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1 a Survey of Health of First and 1.5 Generation Immigrant and Refu A Survey of Health of First and 1.5 Generation Immigrant and Refugee Students in an all Immigrant School Jennifer Bromberg Senior Honors Thesis Dr. Kristen Lucken, Advisor International and Global Studies, Brandeis University May 5, 2015 1 Abstract This mixed-methods study was completed to explore how immigrants’ integration correlates to health outcomes. In this paper integration was defined by the interaction with American-born people with American-born parents, and the health outcome measured was Body Mass Index (BMI). The hypothesis was that the integrated students would have a higher BMI, based on previous research that says that the longer an immigrant is in the United States, the higher their BMI is. These data were collected in a middle/high school where all of the students are recent immigrants and refugees. 80 students were surveyed and 6 students were interviewed. The study found that the integrated group of students (n=33) has a mean BMI 2.29 lower than the mean BMI for non-integrated students (n=47) when controlling for demographic variables. This could potentially be due to factors relating to socioeconomic status or because the students are recent immigrants, so they have not been living in the United States for a long enough time to see a substantial change in BMI. Future studies should look at new ways of defining integration, and should also emphasiZe more research in the beginning stages of integration in the first ten years of an immigrant’s life in the United States. 2 Table of Contents Abstract Table of Contents Definitions Chapter I: Introduction to Study Introduction Literature Review a. Overweight/Obesity in Immigrant and Refugee Populations b. Social Determinants of Health in Immigrant and Refugee Populations c. Barriers to Health in Immigrant and Refugee Populations d. Education in Immigrant and Refugee Populations Study Design and Methodology Chapter II: Context of the Study a. Health in Columbus and Ohio b. Immigrants and Refugees in Columbus and Ohio i. Somali Refugees ii. Bhutanese/Nepali Refugees c. Columbus Global Academy Chapter III: Findings a. Results from surveys (quantitative data) i. Demographic data ii. Health-related data iii. Combined demographic and health-related data regression 3 b. Results from interviews (qualitative data) i. Interview 1 ii. Interview 2 iii. Interview 3 iv. Interview 4 Chapter IV: Discussion a. Demographics i. Defining country of origin ii. Religion iii. Age iv. Integration (interaction with American-born people with American-born parents) b. Health-related data i. BMI ii. Meals eaten outside school iii. School lunches iv. Fruits and vegetables v. Physical activity vi. Hours spent watching TV and playing videogames c. Regression analysis Comparison to state statistics a. BMI b. Physical activity 4 c. Fruit and vegetable consumption Limitations a. Sample siZe b. Lack of measurement for socioeconomic status c. Too short of length of residency d. Language barrier Future of the school Chapter V: Conclusion Bibliography Appendixes A. Student Health Survey B. Student Interview Questions 5 Definitions Body Mass Index (BMI): a value used to measure overweight and obesity in adults using height and weight; for most people this value correlates to their amount of body fat (Defining Overweight and Obesity, 2012). Immigrant Generations: a. First Generation Immigrant: a person who was born outside of the United States, Puerto Rico, or other United States territories where neither parent is an American citiZen; this term may be used interchangeably with foreign born (Pew Research Center, 2013). b. 1.5 generation Immigrant: a person who arrives into the United States before the age of 10 (Ellis & Goodwin-White, 2006). c. Second Generation Immigrant: a person who is born in the United States with at least one first-generation immigrant parent (Pew Research Center, 2013). d. Third and Higher Generation Immigrant: a person who is born in the United States, including Puerto Rico or other United States territories whose both parents were both also born in the United States, including Puerto Rico or other United States territories (Pew Research Center, 2013). Obese: In adults, being obese is categorized as having a BMI over 30 (Defining Overweight and Obesity, 2012). Overweight: In adults, being overweight is categorized as having a BMI over 25 (Defining Overweight and Obesity, 2012). Refugee: a person who is owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it (United Nations High Commissioner for Refugees). 