Ethnic and Generational Influences on Emotional ...

Research in Nursing & Health, 2006, 29, 311–324

Ethnic and Generational Influences on Emotional Distress and Risk Behaviors Among Chinese and Filipino American Adolescents Mayumi Anne Willgerodt,* Elaine Adams Thompson{

Department of Family and Child Nursing, University of Washington, School of Nursing, Box 357262, Seattle, WA 98195-7262 Accepted 29 January 2006

Abstract: The purpose of this study was to explore ethnic and generational influences among Chinese, Filipino, and Euro American adolescents on emotional distress and risk behaviors. Hierarchical multiple regression analyses were conducted with 216 Chinese, 387 Filipino, and 400 Euro American adolescents from the National Longitudinal Study on Adolescent Health to investigate the influence of ethnicity on depression, somatic symptoms, delinquency, and substance use; and to examine the influence of generation on the outcome variables among Chinese and Filipino American adolescents. Ethnicity predicted depression and delinquency scores, while generation within ethnic groups predicted somatic symptoms and substance use. The findings diverge from theories using acculturation as an explanatory mechanism for distress and risk behaviors and underscore the importance of examining sub-groups and generations of Asian American youth. ß 2006 Wiley Periodicals, Inc. Res Nurs Health 29:311–324, 2006

Keywords: Asian Americans; generation; emotional distress; risky behaviors; adolescent health

Immigration to the United States continues to increase. According to the U.S. Census, approximately 11.1% of the population is foreign born, and 20% of all children are either foreign born or living in households with foreign-born adults (Lugalia & Overturf, 2004; Malone, Baluja, Costanzo, & Davis, 2003). Asian Americans are

rapidly becoming one of the largest minority groups in the US, with Chinese and Filipinos being the first and second largest sub-groups of Asian Americans respectively. Between 2000 and 2050, the Asian American population will increase by about 213%, compared to a 49% projected increase in the general population. As an

This research was supported by a career development award NINR K01 NR08334-02. This research was based on data from the Add Health project, a program project designed by J. Richard Udry (PI) and Peter Bearman and funded by grant P01HD31921 from the National Institute of Child Health and Human Development to the Carolina Population Center, University of North Carolina at Chapel Hill. Additional information on the National Longitudinal Study of Adolescent Health can be obtained at http://www.cpc.unc.edu/projects/addhealth/. * Assistant Professor. { Professor. Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/nur.20146

ß 2006 Wiley Periodicals, Inc.

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indicator of these coming changes, 24% of all Asian Pacific Islanders in the United States are under the age of 18 (Reeves & Bennett, 2004). Immigration and acculturation processes influence mental health (Organista, Organista, & Kurasaki, 2002). Despite the knowledge that depression and other disorders often originate in childhood or adolescence, relatively little research has been conducted with immigrant youth, particularly Asian American youth. This is of particular concern because of the rise in the number of immigrant children and because 20–50% of depressed youths have two or more other mental health conditions, including dysthymia, anxiety disorders, disruptive disorders, and substance abuse (Roberts, 2000). In studies focused on ethnic differences in emotional distress and risk behaviors in immigrant youth, Asian American groups are typically combined, making it impossible to identify critical sub-group differences. Asian Americans are composed of heterogeneous communities, each with its own history, culture, values, immigration history, experience in adapting to the US, and health issues. Asian groups vary in their adaptation to the U.S. culture, and for several decades researchers have called for studies that separate Asian sub-groups (Uba, 1994). In addition to differentiating among subgroups of Asian Americans, it is important to explore differences by generational status within cultural groups. Cultural adaptation and orientation are influenced by place of birth and age at migration. Asians who immigrate at an early age (i.e., less than 6 years old) or are American-born, compared to those who immigrate as adults, more quickly adopt and internalize American values and customs (Tsai & Chentsova-Dutton, 2002). As Asian immigrant youth become socialized to American society, they begin to mimic Euro American youth behaviors and attitudes (Rumbaut, 1997). Thus, a first-generation Asian adolescent compared to a third-generation Asian adolescent is likely to present differently in terms of emotional distress and risk behaviors. Understanding which Asian groups and generations of adolescents are experiencing higher levels of psychological symptoms and engaging in risk behaviors will allow nurses to focus their attention on designing and implementing theoretically robust and systematically tailored interventions. The purpose of this study was to explore ethnic and generational influences in Chinese, Filipino, and Euro American adolescents on emotional distress and risk behaviors. Research in Nursing & Health DOI 10.1002/nur

