Comparison between non-immigrant and 2nd generation immigrant youth: Self-Reported Health Status,BMI,and Internal and External Resources

Abstract

Increasingly evidence suggests that the self-reported health status (SRH) of 2nd generation immigrant youth (native-born youth with at least one parent who was born abroad) may be lower than non-immigrant youth. This cross-sectional study compared the SRH of 2nd generation immigrant to non-immigrant youth (n = 291), accounting for confounders including a clinical measure (i.e., body mass index), internal resources (i.e., diet, exercise, smoking), and external resources (i.e., socioeconomic status, family social support). Regressions showed SRH was associated with socioeconomic status (p < .05), family social support (p < .05) and exercise (p < .05) but not immigrant status. Yet, bivariate analyses, showed that among youth, 2nd generation immigrants had poorer diets (p < .01), were smokers (p < .0001), had lower socioeconomic status (p < .05) and less family social support (p < .05). Thus, although SRH did not differ by immigration status among youth, the differences in internal and external resources by immigrant status may lead to health differences in the future.

Keywords

acculturation health socioeconomic status/social class

Introduction

Increasing globalization has resulted in large populations of immigrants and children of immigrants. Questions persist on whether immigrants and children of immigrants have better or poorer health than native-born populations. Adding to the confusion was that not so long ago, studies compared groups of non-immigrant to immigrant youth without specifying whether both the youth and parents were foreign-born or only the parents were foreign-born (Flores & Brotanek, 2005; Kwak & Rudmin, 2014; Singh et al., 2013). Recent studies have begun teasing apart findings on immigrant youth by comparing native-born youth living in families with at least one immigrant parent (i.e., 2nd generation immigrants) compared to native-born youth living in families with non-immigrant parents (i.e., non-immigrants) (Borraccino et al., 2018; Singh et al., 2009). Although some findings suggest that 2nd generation immigrant youth have better or similar levels of health and well-being compared to non-immigrant youth (Nesterko et al., 2019), others have found that 2nd generation immigrant, compared to non-immigrant, youth have lower life satisfaction (Borraccino et al., 2018), more mental and physical health problems (Borraccino et al., 2018; Ceri et al., 2017), and lower self-reported health (SRH; de Grande et al., 2014). Thus, research results of comparisons between 2nd generation immigrant and non-immigrant youth’s health and well-being have been inconsistent.

Conversely, researchers have consistently noted health disparities between 1st generation immigrant youth (i.e., both youth and parents born abroad) and non-immigrant youth, and these disparities were attributed to the lack of resources and increased stresses that 1st generation immigrants experience while adapting to a new country (Berry, 1997). Second generation immigrant also may lack the resources possessed by non-immigrant youth, and this lack of resources also may be related to differences in health status between the two groups of youth (Borraccino et al., 2018; Kotwal, 2010; Nesterko et al., 2019); but, this topic has not yet been studied in a systematic way.

Self-Reported Health

Self-reported health (SRH), a single-item question with five categorical options, is a reliable measure of health status for different ethnic and immigration populations (Allen et al., 2016) and for men and women (Haas & Fosse, 2008). Due to the lack of variability in health status for an apparently healthy adolescent populations, researchers dichotomized SRH responses into “excellent” versus not (George & Bassani, 2013; Gooding et al., 2014; Segura-Jiménez et al., 2015; Zlotnick et al., 2017). SRH demonstrates positive relationships with protective health factors such as physical activity (Breidablik et al., 2008; Granger et al., 2017; Novak et al., 2017), and negative relationships with risk factors such as overweight (Breidablik et al., 2008; Novak et al., 2017).

Clinical Health Indicator—Body Mass Index

Accordingly, SRH is negatively related to body mass index (BMI; Novak et al., 2017). Due to the worldwide epidemic in obesity in youth and children, BMI is among the most important health indicators of adolescents (World Health Organization, 2016). Some researchers found that the BMI of immigrants was similar to non-immigrant for all generations (Singh et al., 2013), while others found immigrant youth had lower BMIs than non-immigrant youth (Wahi et al., 2014). Research findings on differences in BMI by immigrant generation were similarly inconsistent. Some researchers found that the BMI of 1st generation immigrant youth was higher than the 2nd generation immigrant youth (Quon et al., 2012), but others found the inverse, that BMI increased from the 1st generation to the 2nd generation immigrant youth due to the 2nd generation immigrant youth’s adaptation to the host country’s diet of high fat and processed foods diet (Perreira & Ornelas, 2011; Sonneville et al., 2015).

Internal and External Resources

Internal resources are those characteristics and qualities unique to the youth such as strong ethnic self-identity, and external resources are those characteristics and situations in the youth’s environment such as socioeconomic status. An important internal resource of possessing a strong sense of ethnic self-identity is a protective health factor indicating a social connection that buffers the stress of immigrant youth who straddle two nationalities—the birth country of their parents and their current host country (Clauss-Ehlers et al., 2006). Immigrant youth who possessed a stronger sense of ethnic self-identity were more resilient, had higher self-esteem and reported lower levels of depression (Costigan et al., 2010).

Other internal resources, such as health behaviors, also may be linked to health status. Investigations on dietary habits noted that immigrants reported more fast food consumption and lower vegetable consumption than non-immigrants (Meroc et al., 2019). Moreover, 1st and 2nd generation immigrant youth were less likely to engage in physical exercise compared to non-immigrant youth (Meroc et al., 2019; Perreira & Ornelas, 2011; Singh et al., 2013).

