High Parenting Aggravation Among US Immigrant Families

Abstract

Objectives. We examined the association between the joint effects of children’s immigrant family type and race/ethnicity on parenting aggravation.

Methods. We analyzed data on a nationally representative sample of 101 032 children aged birth through 17 years from the 2003 National Survey of Children’s Health.

Results. Analysis of the Aggravation in Parenting Scale showed that 26% of foreign-born parents with foreign-born children were highly aggravated, followed by 22% of foreign-born parents with US-born children and 11% of US-born parents. Multivariable analyses indicated that all minority parents experienced high parenting aggravation compared with non-Hispanic White US-born parents; the odds of reporting parenting aggravation were 5 times higher for Hispanic foreign-born parents. All foreign-born parents, regardless of race/ethnicity, reported significantly elevated parenting aggravation. Parents of adolescents, children with special health care needs, and nontraditional and lower-income households were also more likely to report high parenting aggravation.

Conclusions. Our findings clearly document significantly elevated levels of parenting aggravation among immigrant and minority families. Public health programs and clinicians should target referrals and interventions for these families to avoid potential health problems for both children and their families.

Between 2000 and 2005, the United States saw the highest 5-year period of immigration in its history.¹ Census data indicate that 22% of children, or 16 million, lived with a foreign-born householder in 2007, an increase from 12.1% from 1990, although only 4% of all US children were themselves foreign born.² In 2005, an estimated 3.1 million children lived in “mixed-status” families that included both citizen and noncitizen members, making the children’s health care access and eligibility for public benefits more complex.³ Five out of 6 undocumented families with children are in this category. Children living with foreign-born householders tend to be younger, and are more likely to live in poverty than those living with US-born householders.⁴

Regardless of nativity, children in immigrant families are a special population since their well-being is very much influenced by the immigrant attributes of their parents, including those related to language and culture, health care–seeking behavior, and public program access and eligibility.^5–8 The notion of “immigrant family type” is therefore important in the study of family dynamics, representing different challenges faced by these families. Within the last decade, immigrants have also dispersed to many states that previously did not have a large foreign-born population and thus may lack the infrastructure and resources to address the special needs of such populations.⁹

Among the many hardships faced by immigrant families, those related to economic conditions, health insurance, acculturation, access of public benefit programs, and English proficiency are likely the most challenging.^10,11 These may all contribute to stress and aggravation in the family lives of immigrants. Raising children in a new country can be difficult. Immigrant parents are frequently limited in their ability to act as advocates for their children in the school and health care settings.¹² On the other hand, the evidence of resilience and the academic and socioeconomic success of children from immigrant households has probably masked the hardships and demanding adjustments experienced by immigrant families.^13–15

Despite studies showing lower mortality and morbidity risks among immigrants compared with US-born infants, children, and adults,^16–22 other measures of health and well-being, such as parent-reported health status, participation in physical activities, access to preventive services, and other psychosocial characteristics have been less favorable.^23–26 The American Academy of Pediatrics recently updated its policy statement describing the unique and complex medical and psychosocial risks faced by immigrant children and recommended that children not be denied needed services on the basis of immigration status.²⁷ Furthermore, the intended and unintended effects of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act^8,28 have posed numerous challenges to health care access and the family lives of recent immigrants.^29,30

Parenting aggravation is a measurement of stress experienced by parents associated with caring for children. High parenting aggravation has previously been associated with maternal and paternal depression, autism, learning disabilities, child obesity, maternal chronic illness, paternal alcoholism, single parenthood, family transitions, and Black race.^31–39 Parenting aggravation has never been explored in immigrant families and racial/ethnic groups.

The 2003 National Survey of Children’s Health (NSCH) is the first national survey that provides information on parenting aggravation on a sufficiently large sample of children from different racial/ethnic groups and immigrant family types to permit such analysis.⁴⁰ Using data from the 2003 NSCH, we aimed to determine the prevalence of parenting aggravation in different immigrant family types and racial/ethnic groups in the United States, and to examine the joint effects of race/ethnicity and immigrant family type on parenting aggravation while controlling for confounding variables. To our knowledge, our study is the first that characterizes parenting aggravation in immigrant families using a large nationally representative probability sample.

