal attitudes toward adolescent sex were the strongest predictor of engagement in all eight sexual behaviors even after controlling for perceived peer and perceived family attitudes.ConclusionsFemale adolescent's personal attitudes toward abstinence appear to be the strongest predictor of engagement in a variety of sexual behaviors. Efforts to influence adolescent attitudes toward abstinence may be an important approach to reducing sexual behaviors that increase the risk of pregnancy and sexually transmitted infections.     

Revisiting the immigrant paradox in reproductive health: the roles of duration of residence and ethnicity

The immigrant paradox refers to the contrasting observations that immigrants usually experience similar or better health outcomes than the native-born population despite socioeconomic disadvantage and barriers to health care use. This paradox, however, has not been examined simultaneously in relation to varying degrees of exposure to the receiving society and across multiple outcomes and risk factors. To advance knowledge on these issues, we analysed data of the Maternity Experiences Survey, a nationally representative cross-sectional survey of 6421 Canadian women who delivered singleton infants in 2006-07. We compared the prevalence of adverse pregnancy outcomes and related risk factors according to women's ethnicity and time since migration to Canada. We calculated prevalences and prevalence ratios (PR) with 95% confidence intervals. Compared to Canadian-born women of European descent, recent immigrants were at lower risk of preterm delivery and morbidity during pregnancy despite having the highest prevalence of low income and low support during pregnancy among all groups, but the paradox was not observed among immigrants with a longer stay in Canada. In contrast, recent immigrants were at higher risk of postpartum depression. Immigrants of non-European origin also had higher prevalence of postpartum depression, irrespective of their length of residence in Canada, but immigrants from European-origin countries did not. Exposure to Canada was also positively associated with higher alcohol and tobacco consumption and body mass index. Canadian-born women of non-European descent were at higher risk of preterm birth and hospitalisation during pregnancy than their European-origin counterparts. Our findings suggest that the healthy migrant hypothesis and the immigrant paradox have limited generalisability. These hypotheses may be better conceptualised as outcome-specific and dependent on immigrants' ethnicity and length of stay in the receiving country.     

Preventing Adolescent Pregnancy: Biological,Social, Cultural,and Political Influences on Age at First Sexual Intercourse

Age at first sexual intercourse (AFSI) is the initial factor related to adolescents’ sexual life that may increase the risk of adolescent pregnancy. We explored the biological, social, cultural, and political predictors of AFSI addressing several gaps that prevent us from generalizing the results of past research to adolescent pregnancy prevention. We also explored the moderating effects of cultural variables on the links between social and political predictors and AFSI. Our sample consisted of 889 Portuguese female adolescents aged 12–19. Earlier age at menarche, non-intact family structure, maternal history of adolescent pregnancy, lower maternal emotional warmth, absence of religious involvement, and living in Portugal’s mainland and in a legal context penalizing abortion predicted earlier AFSI. School attendance predicted earlier AFSI among adolescents of European ethnic origin; adolescents of non-European ethnic origin presented the opposite, but non-significant, pattern. These findings suggest that, in addition to isolated characteristics, factors from different ecological contexts should be considered when planning interventions designed to foster healthy and informed transitions to sexual initiation and prevent the related risks of unwanted outcomes. We discuss implications for future research and practice.