The health behavior of smoking also has been examined, but comparisons between immigrant and non-immigrant youth have revealed inconsistent findings. While some countries noted that 1st and 2nd generation immigrant youth were less likely to smoke than non-immigrant youth (Meroc et al., 2019), other investigators found smoking was far more prevalent in immigrant youth (Kahan-Strawczynski et al., 2012; Zlotnick et al., 2018). These inconsistencies may be related to the prevalence of smoking in the country of origin compared to the host country

Not all variables associated with health status stem from the internal resources of youth. The family context (external resources) also influences health. The most notable external resources related to health and well-being for youth, including immigrant youth, are socioeconomic status (SES) and family social support (Runarsdottir & Vilhjalmsson, 2015). Social support’s protective effects for higher levels of somatic and mental health symptoms were noteworthy for both 1st and 2nd generation immigrants and persisted over time (Sirin et al., 2013). Health status inequalities related to SES, noted in early childhood, persisted to late adolescence for children in most high-, middle- and low-income countries studied (van Zwieten et al., 2018). Higher SES was related to better dietary habits and was more common among non-immigrants than 1st or 2nd generation immigrants (Rouche et al., 2019). This literature reflects the well-established impact of internal and external resources on SRH.

Demographic Characteristics

Certain demographic characteristics also appear to be related to health status. Gender is related to differences in health status for immigrant youth (Frisco et al., 2016; Zlotnick et al., 2017). Health status in immigrant youth may be linked to the parents’ birth country. In studies examining immigrants from several countries, more health concerns were reported by 2nd generation immigrant youth whose parents came from Eastern European countries (Borraccino et al., 2018; de Grande et al., 2014).

Between 1987 and 1991, almost 140,000 citizens immigrated to Israel from Russian-speaking countries of the former Union of Soviet Socialist Republics (FSU; Chudinovskikh & Denisenko, 2017). In 2010, 21,000 2nd generation immigrant youth ages 12 to 17 years from the FSU exhibited at-risk behaviors and reported feeling detached from Israeli society (Kahan-Strawczynski et al., 2012). The current study recruited immigrant and non-immigrant youth who completed high school and were about to enter mandatory military service. All 2nd generation immigrant youth had at least one parent from the FSU. The study objective was to compare the SRH of 2nd generation immigrant youth to non-immigrant youth. We hypothesized that: (1) non-immigrant youth would report lower BMIs and more internal and external resources than 2nd generation immigrant youth; and (2) more non-immigrant compared to 2nd generation immigrant youth would report excellent health status, after adjusting for the potential confounders including the clinical indicator of BMI, and internal and external resources.

Methods

Participants and Procedure

Using social media, such as Facebook and other online sources targeting youth about to enter the Israel Defense Forces (IDF), the study recruited youth age 18 or above who were within 6 months of entering the IDF. A link was posted on several online sites with a description of the study, consenting procedure, contact information to enable follow-up interviews, the questionnaire, and a website link to obtain a 50-shekel gift certificate (equivalent to approximately $14) upon completion of the questionnaire. Since the study was a two-wave longitudinal study, email addresses were retained to enable contact for the second wave questionnaire. Based on the birthplace of the parents and youth, the completed surveys (n = 307) were categorized as from either non-immigrant youth (n = 215), 2nd generation immigrant youth (n = 76) or 1st generation immigrant youth (n = 16). This study reports on the cross-sectional data (n = 291) obtained from non-immigrant and 2nd generation immigrant youth who had at least one parent from the FSU.

Measures

The questionnaire required approximately 25 min to complete and contained questions on: demographic characteristics, internal and external resources, and health status. Demographic characteristics included gender, month and year of birth, place of birth, place of mother’s birth, and place of father’s birth.

External resources included socioeconomic status (SES) and family social support. For SES, youth responded to the question “how would you define your family’s economic status?” via a five-point Likert scale. The four categories of SES were collapsed into three categories, good/very good, average and not good/poor. The Perceived Social Support from Family (PSS-FA) uses a 20-item scale with a yes or no response (Procidano & Heller, 1983). The Cronbach alpha assessing internal consistency for this scale in the study sample was 0.811.

BMI for youth were calculated in two steps: (1) using the standard BMI equation of ([weight in kg]/[height in meters]²), and (2) applying these values to standard curves based on gender and age for adolescents to determine whether the BMI was within normal limits or not (National Center for Health Statistics, 2010a, 2010b).

Internal resources included ethnic self-identity, body mass index (BMI), dietary habits, exercise, and being a current smoker. Ethnic self-identity was measured by the Multigroup Ethnic Identity Measure (MEIM), a 12-item scale with a 4-point Likert scale developed measuring the total score, the element of the exploration or search for ethnic identity, and the affirmation/belonging (Phinney, 1992). The Cronbach alphas assessing internal consistency for the total scale, exploration and affirmation in the study sample were 0.884, 0.821, and 0.804, respectively.

Internal resources also included the following dietary habits: fruits, vegetables, sweets, soft drinks such as colas, and fast foods such as pizza and hamburgers. All five dietary habits were ranked on the identical six-category frequency of consumption (i.e., every day more than once, once per day, 5–6 times per week, 2–4 times per week, once a week, less than once per week). To identify groupings or clusters of dietary habits among youth, cluster analysis was conducted using SPSS (version 25) of K-means clustering with the a priori determination of three groups. The a priori number of groups was decided based on the frequent a three-category ranking of dietary habits suggested by authors examining youth dietary habits (de Oliveira Figueiredo et al., 2019). The process of K-means clustering consists of calculating the centroid of each group and then conducting an iterative process that minimizes the sum of squares using Euclidean distance; this results in placing each observation within the group possessing the smallest distance to the centroid (Clatworthy et al., 2005). The resulting three dietary clusters were high fruits/vegetables, high sugary drinks/processed foods, and light eaters (see Figure 1). The first cluster contained youth consuming diets with high levels of sugar and fast foods, the second contained those consuming high levels of fruit and vegetables, and the third cluster contained those who were “light eaters” meaning they consumed very little overall.