BACKGROUND AND SIGNIFICANCE Ethnic and Generational Differences in Emotional Distress Few researchers, particularly in nursing, have examined ethnic differences in emotional distress. Current researchers either examine one cultural group (e.g., Chinese) or examine differences between multiple ethnic groups with Asian American sub-groups combined into one grouping. These approaches make it difficult to understand how sub-groups of Asian Americans compare with each other or with other groups (e.g., Euro American adolescents). This is particularly relevant, as much of what is known about adolescent emotional distress is confined to Euro American youth. Further, adjustment to a new culture intensifies the identity explorations, generational conflicts, and the desire for autonomy that characterizes adolescence and may lead to psychological distress and risk behaviors in minority youth (Huang, 1991). Comparative studies that document how and in what ways Asian Americans differ from Euro American youth are needed to understand the mental health and risk behavior profile for each group and to identify which Asian sub-groups are at increased risk. Early studies with Asian Americans, conducted primarily with college students, consistently revealed more somatic complaints, isolation, and anxiety (Sue & Sue, 1974; Sue & Zane, 1985). Researchers studying rates of depression and depressed mood cross-culturally among minority adolescents have found inconsistent and sometimes ambiguous results (I.G. Chen, Roberts, & Aday, 1998; Lorenzo, Frost, & Reinherz, 2000; Siegel, Aneshensel, Taub, Cantwell, & Driscoll, 1998). For example, Siegel and colleagues found that Asian American adolescents aged 12–17 scored lower on measures of depressed mood compared with Latinos, Euro Americans, and African Americans. Other researchers who have included Chinese (Chiu, Feldman, & Rosenthal, 1992; Way & Robinson, 2003) and Filipinos (Edman et al., 1998) found no differences compared with Euro Americans. Investigators have challenged the model minority myth that depicts Asian Americans in better psychological health than the general population (Lorenzo et al., 2000; Wong, 2001). Greenberger and Chen (1996) reported that Asian American adolescents compared with Euro Americans showed more symptoms of depressed mood. In a nationally representative study of immigrant youth, Harker

ETHNIC AND GENERATIONAL INFLUENCES / WILLGERODT AND THOMPSON

(2001) found that Filipino and other Asian adolescents were more likely to report depressive symptoms compared to non-Hispanic Whites. Investigators have also demonstrated that academic achievement among Chinese students exceeds those of their Euro American counterparts, indicating that the conventional use of school performance to assess psychological function is not always appropriate (Abe & Zane, 1990). Lorenzo et al. recently confirmed this observation when they found that Asian American adolescents performed better academically but reported higher levels of depressive symptoms, withdrawn behavior, poor self-esteem and dissatisfaction with social support. Differences in emotional distress by generational status are more difficult to discern from the literature. Although mean levels of emotional well-being were lower in first- and secondgeneration immigrant youth compared to Euro Americans, Harker (2001) found that controlling for other demographics removed the influence of generational status on well-being. Yet, clinical evidence shows that different generations of immigrant adolescents have different experiences, which, in turn, influence the mental health of this group (Rumbaut, 1994). More research is needed to understand better the differences in the experience and expression of psychological health in different generations of Asian American youth. Ethnic and Generational Differences in Risk Behaviors Relatively little is known about the prevalence of risk behaviors (e.g., delinquency and substance use) in Asian American adolescents, and research findings have been inconsistent. Although Asians reportedly engage in fewer risk behaviors compared to their Euro American counterparts (Feldman, Rosenthal, Mont-Reynaud, Leung, & Lau, 1991), some investigators have found similar levels of risk behaviors among different cultural groups, Asian and non-Asian (C. Chen, Greenberger, Dong, & Guo, 1998; Makini et al., 2001; Weine, Phillips, & Achenbach, 1995), while others have found higher levels among Asian American youth compared to other ethnic groups (Sharma, 2004). Comparisons of adolescents in different Asian sub-groups suggest more substance use by Filipino youth than Chinese youth (X. Chen & Unger, 1999; Faryna & Morales, 2000; James, Kim, & Moore, 1997). More specifically, X. Chen and Unger examined smoking initiation rates in a randomly selected sample of Asian and Research in Nursing & Health DOI 10.1002/nur

