Examining Segmented Assimilation and the Immigrant Health Paradox: Neighborhood Context and Asian American Immigrants' Mental Health and Substance Use

Introduction:Studies on immigrant health have consistently reported that while immigrants are healthier during the earlier years of migration, their health declines over time to eventually converge with that of the native-born, evidencing a negative assimilation effect. Less is known about factors contributing to this phenomenon, referred to as “immigrant paradox”. Immigrant families are often overrepresented in more disadvantaged neighborhoods and their experiences are often intertwined with those of communities of color and ethnic minorities. “Place” or context as well as race may be particularly relevant when examining the well-being of immigrants. The role of place in immigrant health is an emerging area of research, however. This paper examines the association of neighborhood disadvantage over a 15-year span with the mental health and substance use of 2nd and 1.5 generation Asian American immigrants, compared with their African American and white non-immigrant counterparts.

Methods:Data were collected from the Seattle Social Development Project -- a longitudinal study that has surveyed fifth graders in 1985 in public elementary schools in higher risk neighborhoods in Seattle, through to age 33. Analyses included 447 individuals in King County, WA in 1990. Neighborhood context was assessed in adolescence at age 15 in 1990 and in adulthood at age 30 in 2005, using tract-level data from the 1990 US Census and the 2008 American Communities Survey, respectively. Six variables were used to create a composite measure of neighborhood socioeconomic disadvantage: unemployment, public assistance, poverty, density of children, female single heads of prevention, and minority population. Outcomes were symptom counts for major depressive episode, generalized anxiety disorder, alcohol abuse and nicotine dependence. Poisson and negative binomial models were used to examine associations between neighborhood context and the four outcomes, and health disparities by race-immigrant status.

Results: Key findings show that the association of neighborhood disadvantage in adulthood with increased alcohol abuse symptoms, controlling for childhood neighborhood, was less pronounced for Asian American immigrants compared with White non-immigrants, while an opposite association was found for African American non-immigrants. Differential associations by race-immigrant status were not found for the other three outcomes.

Conclusions: Neighborhood disadvantage may have differential impact across various health outcomes and across categories of race-immigrant status. Findings are discussed with respect to prevention strategies that consider immigrant status, race, and neighborhood context, including those testing universal versus selective or indicated prevention strategies.