Figure 1.

Adolescents (n = 291) in clusters based on dietary habits.

Youth reported their exercise via the question “how many hours did you engage in physical activity over the last week?” The five possible responses were: never, up to an hour, 1 to 2 hr, 2.5 to 4 hr, and more than 4 hr. Due to the distribution, this variable was categorized into an ordinal three-level variable: never, 1 to 4 hr per week, more than 4 hr per week. The question on current smoking received either a yes or no response.

The four-category health status question required that youth rank their health at the current time as excellent, good, okay, or not good. Health status was categorized as excellent versus not due to the generally healthy nature of the sample.

Analyses

Data were analyzed using SPSS® Version 25. Imputed values were calculated using the Monte Carlo Markov Chain (MCMC) method for variables with fewer than 6% missing (Schafer & Olsen, 1998; Yuan, 2011). Comparisons between groups were made using Chi-square Test for Independent for categorical variables and Independent Student t-Tests for continuous variables. Cluster analyses (see Figure 1) were used to identify relatively homogeneous groups of youth based on the five dietary habits of: fruits, fast food, vegetables, sugary drinks, and sweets. Multivariable logistic regression models were used to examine the association between the dependent dichotomous variable of excellent health status versus not. Variables were entered in three blocks: (1) independent variable of interest—2nd generation immigrant versus non-immigrant and the demographic variable of gender; (2) external resources: SES and family social support; (3) and BMI and internal resources: ethnic self-identity, dietary clusters, exercise. Significance was declared at p < .05.

Results

Of the total study sample (n = 291), more than two-thirds were women (see Table 1). External resources included SES and family social support. SES was ranked as good/very good by almost two-thirds, as average by about a third and not good or poor by less than a tenth. Family social support averaged a score of 14.0 (SD = 5.28).

Table 1.

Demographic Characteristics of Youth by Immigrant Status after Imputation (n = 291).

	Second generation immigrants(n = 76)	Non-immigrants(n = 215)	Total(n = 291)
	Percent	Percent	Percent
Demographic characteristics
Gender-girl	69.7	70.7	70.4
External resources
Socioeconomic Status *
• Good/very good	53.3	66.0	62.8
• Average	37.3	27.4	30.0
• Not good/poor	9.3	6.5	7.2
Family social support (Mean, SD)*	12.8 (5.69)	14.4 (5.04)	14.0 (5.28)
Internal resources
Total score of Multi-group ethnic identity measure (MEIM)—Ethnic self-identity (Mean, SD)*	38.5 (7.56)	35.8 (8.18)	36.4 (8.10)
• MEIM—Identity affirmation (Mean, SD)	14.7 (3.18)	14.4 (2.98)	14.4 (3.09)
• MEIM—Identity exploration (Mean, SD)**	19.4 (4.11)	17.3 (4.79)	17.8 (4.65)
Body Mass Index - Normal	76.7	77.7	77.4
Dietary clusters**
• Multiple daily servings of fruits/vegetables	29.3	43.1	39.4
• Multiple daily consumption of sugary drinks/processed foods	17.3	24.9	22.9
• Light eaters	53.3	32.1	37.7
Exercise past week
• >4 hours	10.6	13.0	12.4
• 1–4 hours	58.8	59.1	59.0
• None	30.5	27.9	28.6
Current smoker ****	45.9	35.5	38.1
Dependent variable
Health status—excellent	52.6	46.0	47.8

p<0.05, ** p<0.01,***p<0.001, ****p<0.0001

BMI and internal resources included the ethnic self-identity measure (MEIM) scores, dietary clusters, exercise and smoking. More than three-quarters had a normal BMI. The mean total MEIM—Ethnic self-identity score was 36.4 (SD = 8.10), the identity affirmation was 14.4 (SD = 3.09) and identity exploration was 17.8 (SD = 4.65). Dietary clusters indicated that more than a third reported diets with multiple daily servings of fruit and vegetables, another third were light eaters, and the remaining had diets with high levels of daily consumption of sugary drinks and processed foods. Exercise of greater than 4 hr was reported by about a tenth, more than half exercised between 1 and 4 hr, and about a quarter reported no weekly exercise. More than a third were current smokers, and almost half reported excellent health status.

Of the sample, about a quarter (n = 76) were 2nd generation immigrant youth and the remaining were non-immigrants. Groups did not differ by gender; however, significant differences between groups were found in both external resources. A larger proportion of 2nd generation immigrant youth, compared to non-immigrant youth, ranked their SES as not good/poor (p < .05). Significantly higher family social support was reported by non-immigrant youth, compared to 2nd generation immigrant youth (p < .05).

Differences between groups also were found in internal sources. The mean total MEIM score and MEIM-identity exploration were significantly higher overall in the 2nd generation youth (p < .05, p < .01, respectively). Dietary clusters differed by group with larger proportions of non-immigrant youth reporting multiple daily servings of fruits/vegetables and more 2nd generation youth reporting being light eaters (p < .01). A greater proportion of 2nd generation immigrant versus non-immigrant youth reported being current smokers (p < .0001). No significant differences were found in BMI or excellent health status.