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non-Asian American adolescents in California. They found that although Asian Americans exhibited a lower risk of smoking initiation in early adolescence, their risk increased throughout adolescence, whereas the risk for other ethnic groups stabilized at 14–15 years of age. Existing survey research findings indicate that smoking prevalence among Asian American youth increases at a rate much faster than any other ethnic group (American Legacy Foundation, 2001). Significant differences also were found among the Asian American sub-groups. Chinese American youth were at lowest risk for smoking; Filipinos were at highest risk. Filipino youth were more likely to engage in other types of risk behaviors. Faryna and Morales found that Filipino youth reported higher prevalence of sexual activity and James et al. reported that Filipinos engaged in more drug use compared to Chinese adolescents. Although such studies of Asian American adolescent risk behaviors are uncommon, the findings underscore the importance of investigating patterns of risk behaviors within Asian sub-groups. The lack of knowledge about risk behaviors is a major research issue because of the association between poor psychological health, delinquency, and substance abuse and the projected increases in drug use among Asian American youth (Jessor, 1991; Roberts, 2000; Zane & Sasao, 1992). Investigators have hypothesized that secondgeneration Asian Americans may increase their substance use behavior as they become more integrated into American culture (Fong, 1992; Ross-Sheriff, 1992). However, empirical evidence testing this hypothesis is limited. CONCEPTUAL FRAMEWORK The study reported here was guided by two theoretical perspectives: the ecological theory of human development (Bronfenbrenner, 1979, 1986) and the Szapocznik, Scopetta, Kurtines, and Aranalde (1978) conceptualization of the acculturation processes in immigrant families. Bronfenbrenner (1979) posited that individual development is a function of the interaction of multiple ecological systems. Following this theory, adolescent development must be viewed within the context of the family, sociocultural, and physical environments. The family is the principal component of the micro-system. The family system, parent-child interactions, and peer relationships play key roles in mediating or ameliorating poor psychological outcomes (Birmaher

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et al., 1996; Ge, Conger, Lorenz, Shanahan, & Elder, 1995). Szapocznik and Williams (2000) focused on the impact of acculturation on families and proposed the ecological perspective as a basis for understanding acculturation and its influence on adolescent development and behavior. Acculturation is a complex process of accommodation to the host culture and involves changes at multiple levels of the ecosystem, including changes in behavior, attitudes, and values (Cuellar, 2000). The acculturation process may be unidimensional, bidimensional, or multidimensional, depending on whether the world in which one resides is primarily mono-cultural, bicultural, or multicultural (Szapocznik & Kurtines, 1993). Immigrant or foreign-born youth often live between two cultural worlds: their family (culture of origin) and the outside community. Their challenge is to develop skills to function effectively in multiple cultural contexts, while trying to adjust to new roles that may or may not be congruent with their culture of origin (Szapocznik & Williams, 2000). Although adolescents acculturate more rapidly than do their parents, their adolescent developmental tasks are complicated by the culture gap often experienced by immigrant families (Zhou, 1997). First-generation youth, particularly recent immigrants, typically maintain more of their culture of origin values and behaviors than later generations. Relative to earlier generations, thirdor later-generation youth, born and raised in the US and whose parents were also born and raised here, are likely to be highly acculturated into Western culture. Hence, first- and third-generation youth’s values and beliefs are hypothesized to be more consonant with their parents. In contrast, second-generation teens tend to struggle most with the differences they perceive between the dominant outside Western culture and their family’s cultural values (Willgerodt, Miller, & McElmurry, 2002). In other words, second-generation teens tend to experience the largest culture gap compared with first- and third-generation Asian American youth. As adolescents struggle for autonomy in the face of their family’s desire for connectedness, acculturation differences among family members manifest themselves as strained parent-adolescent relationships and inter-generational conflict, which, in immigrant families, can give rise to adolescent emotional distress, delinquency, and substance use (Szapocznik, Hervis, & Schwartz, 2003; Szapocznik & Kurtines, 1993; Szapocznik, Kurtines, & Fernandez, 1980; Zhou, 1997). Research in Nursing & Health DOI 10.1002/nur

In this study, we addressed these research gaps by exploring the influence of ethnicity and generational status on emotional distress and risk behaviors, controlling for age, gender, and family income. The ecological and acculturation theoretical perspectives underpinning this research provided the context to explore generational differences within families to understand better adolescent emotional distress and involvement in risk behaviors. The following research questions were addressed: (1) Does ethnicity influence depression, somatic symptoms, delinquency, and substance use among Chinese, Filipino, and Euro American adolescents? (2) Does generational status influence depression, somatic symptoms, delinquency, and substance use among Chinese and Filipino American adolescents? METHODS Study Overview, Design, and Procedures Data for this study were drawn from Wave 1 of the National Longitudinal Study on Adolescent Health (Add Health) collected in 1994 (Udry, 2003). This is an ecologically framed, nationally representative study of individual, family, and environmental influences on various aspects of health, including substance use and mental health. The study included all high schools in the US that had an 11th grade and at least 30 students in the school (n ¼ 26,666). A random sample of 80 high schools and 52 middle schools from the US was selected, stratified by region, urbanicity, school type, and percentage Euro American. One hundred thirty four schools agreed to participate. A random sample of adolescents in grades 7– 12 was selected to participate in an in-home interview (n ¼ 12,118). In-home interviews included detailed questions on health status, peer networks, family composition and dynamics. Adolescents aged 15 and older were also asked sensitive questions, including questions about substance use. Adolescents listened to the questions through earphones and then entered their responses directly into a laptop computer to protect confidentiality and minimize interviewer and parental influence on the responses (Bearman, Jones, & Udry, 1997). Parents of adolescents participating in the in-home interview were interviewed to provide further information about the family