METHODS

The 2003 National Survey of Children’s Health was a random digit-dialing telephone survey that used the sampling frame of the National Immunization Survey and the State and Local Area Integrated Telephone Survey mechanism developed by the National Center for Health Statistics. The survey (n = 102 353) examined the physical and emotional health of around 2000 children (aged birth–17 years) in each of the 50 states and the District of Columbia. The respondent for the survey interview was the parent or legal guardian most knowledgeable about the health and health care of the randomly selected child. The survey was conducted in English or Spanish. Among households with children, the response rate for the interview was 68.8%. Details of this survey can be found elsewhere.⁴¹

Measures

The major independent variable was a compound variable composed of the child’s immigrant family type and race/ethnicity. The 4 immigrant family types were as follows: foreign-born child, US-born child with 1 foreign-born parent, US-born child with 2 foreign-born parents, and US-born child and US-born parents (comparison group). Race/ethnicity included non-Hispanic White, non-Hispanic Black, Hispanic, multiracial, and non-Hispanic other. We used US-born non-Hispanic White as the comparison group, since 66% of the children were in this category. We weighted data to represent all children in the United States.

We measured parenting aggravation by the Aggravation in Parenting Scale.⁴² Strong psychometric properties have been reported for this scale (α = 0.63). It has been included in the National Surveys of American Families, the National Survey of Income Dynamics, and the National Surveys of Children’s Health to measure parenting stress.^37,38,43 Respondents were asked how often in the past months they felt (1) that the child was much harder to care for than most same-aged children, (2) bothered a lot by things the child did, (3) that they were giving up more of their life than expected to meet the child’s needs, and (4) angry with the child. Each of the 4 outcomes was given equal weights in the scale. We reverse coded items to enable calculation of the score. We did not include in the analytic sample respondents who did not respond to all 4 questions (n = 1321). We summed the responses for a possible total of 16 points. Higher scores on the scale indicate less aggravation. A score of 11 or below indicates high aggravation in parenting; the respondent in this category had to answer “usually” or “sometimes” to at least 2 of the 4 scale items. A score of 16 indicates low levels of aggravation in parenting; the respondent in this category had to answer “never” to all 4 scale items. To address the issue of construct validity of the scale, we empirically assessed its association with child and maternal health outcomes and found that higher levels of parenting aggravation were associated with poorer overall health among children and mothers (data not shown). Furthermore, the relationships between the aggravation scale and child and maternal health outcomes were in the same direction for all racial/ethnic and immigrant groups as those for the overall population. The Cronbach α of the scale based on our data was 0.63.

Using the Federal Maternal and Child Health Bureau’s definition, we classified children as “children with special health care needs” if they (1) needed or used medicine prescribed by a doctor (other than vitamins), (2) needed or used more services than is usual, (3) were limited or prevented in ability to do what most same-aged children can do, (4) needed or got special therapy, or (5) had an emotional, developmental, or behavioral problem that needed treatment. Those answering yes were asked whether the condition was because of a medical, behavioral, or other health condition, and if yes, whether that condition had lasted or was expected to last 12 months or longer.⁴⁴

Other sociodemographic variables included the child’s age group (birth–5, 6–8, 9–11, 12–14, and 15–17 years), gender, federal poverty level (FPL; < 100% [poor], 100%–199% [near-poor], 200%–399%, and ≥ 400%), highest education level attained by anyone in the household (< high school, high school graduate, and > high school), family structure (2-parent biological or adopted, 2-parent step family, single mother with no father, and other), and number of children in household (1, 2, 3, and ≥ 4).