Logistic regression models with the dependent variable of excellent health versus not were examined via the three blocks of demographic characteristics (including immigrant status), internal resources and external resources (see Table 2). The first block of variables, 2nd generation immigrant versus non-immigrant and gender, was added; but neither variable was significant. To the first block of variables, the second block of variables comprising external resources (i.e., SES and family social support) was added. Findings showed that the first block of variables remained insignificant; however, from the second block of variables, youth with average SES (OR = 0.49, CI = 0.28–0.84, p < .01) or less than average SES (OR = 0.40, CI = 0.13–0.99, p < .05), compared to high SES, were less likely to have excellent health status. Youth with greater family social support compared to less (1.06, CI = 1.01–1.11, p < .05) were more likely to report excellent health status. The third block of variables containing BMI and internal resources (i.e., ethnic identity, dietary clusters, exercise) was added. Findings showed that the variables of the first block remained insignificant, the second block of external resources demonstrated the same associations as before, youth with average (OR = 0.50, CI = 0.29–0.88, p < .05) or less than average SES (OR = 0.35, CI = 0.12–0.99, p < .05), compared to above average income, were less likely to have excellent health status, and youth with greater family social support (1.06, CI = 1.01–1.11, p < .05), compared to less, were more likely to report excellent health status. Of BMI and the internal resources, only exercise demonstrated a significant relationship to excellent health status, such that those who did not exercise at all (0.32, CI = 0.13–0.79, p < .05), compared to those who exercised more than 4 hr weekly, were less likely to report excellent health status.

Table 2.

Logistic Regression Predicting Excellent Health Status among 2nd Generation and Non-Immigrant Youth, with Odds Ratios (OR) and 95% Confidence Intervals (CI).

	Model 1		Model 2		Model 3
	OR	CI	OR	CI	OR	CI
Demographic characteristics
2nd generation immigrant	0.79	0.46–1.35	0.65	0.37–1.15	0.34	0.34–1.09
Gender - Male	0.99	0.59–1.66	1.13	0.66–1.95	0.96	0.54–1.71
External resources
Socioeconomic – >Average (ref)
<Average			0.40*	0.13–0.99	0.35*	0.12–0.99
Average			0.49**	0.28–0.84	0.50*	0.29–0.88
Family social support			1.06*	1.01–1.11	1.06*	1.01–1.11
Clinical indicator
Body mass index (Normal)					1.44	0.78–2.65
Internal resources
Ethnic self-identity					1.00	0.97–1.04
Dietary cluster-Light eaters (ref)
High fruit and vegetable intake					0.55	0.27–1.09
High sugar and processed foods					0.55	0.27–1.12
Exercise - >4 hr (ref)
1–4 hr					0.48	0.22–1.07
Not at all					0.32*	0.13–0.79
Current smoker					0.72	0.31–1.66
–2 Log Likelihood	377.35		368.68		357.32

p < 0.5, **p < .01, ***p < .001.

Discussion

Findings did not support the study’s hypothesis that more non-immigrant, compared to 2nd generation immigrant, youth would report excellent health status after adjusting for confounders (Hypothesis #2), although consistent with the literature, many external and internal resources were associated with excellent health status. Study results, however, did show that non-immigrant compared to 2nd generation immigrant youth possessed more external resources (i.e., higher socioeconomic status and more family social support), and more internal resources (i.e., better dietary behaviors and tended to be non-smokers) (Hypothesis #1).

Health Status Comparison between 2nd Generation Immigrant Youth and Non-Immigrants

Immigrant status was not associated to health status after adjusting for BMI, and internal and external variables. This finding is based on analyses using measures known for their validity and reliability, and a study with sufficient sample size to detect a difference if one existed (Type II error). That is, the categorical dependent variable of self-reported health status demonstrated concurrent validity with mental health measures (i.e., negative associations with depression) and physical health measures (i.e., functional limitations and chronic health conditions) for adolescents and young adults, including 1st and 2nd generation immigrant and non-immigrant youth (Allen et al., 2016). Moreover, this study possessed at least 90% statistical power using the criteria that the probability of a Type I error <.05 and the alternative hypothesis of 50%, and assuming a 15% r-squared for other independent variables.

There is the possibility that no significant difference in health status between 2nd generation immigrant and non-immigrant youth was found could be due to the sample selection of 2nd generation immigrant youth. In this study, the convenience sample of 2nd generation immigrant youth had parents born in the FSU. It is important to note that several researchers, who compared 2nd generation immigrant youth from Eastern European, certain parts of Asia and north Africa countries to non-immigrant youth, also found that the 2nd generation immigrant youth reported more distress, less well-being or poorer health compared to non-immigrant youth (Borraccino et al., 2018; de Grande et al., 2014). These findings were disputed by other researchers with studies containing samples of 2nd generation immigrant youth from these same countries who found no significant difference in health status (Nesterko et al., 2019).

A potential explanation for these inconsistent findings may be that health status is linked to both the country of parents’ origin and the host country. This possibility is consistent with theoretical depiction of acculturation as a two-part process comprising both the shedding of values and habits of one country, and also the acquisition of values and habits of another (Berry et al., 2006). This second aspect of acculturation focuses on the post-immigration context including the host country and family. Acculturation to the host country may be more difficult when there are dramatic differences in lifestyle conveniences, multiple food choices and exercise habits between the parents’ country of origin and the host country (Rouche et al., 2019). Accordingly, these differences would be far less dramatic for 2nd generation immigrant Israeli youth whose parents came from the FSU as approximately 20% of Israel’s total population are FSU immigrants (Central Bureau of Statistics in Israel, 2019).