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composition and the adolescent’s health history. Parental consent was required to list student names in a directory and to allow students to participate in the study. To protect the identities of participants, a rigorous security system prevents anyone from being able to link a respondent’s answers to a name or other identity, but, at the same time, allows researchers to link questionnaires across all components of the study (Harris et al., 2003). In this study, we used data from the adolescent and parent in-home interviews. Consent was obtained from the University of North Carolina at Chapel Hill (UNC-CH) under the contractual agreement held by the second author. This study was reviewed by the Human Subjects Divisions of both UNC-CH and the University of Washington. Sample The sample for this study was composed of 216 Chinese, 387 Filipino, and 400 Euro American adolescents (see Table 1). Analyses of variance, with Tukey’s post hoc tests and Chi-square tests, were conducted to determine if the three ethnic groups differed from one another. The groups differed significantly in age (F[2,1002] ¼ 62.3, p .001). Filipino adolescents were older than the Chinese and Euro American youth, but Chinese youth were not significantly different from the Euro Americans. The sex distribution differed significantly by ethnic group (w2[2, n ¼ 1003] ¼ 6.31, p .05). The Euro American group had proportionately fewer males

compared to the Chinese and Filipino groups. Group differences were also noted in family income (F[2,697] ¼ 3.10, p .05). Filipino youth came from families with significantly lower family incomes compared to the Chinese adolescents, who did not differ from the Euro American adolescents (Table 1). All subsequent analyses were conducted controlling for age, sex, and family income.

Measures Measures were constructed using student and parent data and were divided into three categories: background, predictor, and outcome variables. For variables indexed with multiple items, inter-item reliability analyses were conducted to determine if the measure demonstrated adequate internal consistency. Background variables. Age was calculated by subtracting the date of birth from the interview date. Gender was measured in terms of biological sex as reported by the interviewer, and family income was measured using parent report of yearly household income before taxes. Predictor variables. Generational status was used as a proxy for acculturation and was calculated using both adolescent and parent data. Both adolescents and parents were asked for their place of birth in their respective interviews. Adolescents who were foreign-born and moved to the US after age 6 and whose parents were foreign-born were categorized as first generation.

Table 1. Sample Characteristics by Ethnicity

Age (in years)a Range Mean (SD) Median Income (in dollars)a Range Mean (SD) Median Sexb Male Female

Chinese (n ¼ 216)

Filipino (n ¼ 387)

Euro American (n ¼ 400)

13–19 15.7 (1.38)c 16

12–20 16.7 (1.35)c 17

12–21 15.6 (1.63) 16

2–600 K 67.6 K (76.32)d 50 K

0–450 K 47.3 K (35.82)d 42 K

117 (54%) 99 (46%)f

a

206 (53%)e 181 (47%)f

0–999 K 54.7 K (89.27) 45 K 182 (45.5%)e 218 (54.5%)f

Analysis of variance. Chi-square. c,d Tukey’s post hoc comparison (p .05). Means that are significantly different have the same superscript. e,f Distributions that differ significantly between ethnic groups have the same superscript. b

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Adolescents who were foreign-born and moved to the US before age 6 or were US-born and whose parents were foreign-born were categorized as second generation. Third-generation adolescents were youth who were US born and whose parents were also US-born. Ethnicity was categorized according to selfreport on two items. Adolescents were first asked to identify themselves by selecting one of five ethnic categories: White, not of Hispanic origin, African American, Asian or Pacific Islander, American Indian or Alaskan Native, or Other (individuals of Hispanic origin were asked to respond to a separate question). Those who selected Asian or Pacific Islander were then asked to specify their ethnic background by selecting one of seven categories. Individuals who selected Chinese or Filipino were included in this study. Further, youth who were of mixed race but who self-identified as either Chinese or Filipino were categorized into the appropriate group. Four hundred adolescents who identified themselves as White were randomly selected from the larger sample and categorized as Euro American. Outcome variables. Emotional distress was defined broadly to capture the various ways that psychological distress is expressed, particularly among Asian youth, and was indexed with items relating to depressive and somatic symptoms. Depression was measured by 19 items in the Feelings Scale, a modified version of the Center for Epidemiological Studies-Depression (CES-D) scale used widely in population-based survey studies (Radloff, 1977). In this study, two items (I had trouble sleeping and I had crying spells) from the original CES-D scale were omitted and one item (I felt that life was not worth living) was added. Items include questions about how the adolescent has been feeling over the past week. Examples include: how often in the last week have you been bothered by things that do not usually bother you, felt lonely, felt sad, and, had a hard time to get started doing things. Four items were positively worded and required reverse coding. In this sample, internal consistency was adequate for all three ethnic groups (a ¼ .84–.87). Somatic symptoms were assessed using 14 items about the frequency of symptoms over the past 12 months, such as poor appetite, trouble falling asleep, trouble relaxing, stomach ache, and frequent crying spells. Responses were summed so that higher scores indicated higher levels of emotional distress. The internal consistency estimates for each of the three ethnic groups was .82. Research in Nursing & Health DOI 10.1002/nur