Statistical Analysis

We used χ² analyses to test for sociodemographic and parenting aggravation differences across different immigrant family types. We used logistic regression analyses to examine the joint effects of immigrant family type and race/ethnicity on parenting aggravation outcomes, adjusting for children’s age, gender, health status, FPL, “children with special health care needs” status, family structure, and total number of children. We did not include educational level as a covariate because of its collinearity with income. Income has been shown to be a better predictor of socioeconomic status for immigrants, since education credentials from foreign countries often result in underemployment in the United States.⁴⁵ We derived adjusted odds ratios and 95% confidence intervals from results of the multivariable logistic analyses. To account for the complex sample design involving stratification, clustering, and multistage sampling of the NSCH, we conducted statistical analyses using SAS version 9.1 (survey procs; SAS Institute, Cary, NC).⁴⁶ We applied Taylor series linearization methods for variance estimation as recommended.

RESULTS

Table 1 shows the demographic distributions of the children by immigrant family type. Most foreign-born children were Hispanic. Foreign-born children were older compared with all US-born children groups. Of the child categories, those with the highest proportion living in poverty were foreign-born and US-born children with 2 foreign-born parents. One third of the foreign-born children lived in poor (< 100% of FPL) households. Foreign-born parents with US-born children were the least educated, followed by foreign-born parents of foreign-born children. Almost one fifth of US-born children with US-born parents were classified as children with special health care needs. US-born children with immigrant parents were likely to reside in 2-parent biological or adoptive households. Households with 2 foreign-born parents had a higher percentage of 4 or more children.

TABLE 1—

Demographic and Socioeconomic Characteristics of US Children (Aged Birth–17 Years), by Immigrant Family Type: National Survey of Children’s Health, 2003

	Foreign-Born Child, % (SE)	US-Born Child, Both Parents Immigrants, % (SE)	US-Born Child, 1 Parent Immigrant, % (SE)	US-Born Child, Both Parents US-Born, % (SE)
Total	4.8 (0.1)	7.2 (0.2)	5.1 (0.1)	82.8 (0.2)
Child’s race/ethnicity
Hispanic	58.0 (1.6)	66.8 (1.3)	34.4 (1.3)	9.5 (0.2)
Non-Hispanic White	16.6 (1.0)	7.7 (0.6)	44.9 (1.3)	68.1 (0.3)
Non-Hispanic Black	5.9 (0.7)	6.7 (0.6)	7.0 (0.7)	15.8 (0.2)
Multirace	1.7 (0.3)	0.9 (0.2)	7.7 (0.6)	3.0 (0.1)
Other	17.8 (1.5)	17.9 (1.2)	6.1 (0.7)	3.6 (0.1)
Child’s age, y
Birth–5	16.3 (1.2)	48.2 (1.3)	40.6 (1.3)	31.9 (0.3)
6–8	16.8 (1.1)	16.6 (1.1)	16.4 (1.0)	15.8 (0.2)
9–11	19.5 (1.3)	15.0 (0.9)	17.0 (1.1)	17.0 (0.2)
12–14	25.1 (1.4)	12.1 (0.9)	14.2 (0.9)	18.3 (0.2)
15–17	22.2 (1.3)	8.2 (0.8)	11.8 (0.7)	17.0 (0.2)
Child’s gender
Male	50.9 (1.6)	52.6 (1.3)	52.4 (1.3)	50.8 (0.3)
Female	49.1 (1.6)	47.4 (1.3)	47.6 (1.3)	49.2 (0.3)
Family poverty level
< 100% FPL	33.2 (1.6)	28.8 (1.3)	8.8 (0.9)	14.3 (0.2)
100%–199% FPL	18.8 (1.3)	26.2 (1.2)	17.6 (1.0)	20.4 (0.3)
200%–399% FPL	15.3 (1.1)	16.1 (1.0)	29.8 (1.2)	31.4 (0.3)
≥ 400% FPL	15.1 (1.0)	15.0 (0.9)	33.2 (1.2)	24.9 (0.2)
Not stated	17.6 (1.2)	13.8 (1.0)	10.5 (0.9)	9.0 (0.2)
Parent’s educationa
< high school	25.5 (1.5)	27.7 (1.2)	4.1 (0.6)	5.2 (0.2)
High school	22.2 (1.3)	28.3 (1.2)	19.6 (1.1)	26.8 (0.3)
> high school	50.6 (1.6)	42.2 (1.3)	76.2 (1.2)	67.7 (0.3)
Not stated	1.7 (0.4)	1.7 (0.4)	0.1 (0.1)	0.3 (0.0)
Children with special health care needs
Yes	10.6 (0.9)	7.8 (0.8)	14.6 (0.9)	19.1 (0.2)
No	89.4 (0.9)	92.2 (0.8)	85.4 (0.9)	80.9 (0.2)
Family structure
2 parents, biological or adopted	63.4 (1.5)	95.6 (0.5)	89.7 (0.9)	57.1 (0.3)
2 parents, step family	7.5 (0.8)	4.0 (0.5)	10.0 (0.9)	8.7 (0.2)
Single mother	22.6 (1.3)	0.0	0.0	26.3 (0.3)
Other	6.5 (0.9)	0.3 (0.1)	0.2 (0.1)	8.0 (0.2)
Children, total no.
1	16.6 (0.8)	16.6 (0.7)	20.8 (0.8)	22.6 (0.2)
2	36.0 (1.4)	35.6 (1.2)	40.5 (1.2)	39.0 (0.3)
3	28.8 (1.6)	28.8 (1.3)	25.3 (1.2)	24.5 (0.3)
≥ 4	18.6 (1.5)	19.1 (1.3)	13.5 (1.2)	13.9 (0.3)