The family context, measured in this study, by the external resources of family SES and social support, demonstrated significant positive associations with health status. In youth and children, SES has a well-established relationship with health status (Goodman, 1999; Newacheck et al., 2003). This same relationship between SES and health status was noted in a study on children and youth in Israel (Tasher et al., 2016) where approximately one in four children live at or below the poverty level (Myers-JDC-Brookdale Institute, 2018). SES was related to food insecurity and food choices (Rouche et al., 2019), and if a child lived in low SES, that level of SES persisted throughout childhood in most countries (van Zwieten et al., 2018). These same two findings (i.e., the link between SES and poor diet, and persistent low SES throughout childhood) found in the general population also was found in 1st and 2nd generation immigrant youth (Rouche et al., 2019). In fact, one investigator found that when the variable for SES was added to regression models, the strength of the relationship between immigration status (2nd generation immigrants) and health status was reduced (Kotwal, 2010). Such findings suggest covariation between immigrant status and SES.

Family social support is another external resource variable. Some researchers noted that both 1st and 2nd generation immigrant youth from Eastern Europe immigrant families, compared to other immigrant families, reported lower family support overall (Dalmasso et al., 2018). Yet, when external resource variables (i.e., family social support and SES) were added to regression models containing the dependent variable of life satisfaction and independent variable of immigrant status, differences by immigrant status that were significant previously, disappeared (Runarsdottir & Vilhjalmsson, 2015). Note that this covariation also was found previously with the external resource of SES (Kotwal, 2010). Consistent with these findings, this study found that the external resources (i.e., SES, family social support) variables were associated with health status while no independent effects were noted by immigrant status.

Differences between 2nd Generation Immigrant Youth and Non-Immigrants

Although of the five internal resources examined (i.e., BMI, diet, smoking, exercise and ethnic self-identity), only exercise was associated with excellent health status. Bivariate data indicated significant differences in diet, smoking and ethnic self-identity between 2nd generation immigrant and non-immigrant youth. Bivariate analyses indicated that 2nd generation immigrant youth ate fewer healthy foods and were living at a lower SES. Such findings are consistent with other studies suggesting that food insecurity and inadequacy were associated with lower SES (Rouche et al., 2019). Another possible contribution to these dietary findings was the context that the parents of 2nd generation immigrant youth were born in the FSU. Israeli youth, compared to the FSU countries, consume substantially more fruits and vegetables (Haug et al., 2009). Consequently, second generation immigrant youth may be influenced by the dietary patterns of their parents born in the FSU where less fruits and vegetables were consumed.

Bivariate results did show that significantly more 2nd generation immigrant youth were current smokers compared to non-immigrant youth. Another Israeli study examining 2nd generation immigrant youth whose parents came from the FSU also noted the high rate of smokers in this group (Kahan-Strawczynski et al., 2012). High rates of smoking among 2nd generation immigrant youth were attributed to problematic family functioning (Cano et al., 2016), and difficulties with integrating into the host country for immigrant youth and discrimination (Walsh et al., 2018). The family context of the parent’s birth country also may be an explanation. For example, 40.9% of the Russians above age 15 years were smokers compared to 25.4% in Israel (World Health Organization, 2018).

The formation and exploration of youth ethnic self-identity is strongly influenced by parents (Else-Quest & Morse, 2015) and a milestone for the developmental process of adolescence. It is associated with fewer depressive symptom, higher self-esteem, better peer relationships and better school grades (Crocetti et al., 2008; Rivas-Drake et al., 2014; Stevens et al., 2015). Berry’s et al., (2006) studies found that the ethnic self-identity of immigrant youth optimally integrates both the parents’ birth country and the host country (Berry et al., 2006). However, researchers examining associations between ethnic self-identity and psychological function in youth belonging to the majority versus minority ethnic group found no differences (Syed & Juang, 2014).

Limitations of this study include its generalizability due to self-report of all measures, the cross-sectional design and convenience sample. Additionally, this study’s sample consisted only of 18-year-old youth, thus reducing generalizability to youth of other ages. Moreover, only apparently healthy youth about to enter army service were eligible for study participation. The focus on this population not only resulted in low variability of SRH but also limited generalizability to youth who would be ineligible for military service due to illness or other issues. Data were collected online, so youth who do not engage in computer use or social media would not be presented; however, it is noteworthy that online social networks are frequented by Israel’s general population of youth. This study had the advantage that all youth in the study sample were the same age, and the parents of all 2nd generation immigrant youth were born in the FSU. Moreover, we found no other study examining both internal and external resources for 2nd generation immigrant youth and non-immigrant youth.

Conclusion

This study makes the following contributions to existing literature. First, excellent health status in apparently healthy non-immigrant and 2nd generation immigrant youth was related primarily to external resources such as family social support and SES, but not to immigrant status. Second, health risks related to both external resources (i.e., SES and family support) and internal resources (i.e., diet, smoking status) were higher among 2nd generation immigrant youth compared to non-immigrant youth. Third, findings suggest that the birth country of 2nd generation immigrant youth may influence internal resources. Lastly, the additional risk of immigration appears to continue into the 2nd generation and is detectable through external and internal resources, rather than by measuring the independent effects of immigrant status.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The author recieved financial support from the Israel’s Ministry of Immigrant Absorption (PI: Zlotnick).

Ethical Approval

After receiving approval from the University’s Ethics’ Committee (Ethics Committee Approval #268/18).

ORCID iD

Cheryl Zlotnick

Author Biographies

Cheryl Zlotnick, RN, DrPH, is an associate professor at the Cheryl Spencer Department of Nursing, University of Haifa, Israel. Her research program focuses healthcare interventions, habits and practices that influence health status and risk in vulnerable populations living in transitional situations (i.e., new immigrants, homeless individuals, and youth in foster care/group homes).

Inbal Manor-Lavon, MA, teaches statistics and research methods in the Faculty of Education, and is involved with research in the field of psychology focusing on attributes and dispositions of family, parents and children.