Delinquency was indexed by a 15-item scale that asked if a respondent had engaged in delinquent activities. Examples include the number of times you have painted graffiti, number of times you stole something worth more than $50, and number of times you used the car without permission. Responses ranged from 0 (never), 1 (1 or 2 times), or 2 (3 or more times). The alpha coefficients for the three groups ranged from .81 to .83. Substance use was defined broadly to include smoking, drinking alcohol without parental supervision, marijuana, cocaine, inhalants and illegal drugs. Respondents were asked if they had ever tried any of the above (no ¼ 0, yes ¼ 1) and responses were summed to determine the number of substances an individual had tried, ranging from 0 (never tried any of the above) to 6 (tried six substances). Data Analysis The data were analyzed to determine if ethnicity and generational status influence depression, somatic symptoms, delinquency and substance use, after controlling for age, sex, and income. Tests of assumptions underlying the statistical tests were conducted and found to be true. Descriptive statistics, including means and standard deviations, were calculated for all outcome variables. Zero-order correlations also were examined. The proportion of missing data for family income was high (30%). To avoid unnecessary loss of cases in the analyses, regression imputations were used to replace the missing data (Allison, 2002; Little, 1992). Correlations between all the variables in the study were examined for each ethnic group to identify variables that were correlated with income. Stepwise regression analyses were conducted incorporating variables significantly correlated with income to estimate missing values. Dummy variables were created for sex, ethnicity, and generation. To answer the first research question, hierarchical multiple regression was conducted with samples of 216 Chinese, 387 Filipino, and 400 Euro American adolescents. Regression analyses were conducted for each of the four outcome variables. Age, sex, and family income were entered into the regression equation as the first block or set of variables; ethnicity, using two dummy variables to reflect the three ethnic groups, was entered as the second block. The regression was re-run, using different referents for the sole purpose of obtaining the betas for the referent

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group. The final regression equation was used to interpret the effects of ethnicity on the major study variables. To address the second research question and because of the small numbers of first- and secondgeneration Euro Americans, only Chinese and Filipino adolescents were included in the analyses. An initial regression analysis was used to test for the interaction of ethnicity and generation. This analysis included all three generations of Chinese and Filipino youth. Age, sex, and income were entered in the first block of predictors; ethnicity was entered in the second block with Filipino youth as the referent; generation was entered in the third block with second generation youth as the referent; and two interaction terms (ethnicity first generation and ethnicity third generation) were entered in the final block. Because this is an early descriptive exploratory investigation, p-values were set at .05 to facilitate observation of even small effects. Analyses were conducted using the Statistical Package for Social Sciences (Version 11.5 for Windows).

RESULTS

Chinese, Filipino, and Euro American adolescents, controlling for age, sex, and family income? Table 2 shows that correlations between depression and somatic symptoms and between delinquency and substance use were moderate across all three ethnic groups. Means and standard deviations for depression, somatic symptoms, delinquency and substance use by ethnicity are presented in Table 3. In general, Filipino Americans had the highest mean depression and delinquency scores; Euro American adolescents had the highest somatic and substance use scores. One-way analyses of variance revealed that mean scores for somatic symptoms and substance use among Chinese American youth were the lowest compared to the Filipinos and Euro Americans, and mean depression scores fell between those for Filipino and Euro American adolescents. Regression analysis, controlling for age, sex, and family income, revealed that ethnicity predicted depression and delinquency; being Filipino was significantly associated with higher depression and delinquency scores compared to both Chinese and Euro American adolescents. Ethnicity did not predict somatic symptoms or substance use (see Table 4).

Research Question #1

Research Question #2

Does ethnicity influence depression, somatic symptoms, delinquency, and substance use among

Does generation status predict depression, somatic symptoms, delinquency, and substance

Table 2. Zero-Order Correlations Among Outcome Variables for Chinese, Filipino, and Euro American Adolescents Variables

1

2

3

4

1. Depression 2. Somatic symptoms 3. Delinquency 4. Substance use

1

.59** 1

.15* .20** 1

.26** .26** .47** 1


1

.58** 1

.24** .28** 1

.18** .18** .56** 1


1

.56** 1

.27** .19** 1

Chinese American (n ¼ 216)

Filipino American (n ¼ 387)a

Euro American (n ¼ 400)a

*p .05. **p .01. a Sample size varies slightly due to missing data.


