Health,Chronic Conditions,and Behavioral Risk Disparities Among U.S. Immigrant Children and Adolescents

Objective

We examined differentials in the prevalence of 23 parent-reported health, chronic condition, and behavioral indicators among 91,532 children of immigrant and U.S.-born parents.

Methods

We used the 2007 National Survey of Children''s Health to estimate health differentials among 10 ethnic-nativity groups. Logistic regression yielded adjusted differentials.

Results

Immigrant children in each racial/ethnic group had a lower prevalence of depression and behavioral problems than native-born children. The prevalence of autism varied from 0.3% among immigrant Asian children to 1.3%–1.4% among native-born non-Hispanic white and Hispanic children. Immigrant children had a lower prevalence of asthma, attention deficit disorder/attention deficit hyperactivity disorder; developmental delay; learning disability; speech, hearing, and sleep problems; school absence; and ≥1 chronic condition than native-born children, with health risks increasing markedly in relation to mother''s duration of residence in the U.S. Immigrant children had a substantially lower exposure to environmental tobacco smoke, with the odds of exposure being 60%–95% lower among immigrant non-Hispanic black, Asian, and Hispanic children compared with native non-Hispanic white children. Obesity prevalence ranged from 7.7% for native-born Asian children to 24.9%–25.1% for immigrant Hispanic and native-born non-Hispanic black children. Immigrant children had higher physical inactivity levels than native-born children; however, inactivity rates declined with each successive generation of immigrants. Immigrant Hispanic children were at increased risk of obesity and sedentary behaviors. Ethnic-nativity differentials in health and behavioral indicators remained marked after covariate adjustment.

Conclusions

Immigrant patterns in child health and health-risk behaviors vary substantially by ethnicity, generational status, and length of time since immigration. Public health programs must target at-risk children of both immigrant and U.S.-born parents.Monitoring the extent and causes of child health disparities among different population subgroups has long represented an important area of public health research and policy in the United States.^1–3 While data on important health, disease, and behavioral risk factors are routinely available by gender, race/ethnicity, and socioeconomic status (SES) in the U.S.,^1–3 such information is generally not categorized according to nativity/immigrant status. The immigrant or foreign-born population in the U.S. has grown considerably in the last four decades. In 2011, there were 40.4 million immigrants, an increase of 30.8 million since 1970.^4–8 Immigrants now account for 13.0% of the total U.S. population.^4,8 The increase in the number of children with foreign-born parents has also been substantial. The number of U.S. children in immigrant families more than doubled in the past two decades, from 8.2 million in 1990 to 17.5 million in 2011.^8,9 In 2011, 24.4% of U.S. children had at least one foreign-born parent.^8,9As the immigrant population continues to grow in numbers and as a share of the total population, there is an increasing need to focus on the health of immigrants. Although reducing social inequalities in health remains the primary focus of Healthy People 2020, this national initiative in health promotion and disease prevention does not include a single policy objective that explicitly targets the health of immigrants in the U.S.^10,11 Moreover, the nation''s premier and most comprehensive annual report on health statistics, “Health, United States,” does not contain any data on the U.S. immigrant population.¹Health, disease, behavioral, and socioeconomic profiles of immigrants differ substantially from those of the U.S.-born.^12–17 There is also evidence that acculturation modifies the health and behavioral risks of immigrants.^13,15–19 The purposes of this study were, therefore, (1) to estimate the prevalence and risks of poor physical and mental health, chronic conditions, and behavioral risk factors (including obesity and physical inactivity) among immigrant and U.S.-born children and adolescents after adjusting for age, gender, race/ethnicity, place of residence, household composition, and SES using a large, nationally representative sample of U.S. children and adolescents; and (2) to examine the extent to which immigrant health, chronic disease, and behavioral patterns vary by ethnicity and level of acculturation.