Note. FPL = federal poverty level. All percentages are weighted. All χ² statistics for testing the association between immigrant status and each of the demographic characteristics were statistically significant at P < .001, with the exception of gender. Total unweighted samples were as follows: for foreign-born children, n = 3663; for US-born children both of whose parents were immigrants, n = 4353; for US-born children 1 of whose parents was an immigrant, n = 4946; for US-born children of US-born parents, n = 88 070.

^aHighest educational attainment of the more educated parent.

Table 2 shows the results of the bivariate analysis on the association between immigrant family type and parenting aggravation measures. A quarter of the foreign-born children with 2 foreign-born parents were categorized in the highly aggravated range, followed by US-born children with 2 foreign-born parents, US-born children with 1 foreign-born parent, and US-born children with US-born parents (P < .001). Across all immigrant family types, households of 2 foreign-born parents with foreign-born children had the highest rate of reporting that “child was usually/always much harder to care for than most children the same age in the past month” (P < .001). Around 30% of households with 2 foreign-born parents reported that they “usually/always gave up more of their life to meet child’s needs than expected,” whereas only 15% or fewer of households with 1 foreign-born parent or with US-born parents reported the same. There was no significant difference between groups in proportion reporting “child does things that bothered parent a lot” or “angry with child.”

TABLE 2—

Aggravation-in-Parenting Scale Items, by Immigrant Family Type: National Survey of Children’s Health, 2003

Scale Item	Foreign-Born Child, % (SE)	US-Born Child, Both Parents Immigrants, % (SE)	US-Born Child, 1 Parent Immigrant, % (SE)	US-Born Child, Both Parents US-Born, % (SE)	P
In the past month, how often did parent feel . . .
That child was much harder to care for than most children the same age?					< .01
Usually or always	12.8 (1.2)	8.6 (0.7)	5.7 (0.7)	5.5 (0.2)
Sometimes or never	87.2 (1.2)	91.4 (0.7)	94.3 (0.7)	94.5 (0.2)
That child did things that bothered parent a lot?
Usually or always	95.4 (0.6)	95.9 (0.5)	95.8 (0.5)	95.0 (0.1)
Sometimes or never	4.6 (0.6)	4.1 (0.5)	4.2 (0.5)	5.0 (0.1)
That parent was giving up more of his or her life to meet child’s needs than expected?					< .01
Usually or always	29.5 (1.5)	31.4 (1.2)	15.1 (1.0)	12.0 (0.2)
Sometimes or never	70.5 (1.5)	68.6 (1.2)	84.9 (1.0)	88.0 (0.2)
Angry with child?
Usually or always	2.9 (0.4)	3.1 (0.5)	2.3 (0.4)	2.9 (0.1)
Sometimes or never	97.1 (0.4)	96.9 (0.5)	97.7 (0.4)	97.1 (0.1)
Composite score in highly aggravated range of ≤ 11	25.5 (1.5)	21.6 (1.1)	12.2 (0.9)	11.2 (0.2)	< .01

Note. The unweighted sample size was n = 101 032. P values that were not significant are not reported.