.03 .04 .02 1

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Table 3. Means and Standard Deviations for Outcome Variables by Ethnicity

Variables (Range)

Emotional distress Depression (0–46) Somatic symptoms (0–43) Risky behaviors Delinquency (0–32) Substance use (0–6)

Chinese American (n ¼ 216)

Filipino American (n ¼ 387)

Euro American (n ¼ 400)

M (SD)

M (SD)

M (SD)

10.87 (7.04) 11.42 (6.62)a

14.27 (6.97)a 11.96 (6.76)

10.67 (7.37)a 12.72 (7.20)a

3.45 (4.36) .62 (1.0)a

4.84 (5.35)a 1.29 (1.37)

3.87 (4.50)a 1.46 (.43)a

a

Denotes significant (p .05) mean differences between ethnic groups.

use among Chinese and Filipino American adolescents, controlling for of age, sex, and family income? One-way analyses of variance indicated that among Chinese American adolescents, thirdgeneration youth scored higher in somatic symptoms and substance use compared to the second generation. Additionally, second-generation Filipino adolescents reported more delinquency and substance use compared to the first generation (Table 5). Using regression analysis, controlling for age, sex, and family income, the interaction of ethnicity and generation on study outcomes was examined first. Observed were significant ethnicity second generation (b ¼ .30, p < .01) and ethnicity third generation interaction effects for somatic symptoms (b ¼ .19, p < .01). A significant ethnicity first generation interaction effect for substance use (b ¼ .15, p < .01) was also observed. In addition, ethnicity second generation (b ¼ .21, p ¼ .06) and ethnicity third generation (b ¼ .13, p ¼ .06) interaction effects for delinquency, and a ethnicity first generation interaction effect (b ¼ .15, p ¼ .07) approached significance. These findings indicate that the effect of generation on the study outcomes was moderated by ethnicity. Thus, to understand better differences between ethnic groups, separate regressions were conducted for the Chinese and Filipino youth (Stevens, 2001). Age, sex, and income were entered into the first block. Generation, using two dummy variables to reflect the three groups, was entered in the second block, with second generation as the referent. Among Chinese American youth, generational status was significantly associated with somatic symptoms and substance use. Third-generation youth reported more somatic symptoms compared to both first- and second-generation youth and Research in Nursing & Health DOI 10.1002/nur

higher substance use compared to first- and second-generation adolescents (Table 6). Among Filipino American youth, generational status predicted delinquency and substance use. Being second generation, compared to first generation, was associated with significantly higher levels of delinquency and substance use. Being third generation, compared to first-generation Filipino youth, was also associated with higher substance use (Table 7).

DISCUSSION This exploratory study was a first step in describing distress and risk behaviors among Asian American and Euro American youth. There were several important differences based on ethnicity and generational status with respect to each of the outcomes in this study. Discussion of the findings is organized by the two research questions, followed by the study limitations.

Ethnicity Effects on Depression, Somatic Symptoms, Delinquency, and Substance Use Ethnicity was predictive of depression, after controlling for age, sex, and family income; Filipino American youth reported significantly more depression than the other ethnic groups. These findings conflict with existing research that reports no difference in depressed mood between Filipino and Euro American adolescents (Edman et al., 1998), and refutes the model-minority myth, which has been associated with Asian Americans for decades. Also demonstrated is that grouping Asian Americans together masks differences

1.21 1.36 0.01 .04 .05 .00 6.92 6.91 .004 1.33 2.14* 3.11** .05 .08 .11 .55 .79 1.33 1.14 1.14 .36 .04 .04 .01 Note: All analyses controlled for age, sex, and family income. B, partial regression coefficient; b, standardized partial regression coefficient. *p .05. **p .01. ***p .001.

.80 .58 .22 .91 5.69*** 3.99*** .03 .20 .14 .55 3.06 2.50 Ethnicity Chinese (1) versus White (0) Filipino (1) versus White (0) Chinese (1) versus Filipino (0)

b t b B t b Predictor Variables

B

t

B b

Delinquency (n ¼ 998) Somatic Symptoms (n ¼ 1,003) Depression (n ¼ 1,001)