Einav Srulovici, PhD, MHA, RN, is a lecturer at the Cheryl Spencer Department of Nursing, University of Haifa, Israel. Her research focuses on improving quality of health care, especially missed nursing care, and healthcare providers’ well-being.

References

Allen

C. D.

McNeely

C. B.

Orme

J. G.

(2016). Self-rated health across race, ethnicity, and immigration status for US adolescents and young adults. Journal of Adolescent Health, 58, 47–56. https://doi.org/10.1016/j.jadohealth.2015.09.006

Berry

J. W.

(1997). Immigration, acculturation, and adaptation. Journal of Applied Psychology, 46, 5–34. https://doi.org/10.1111/j.1464-0597.1997.tb01087.x

Berry

J. W.

Phinney

J. S.

Sam

D. L.

Vedder

(2006). Immigrant youth: Acculturation, identity, and adaptation. Applied Psychology: An International Review, 55(3), 303–332. https://doi.org/10.1111/j.1464-0597.2006.00256.x

Borraccino

Charrier

Berchialla

Lazzeri

Vieno

Dalmasso

Lemma

(2018). Perceived well-being in adolescent immigrants: It matters where they come from. International Journal of Public Health, 63(9), 1037–1045. https://doi.org/10.1007/s00038-018-1165-8

Breidablik

H. J.

Meland

Lydersen

(2008). Self-rated health in adolescence: A multifactorial composite. Scandinavian Journal of Public Health, 36(1), 12–20. https://doi.org/10.1177/1403494807085306

Cano

M. Á.

Schwartz

S. J.

Castillo

L. G.

Unger

J. B.

Huang

Zamboanga

B. L.

Romero

A. J.

Lorenzo-Blanco

E. I.

Córdova

Des Rosiers

S. E.

Lizzi

K. M.

Baezconde-Garbanati

Soto

D. W.

Villamar

J. A.

Pattarroyo

Szapocznik

(2016). Health risk behaviors and depressive symptoms among Hispanic adolescents: Examining acculturation discrepancies and family functioning. Journal of Family Psychology 30(2), 254–265. https://doi.org/10.1037/fam0000142

Central Bureau of Statistics in Israel. (2019). Table E/4. Immigrants, (1) By Last Country of Residence. Retrieved 12 December, 2019, from https://www.cbs.gov.il/he/publications

Ceri

Ozlu-Erkilic

Ozer

Kadak

Winkler

Dogangün

Akkaya-Kalayci

(2017). Mental health problems of second generation children and adolescents with migration background. International Journal of Psychiatry in Clinical Practice, 21(2), 142–147. https://doi.org/10.1080./13651501.2017.1291820

Chudinovskikh

Denisenko

(2017). Russia: A migration system with Soviet roots. MPI - Migration Policy Institute, May. https://www.migrationpolicy.org/article/russia-migration-system-soviet-roots

10.

Clatworthy

Buick

Hankins

Weinman

Horne

(2005). The use and reporting of cluster analysis in health psychology: A review. British Journal of Health Psychology, 10, 329–358. https://doi.org/10.1348/135910705X25697

11.

Clauss-Ehlers

C. S.

Yang

Y.-T. T.

Chen

W.-C. J.

(2006). Resilience from childhood stressors: The role of cultural resilience, ethnic identity, and gender identity. Journal of Infant, Child, and Adolescent Psychotherapy, 5(1), 124–138. https://doi.org/10.2513/s15289168jicap0501_7

12.

Costigan

C. L.

Koryzma

C. M.

Hua

J. M.

Chance

L. J.

(2010). Ethnic identity, achievement, and psychological adjustment: Examining risk and resilience among youth from immigrant Chinese families in Canada. Cultural Diversity and Ethnic Minority Psychology, 16(2), 264. https://doi.org/10.1037/a0017275

13.

Crocetti

Rubini

Meeus

(2008). Capturing the dynamics of identity formation in various ethnic groups: Development and validation of a three-dimensional model. Journal of Adolescence, 31(2), 207–222. https://doi.org/10.1016/j.adolescence.2007.09.002

14.

Dalmasso

Borraccino

Lazzeri

Charrier

Berchialla

Cavallo

Lemma

(2018). Being a Young Migrant in Italy: The effect of perceived social support in adolescence. Journal of Immigrant and Minority Health, 20(5), 1044–1052. https://doi.org/10.1007/s10903-017-0671-8

15.

de Grande

Vandenheede

Gadeyne

Deboosere

(2014). Health status and mortality rates of adolescents and young adults in the Brussels-Capital Region: Differences according to region of origin and migration history. Ethnicity & Health, 19(2), 122–143. https://doi.org/10.1080/13557858.2013.771149

16.

de Oliveira Figueiredo

R. A.

Viljakainen

Roos

Rounge

T. B.

Weiderpass

(2019). Identifying eating habits in Finnish children: A cross-sectional study. BMC Public Health, 19(1), 312. https://doi.org/10.1186/s12889-019-6603-x

17.

Else-Quest

N. M.

Morse

(2015). Ethnic variations in parental ethnic socialization and adolescent ethnic identity: A longitudinal study. Cultural Diversity and Ethnic Minority Psychology, 21(1), 54–64. https://doi.org/10.1037/a0037820

18.

Flores

Brotanek

(2005). The healthy immigrant effect: A greater understanding might help us improve the health of all children. Archives of Pediatrics & Adolescent Medicine, 159(3), 295–297. https://doi.org/10.1001/archpedi.159.3.295

19.

Frisco

M. L.

Quiros

Van Hook

(2016). One size may not fit all: How obesity among Mexican-origin youth varies by generation, gender, and age. Demography, 53(6), 2031–2043. https://doi.org/10.1007/s13524-016-0525-3

20.