6 Chapter I: Introduction to Study Introduction The United States has a rich history of being the end destination for many immigrants and their families. In 2012, approximately 41 million immigrants (naturaliZed, legal permanent residents, refugees and asylees, international students, and undocumented immigrants) resided in the United States, which accounts for about 20 percent of all international migrants in the world (Nwosu, Batalova & Auclair, 2014). Additionally, in 2012, the number of refugees authoriZed for admission was 76,000 (Burt & Batalova, 2014). An estimated 11.5 million undocumented immigrants resided in the United States in 2011 (Nwosu, Batalova & Auclair, 2014). Immigrants and refugees come to a new culture and health system, where the environment may differ distinctly from their homeland. This often leads to change in their lifestyle and eating habits that negatively impact various aspects of their health. One area where this negative impact is particularly evident is in the weight increase among newcomers after living in the United States for a particular length of time. Studies have found that the immigrant population tends to enter the United States at a lower average weight than the average American. However after about a decade of living in the United States, this weight advantage dissipates and the immigrant weight patterns converge with those of third-generation Americans (Cunningham, Ruben, & Narayan, 2008). The digression in health status is often attributed to acculturation and conforming to some of the cultural norms and habits in the United States that affect health, such as drinking, smoking and developing an unhealthy diet (Viruell-Fuentes, Miranda & Abdulrahim, 2012). Being overweight or obese can lead to an increased risk for many 7 health complications, such as coronary heart disease, high blood pressure, stroke, type two diabetes, abnormal blood fats, cancer, osteoarthritis, sleep apnea, obesity hypoventilation syndrome, reproductive problems and gallstones (National Heart, Lung, and Blood Institute, 2012). These health-related issues are of upmost importance where immigrant and refugee populations are concerned because they are one of many minority groups that face additional barriers to accessing and receiving high quality healthcare. Additionally, several social determinants of health such as race, level of education, socioeconomic status and religion may put immigrants at a disadvantage to living a healthy lifestyle and achieving better health outcomes than they currently have. These specifically will be further discussed in the literature review of the paper. The primary goal of this thesis is to fill in some gaps in the research regarding immigrant health outcomes after life in the United States. To begin with, this study will explore the overall health of Columbus Global Academy (CGA) students to determine if their health status coincides with outcomes of immigrants and refugees who have regular contact with Americans. What happens when the influence of third-generation Americans is removed from immigrant social life? Will CGA student health outcomes track with other immigrants that conform to average American health outcomes after a particular length of time? At the CGA, all of the students are English as a Second Language (ESL) students.1 This school provides a unique environment that is devoid of ‘mainstream’ American peers. This 1 It is important to note that a few may not fit the specific definition of a first-generation immigrant if they are from Puerto Rico or a different United States territory where English is not spoken, but for the purpose of this paper all of the students will be considered to be first-generation immigrants. 8 paper will explore what the effects of an ‘all immigrant’ environment might be on the health and health practices of the CGA students. This paper will use interaction with American-born people with American parents as a proxy for integration. By doing this, there is a new variable used in place of length of residency, which is how immigrant health status is usually measured in the literature. Additionally, this paper has a unique view on integration and health because it studies students in the midst of their integration process rather than studying the health of immigrants after they have been in the United States for a decent amount of time. This study offers a new way of looking at how immigrants integrate into American culture and society made possible by the ESL focus in the school. Literature Review a. Overweight/Obesity in Immigrant and Refugee Populations Upon arrival to the United States, immigrants generally exhibit lower BMIs than the average BMI for American-born population, but after approximately ten years of living in the United States, they tend to fall into a BMI range similar to that of third-generation Americans (Cunningham et al., 2007). A longer period of residence in the United States leads to greater assimilation into American culture, a time during which the average BMI for second and third generation immigrants increases, and some immigrant race groups, such as immigrant Hispanic women, even surpass the average native Hispanic BMI (Antecol & Bedard, 2006).
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