Table 4. Multiple Regression Results for the Effects of Ethnicity on Outcomes

Outcome Variables

B

Substance Use (n ¼ 1,003)

t



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between sub-groups. Research that explores mental health issues with Filipino American adolescents is virtually non-existent; thus, the reasons why Filipino youth report more depression than other Asian ethnic groups, after controlling for age, sex, and family income are difficult to understand. More studies are clearly needed, particularly those that explore mental health in various social and environmental contexts to unearth the factors associated with differential depression experiences among Asian American sub-groups. With respect to somatic symptoms, widespread documentation indicates that Asians are more likely to somaticize psychological processes compared to other non-Asian groups because of the cultural stigma associated with psychological illness (Greenberger & Chen, 1996; Uba, 1994). Negative social consequences such as ostracism and isolation are not associated with somatic symptoms as they are with mental health problems. Accordingly, Asians are likely to be more comfortable talking about physical as opposed to psychological complaints (Uba, 1994). In this study, however, ethnicity was not significantly associated with somatic symptoms. In fact, Euro American youth reported more somatic symptoms than either Chinese or Filipino American adolescents when examining mean scores. These unexpected findings need to be confirmed with more research. Ethnicity, specifically, being Filipino compared to Chinese and Euro American adolescents, was associated with delinquency, confirming findings from previous research (James et al., 1997). Further, delinquency between Chinese and Euro American youth did not differ dramatically. Asian Americans, in general, are thought to have greater family stability, to socialize their children to group norms, to obey authority, and to maintain group honor (Uba, 1994). These values, which may serve as behavioral controls for some Asian American adolescents, may not be held in similar ways for Filipinos. The Filipino culture, with historical exposure to Western culture and values, may value individual autonomy and adolescent independence more strongly than other Asian groups. This may explain the difference observed between Filipino and Chinese adolescents. Yet, why Filipino youth engaged in more delinquent acts than Euro American youth remains unclear. These differences challenge the notion that Asian Americans, in general, commit less deviant acts. The lack of significant ethnicity effects with respect to substance use also warrant further examination, particularly in light of the finding

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Table 5. Means and Standard Deviations for Outcome Variables by Ethnicity and Generation Chinese American Variables (Range)

Emotional distress Depression (0–46) Somatic symptoms (0–43) Risky behaviors Delinquency (0–32) Substance use (0–6)

Filipino American

First

Second

Third

First

Second

Third

M (SD)

M (SD)

M (SD)

M (SD)

M (SD)

M (SD)

12.02 (7.17) 11.02 (6.84)

10.41 (6.2) 11.26 (8.95) 14.89 (6.2) 14.07 (7.52) 11.78 (7.8) 10.85 (5.63)a 13.98 (8.36)a 11.53 (6.88) 12.59 (6.78) 10.26 (5.75)

3.04 (4.01)

3.45 (4.26)

.70 (.92)

.47 (.77)a

4.09 (5.07) .95 (1.46)a

3.93 (4.44)a 5.88 (6.0)a

4.09 (5.33)

1.06 (1.21)a 1.45 (1.45)a 1.48 (1.34)

a

Denotes significant (p .05) mean differences between generations.

that Filipino youth reported more delinquency and that delinquency was moderately correlated with substance use. The need to separate Asian subgroups analytically when comparing them to Euro American adolescents to identify those at higher risk for poor psychological and behavioral outcomes is further highlighted by these findings, and underscores the need for Asian-specific research in this area. Generational Status Effects on Depression, Somatic Symptoms, Delinquency, and Substance Use Generational status effects were not noted with depression, but generational influences on somatic symptoms were evident among Chinese American youth. Increased somatic symptoms were associated with third-generation status, compared to both first and second generations. This finding is intriguing; we speculated that some Asian groups were more likely to somaticize than others but we still expected that the tendency to somaticize would decrease with each generation, given the evidence that with acculturation, behavior begins to mimic the majority culture (Ross-Sheriff, 1992). That is, we expected that third-generation Asian youth would not somaticize as much as earlier generations because third-generation youth may not feel that psychological issues carry the same degree of stigma as earlier generations, who may retain the more traditional Asian views of mental health. Findings from this study contradict this notion. The mean scores indicate that symptoms expression patterns were different between Chinese and Filipino American youth. Second-generation Chinese adolescents reported Research in Nursing & Health DOI 10.1002/nur

the least somatic symptoms, and the third generation reported the highest. In contrast, thirdgeneration Filipino youth reported the fewest symptoms and the second generation reported the highest. These findings, in part, may be an indication of the inadequacy of generation as a proxy of acculturation. As for other findings in this study, there is little research and undeveloped theoretical basis for understanding this apparent generation effect. Additional studies are needed to validate such findings and to explore why Chinese youth who have lived in the US longer tend to report more somatic symptoms. Generational influences on delinquency and substance use were noted with both Chinese and Filipino American youth. Being second generation was associated with more delinquency compared to first generation among Filipino youth only. Generation effects for delinquency were not noted for Chinese youth. Generational influences were present, however, among both Chinese and Filipino groups with respect to substance use. For Chinese youth, being third generation, compared to second, was associated with increased substance use. For Filipino youth, being second and third generations, compared to first, was associated with increased substance use; that is, the likelihood of engaging in substance use increased with each generation. The results confirm speculation that higher levels of acculturation in Asian Americans is associated with increased substance use (Fong, 1992; Hahm, Lahiff, & Guterman, 2004; Ross-Sheriff, 1992). These findings, however, only partially support the Szapocznik and Williams (2000)’s acculturation framework, which posits that members of the second generation are more likely to experience the largest culture gap between parent