George

M. A.

Bassani

(2013). Does living in a neighbourhood with others of the same ethnic background contribute to health of Canada’s immigrant children? Canadian Journal of Public Health, 104(7), e482–e486.

21.

Gooding

H. C.

McGinty

Richmond

T. K.

Gillman

M. W.

Field

A. E.

(2014). Hypertension awareness and control among young adults in the national longitudinal study of adolescent health. Journal of General Internal Medicine, 29(8), 1098–1104. https://doi.org/10.1007/s11606-014-2809-x

22.

Goodman

(1999). The role of socioeconomic status gradients in explaining differences in US adolescents’ health. American journal of public health, 89(10), 1522–1528. https://doi.org/10.2105/ajph.89.10.1522

23.

Granger

Di Nardo

Harrison

Patterson

Holmes

Verma

(2017). A systematic review of the relationship of physical activity and health status in adolescents. European Journal of Public Health, 27(suppl_2), 100–106. https://doi.org/10.1093/eurpub/ckw187

24.

Haas

S. A.

Fosse

N. E.

(2008). Health and educational attainment of adolescents: Evidence from the NLYS97. Journal of Health and Social Behavior 49(2), 178–192. https://doi.org/10.1177/002214650804900205

25.

Haug

Rasmussen

Samdal

Iannotti

Kelly

Borraccino

Vereecken

Melkevik

Lazzeri

Giacchi

Ercan

Due

Ravens-Sieberer

Currie

Morgan

Ahluwalia

, & HBSC Obesity Writing Group. (2009). Overweight in school-aged children and its relationship with demographic and lifestyle factors: Results from the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) Study. International Journal of Public Health, 54(2), 167–179. https://doi.org/10.1007/s00038-009-5408-6

26.

Kahan-Strawczynski

Amiel

Levi

Konstantinov

(2012). First and Second Generations of Immigrant Youth from Ethiopia and the Former Soviet Union – Similarities and Differences. Jerusalem, Israel. https://brookdale.jdc.org.il/en/publication/first-second-generations-immigrant-youth-ethiopia-former-soviet-union-similarities-differences/

27.

Kotwal

A. A.

(2010). Physical and psychological health of first and second generation Turkish immigrants in Germany. American Journal of Human Biology, 22(4), 538–545. https://doi.org/10.1002/ajhb.21044

28.

Kwak

Rudmin

(2014). Adolescent health and adaptation in Canada: Examination of gender and age aspects of the healthy immigrant effect. International Journal for Equity in Health, 13, 103. https://doi.org/10.1186/s12939-014-0103-5

29.

Meroc

Moreau

Lebacq

Dujeu

Pedroni

Godin

Castetbon

(2019). Immigration and adolescent health: the case of a multicultural population. Public health, 175, 120–128. https://doi.org/10.1016/j.puhe.2019.07.001

30.

Myers-JDC-Brookdale Institute. (2018, 12 December 2019). Poverty in Israel - Fact and Figures. https://brookdale.jdc.org.il/wp-content/uploads/2018/02/Facts_and_Figures_Poverty_in_Israel_2018.pdf

31.

National Center for Health Statistics. (2010a). 2 to 20 years: Boys Body Mass Index-for-age percentiles. http://www.cdc.gov/growthcharts

32.

National Center for Health Statistics. (2010b). 2 to 20 years: Girls Body Mass Index-for-age percentiles. http://www.cdc.gov/growthcharts

33.

Nesterko

Turrion

C. M.

Friedrich

Glaesmer

(2019). Trajectories of health-related quality of life in immigrants and nonimmigrants in Germany: A population-based longitudinal study. International Journal of Public Health, 64, 49–58. https://doi.org/10.1007/s00038-018-1113-7

34.

Newacheck

P. W.

Hung

Y. Y.

Jane Park

Brindis

C. D.

Irwin

C. E.

Jr (2003). Disparities in adolescent health and health care: Does socioeconomic status matter? Health Services Research, 38(5), 1235–1252. https://doi.org/10.1111/1475-6773.00174

35.

Novak

Štefan

Emeljanovas

Mieziene

Milanović

Janić

S. R.

Kawachi

(2017). Factors associated with good self-rated health in European adolescents: A population-based cross-sectional study. International Journal of Public Health, 62(9), 971–979. https://doi.org/10.1007/s00038-017-1015-0

36.

Perreira

K. M.

Ornelas

I. J.

(2011). The physical and psychological well-being of immigrant children. The Future of Children, 21, 195–218. https://doi.org/10.1353/foc.2011.0002

37.

Phinney

J. S.

(1992). Multigroup ethnic identity measure: A new scale for use with diverse groups. Journal of Adolescent Research, 7(2), 156–176. https://doi.org/10.1177/074355489272003

38.

Procidano

M. E.

Heller

(1983). Measures of perceived social support from friends and from family: Three validation studies. American Journal of Community Psychology, 11(1), 1–24. https://doi.org/10.1007/BF00898416

39.

Quon

E. C.

McGrath

J. J.

Roy-Gagnon

M.-H.

(2012). Generation of immigration and body mass index in Canadian youth. Journal of Pediatric Psychology, 37(8), 843–853. https://doi.org/10.1093/jpepsy/jss037

40.

Rivas-Drake

Markstrom

Syed

Lee

R. M.

Umana-Taylor

A. J.

Yip

Seaton

E. K.

Quintana

Schwartz

S. J.

French

, & Ethnic and Racial Identity in the 21st Century Study Group. (2014). Ethnic and racial identity in adolescence: Implications for psychosocial, academic, and health outcomes. Child Development, 85(1), 40–57. https://doi.org/10.1111/cdev.12200

41.

Rouche

De Clercq

Lebacq

Dierckens

Moreau

Desbouys

Godin

Castetbon

(2019). Socioeconomic disparities in diet vary according to migration status among adolescents in Belgium. Nutrients, 11(4), 812. https://doi.org/10.3390/nu11040812

42.

Runarsdottir

E. M.

Vilhjalmsson

(2015). Ethnic differences in youth well-being: The role of sociodemographic background and social support. Scandinavian Journal of Public Health, 43(6), 580–587. https://doi.org/10.1177/1403494815588644

43.

Schafer

J. L.

Olsen

M. K.

(1998). Multiple imputation for multivariate missing-data problems: A data analyst’s perspective. Multivariate Behavioral Research, 33(4), 545–571. https://doi.org/10.1207/s15327906mbr3304_5

44.

Segura-Jiménez

Carbonell-Baeza

Keating

X. D.

Ruiz

J. R.

Castro-Piñero

(2015). Association of sleep patterns with psychological positive health and health complaints in children and adolescents. Quality of Life Research, 24(4), 885–895. https://doi.org/10.1007/s11136-014-0827-0

45.

Singh

G. K.

Kogan

M. D.

S. M.

(2009). Disparities in obesity and overweight prevalence among US immigrant children and adolescents by generational status. Journal of Community Health, 34(4), 271–281. https://doi.org/10.1007/s10900-009-9148-6

46.

Singh

G. K.

S. M.

Kogan

M. D.

(2013). Health, chronic conditions, and behavioral risk disparities among US immigrant children and adolescents. Public Health Reports, 128(6), 463–479. https://doi.org/10.1177/003335491312800606

47.

Sirin

S. R.

Gupta

Ryce

Katsiaficas

Suárez-Orozco

Rogers-Sirin

(2013). Understanding the role of social support in trajectories of mental health symptoms for immigrant adolescents. Journal of Applied Developmental Psychology, 34(5), 199–207. https://doi.org/10.1016/j.appdev.2013.04.004

48.

Sonneville

K. R.

Duncan

D. T.

Johnson

R. M.

Almeida

(2015). Are first-generation adolescents less likely to be overweight? Results from a Survey of Boston Youth. Journal of Immigrant and Minority Health, 17(2), 605–609. https://doi.org/10.1007/s10903-013-9937-y

49.

Stevens

G. W.

Walsh

S. D.

Huijts

Maes

Madsen

K. R.

Cavallo

Molcho

(2015). An internationally comparative study of immigration and adolescent emotional and behavioral problems: Effects of generation and gender. Journal of Adolescent Health, 57(6), 587–594. https://doi.org/10.1016/j.jadohealth.2015.07.001.

50.

Syed

Juang

L. P.

(2014). Ethnic identity, identity coherence, and psychological functioning: Testing basic assumptions of the developmental model. Cultural Diversity and Ethnic Minority Psychology, 20(2), 176. https://doi.org/10.1037/a0035330

51.

Tasher

Rubin

Grossman

Grotto

Dahan

Berlowitz

Somekh

(2016). Child Health Care in Israel. The Journal of Pediatrics, 177, S107–S115. https://doi.org/10.1016/j.jpeds.2016.04.047

52.

van Zwieten

Saglimbene

Teixeira-Pinto

Howell

Howard

Craig

J. C.

Wong

(2018). The impact of age on income-related health status inequalities from birth to adolescence: A systematic review with cross-country comparisons. The Journal of Pediatrics, 203, 380–390.e314. https://doi.org/10.1016/j.jpeds.2018.07.030

53.

Wahi

Boyle

M. H.

Morrison

K. M.

Georgiades

(2014). Body mass index among immigrant and non-immigrant youth: Evidence from the Canadian Community Health Survey. Canadian Journal of Public Health, 105(4), e239–e244. https://doi.org/10.17269/cjph.105.4288

54.

Walsh

S. D.

Kolobov

Harel-Fisch

(2018). Social Capital as a moderator of the relationship between perceived discrimination and alcohol and cannabis use among immigrant and non-immigrant adolescents in Israel. Frontiers in Psychology, 9, 1556–1556. https://doi.org/10.3389/fpsyg.2018.01556

55.

World Health Organization. (2016). Consideration of the evidence on childhood obesity for the commission on ending childhood obesity: Report of the ad hoc working group on science and evidence for ending childhood obesity (9241565330). https://apps.who.int/iris/bitstream/handle/10665/206549/9789241565332_eng.pdf

56.

World Health Organization. (2018). World Health Statistics data visualizations dashboard. SDG Target 3.a | Tobacco control. Tobacco smoking - Europe. Tobacco smoking: Prevalence of tobacco smoking. http://apps.who.int/gho/data/node.sdg.3-a-viz?lang=en

57.

Yuan

Y. C.

(2011). Multiple imputation using SAS software. Journal of Statistical Software, 45(6), 1–25. https://doi.org/10.18637/jss.v045.i06

58.

Zlotnick

Birenbaum-Carmeli

Goldblatt

Dishon

Taychaw

Shadmi

(2017). Adolescent immigrants, the impact of gender on health status. European Journal of Public Health, 27(3), 453–459. https://doi.org/10.1093/eurpub/ckw208

59.

Zlotnick

Birenbaum-Carmeli

Goldbaltt

Dishon

Taychaw

Shadmi

(2018). Health indicators and social gradient in adolescent immigrants’ health risk and healthcare experiences. European Journal of Pediatrics, 177(2), 221–228. https://doi.org/10.1007/s00431-017-3052-3