.16 1.40 0.24

Generational status 1st gen. (1) versus 2nd (0) 3rd gen. (1) versus 2nd (0) 1st gen. (1) versus 3rd (0)

.10 .08 .01

b 1.32 1.10 0.16

t

0.08 3.07 2.99

B

.005 .19 .19

b

Research in Nursing & Health DOI 10.1002/nur .39 .87 1.27

B .04 .08 .12

b t .50 1.09 1.32

Delinquency (n ¼ 212)

.19 1.42 1.23

.01 .05 .09

.24 .93 .80

1.35 1.98 .64

B

.10 .07 .05

1.80 1.33 .41

t

b

t

b

B

Note: All analyses controlled for age, sex, and family income. B, partial regression coefficient; b, standardized partial regression coefficient. *p .05. **p .01.

Generation status 1st gen. (1) versus 2nd (0) 3rd gen. (1) versus 2nd (0) 1st gen. (1) versus 3rd (0)

Predictor Variables

Somatic Symptoms (n ¼ 384)

Depression (n ¼ 383)

1.91 1.85 .06

B

.18 .08 .01

b

B

1.04 3.44*** 2.03*

t

.53 .14 .67

B

.20 .03 .25

b

3.58*** .49 2.20*

t

Substance Use (n ¼ 384)

.07 .24 .18

b

Substance Use (n ¼ 212)

.18 .60 .43

3.23*** 1.58 .05

t

Delinquency (n ¼ 381)

Table 7. Multiple Regression Results for the Effects of Generational Status on Outcomes Among Filipino American Youth

.07 2.56** 2.08*

t

Somatic Symptoms (n ¼ 212)

Note: All analyses controlled for age, sex, and family income. B, partial regression coefficient; b, standardized partial regression coefficient. *p .05. **p .01. ***p .001.

B

Predictor Variables

Depression (n ¼ 212)

Table 6. Multiple Regression Results for the Effects of Generational Status on Outcomes Among Chinese American Youth


321

322


and child and to perceive a less supportive family environment, rendering them more vulnerable to poor psychological outcomes and more likely to engage in risk behaviors. Although second-generation youth in this study engaged in more substance use than the first generation, they engaged in less than the third generation. An alternative explanation for the generational findings is that with acculturation, immigrants become behaviorally more similar than dissimilar to the majority culture. Cultural adaptation may weaken the traditional hierarchical parent-child relations that previously served as behavioral controls for immigrant children (Lin & Liu, 1993). Exploration of generational differences among Euro American adolescents was not possible due to a small sub-sample; future researchers should determine if third generation behavior patterns of multigroup immigrant adolescents are like those of the general population. The unique generational differences in risk behaviors among Chinese and Filipino American adolescents in this study highlight the importance of and the need to understand the social, familial, and environmental contexts in which various generations of immigrant adolescents live. Limitations Results from this study must be interpreted cautiously. Because this was a secondary analysis of a large existing database, findings are limited by the available measurement of the variables under study. The constructs of depression, somatic symptoms, delinquency, and substance use created for this analysis might not capture the breadth and depth of emotional distress and risk behaviors, particularly among Chinese and Filipino immigrant youth whose perceptions of psychological health may be culturally bound. Every effort was made to utilize as many symptom items as possible that reflected underlying potential psychological issues. Yet somatic symptoms commonly and uniquely experienced by Asian Americans may not have been identified. Further, substance use was calculated by summing the number of substances tried. Measures that incorporate both experimenting with and the frequency with which adolescents actually engage in cigarette-smoking or drug use may be a more robust method to assess substance use among adolescents. The crosssectional design of the study did not allow for exploration of the persistence of emotional distress and substance use across time. Behavioral and psychological outcomes, in particular, are Research in Nursing & Health DOI 10.1002/nur

important to examine across time in longitudinal studies because in adolescence, they are prone to fluctuation and contextual influences. The Euro American sample was randomly selected from the pool of participants who self identified as White. Euro Americans as a group, however, are not a homogeneous group and the diversity within this group may have influenced the study findings. Finally, although the Add Health database provided one of the largest samples of Chinese and Filipino youth available, the relatively small, unweighted sample precludes generalization of these findings to the general population. Nevertheless, despite these limitations, observations made in this study provide an important starting point to understand ethnic and generational differences among immigrant youth about whom few empirical studies exist. Findings from this study provide initial comparative data with Euro American youth and begin to add clarity to the psychological status and behavior patterns of different generations of Chinese and Filipino American adolescents. The unique findings noted in this study underscore the need and importance of conducting ethnic and generation-specific research among Asian American youth.

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