Table 3 shows the multivariable analysis of predictors of high and low parenting aggravation, where immigrant family type and race/ethnicity were included as a 12-category joint variable. In the model for high aggravation, foreign-born Hispanic parents of both foreign-born and US-born children were 5 times more likely to be highly aggravated than US-born, non-Hispanic White parents of US-born children (the reference group). In Hispanic households with a US-born child in which 1 parent or both parents were foreign born, parents had 3 and 2 times greater odds of high aggravation, respectively, than did the reference group. In households with 1 or 2 non-Hispanic White foreign-born parents, the parents had 50% greater odds of high aggravation than their US-born counterparts. All non-Hispanic Black parents, both foreign born and US born, had 70% greater odds of high aggravation than the reference group. Among all other ethnic groups, in households in which 1 or both parents were foreign born, the odds of high aggravation were 2.4 greater than in the reference group if there was a foreign-born child and 2.1 times greater if there was a US-born child.

TABLE 3—

Adjusted Odds of High and Low Parenting Aggravation Among Parents of Immigrant and US-Born Children Aged Birth–17 Years: National Survey of Children’s Health, 2003

	No., Unweighted	High Aggravation, OR (95% CI)	Low Aggravation, OR (95% CI)
Hispanic
Foreign-born child, both parents immigrants	1887	4.94 (4.04, 6.04)	0.44 (0.32, 0.59)
US-born child, both parents immigrants	2922	5.04 (4.28, 5.94)	0.39 (0.31, 0.49)
US-born child, 1 parent immigrant	1410	3.36 (2.54, 4.43)	0.70 (0.53, 0.92)
US-born child, both parents US-born	6876	2.04 (1.79, 2.32)	0.82 (0.72, 0.94)
Non-Hispanic White
1 or both parents immigrantsa	3720	1.46 (1.19, 1.79)	0.85 (0.72, 1.01)
US-born child, US-born parents (Ref)	65 808	1.00	1.00
Non-Hispanic Black
1 or both parents immigrantsa	632	1.71 (1.20, 2.43)	0.71 (0.49, 1.02)
US-born child, US-born parents	8854	1.66 (1.48, 1.85)	0.95 (0.85, 1.06)
All other ethnic groups
Foreign-born child, both parents immigrants	766	2.44 (1.38, 4.29)	0.58 (0.36, 0.95)
US-born child, both parents immigrants	801	2.09 (1.43, 3.04)	0.74 (0.49, 1.12)
US-born child, 1 parent immigrant	824	1.70 (1.00, 2.91)	1.18 (0.79, 1.74)
US-born child, both parents US-born	6532	1.48 (1.24, 1.76)	0.96 (0.82, 1.11)
Age, y
Birth–5 (Ref)	32 874	1.00	1.00
6–8	14 976	1.07 (0.95, 1.20)	0.52 (0.47, 0.57)
9–11	15 747	1.01 (0.89, 1.14)	0.54 (0.49, 0.60)
12–14	17 943	1.32 (1.18, 1.48)	0.48 (0.43, 0.53)
15–17	19 492	1.48 (1.33, 1.65)	0.54 (0.49, 0.59)
Gender
Male	51 890	1.02 (0.95, 1.10)	0.91 (0.85, 0.96)
Female (Ref)	49 142	1.00	1.00
Family poverty level
< 100% FPL	11 130	1.81 (1.59, 2.05)	1.19 (1.05, 1.35)
100%–199% FPL	18 662	1.46 (1.30, 1.63)	1.08 (0.98, 1.18)
200%–399% FPL	33 300	1.10 (0.99, 1.22)	1.07 (0.99, 1.15)
≥ 400% FPL (Ref)	29 075	1.00	1.00
Not stated	8865	1.34 (1.17, 1.54)	1.29 (1.15, 1.45)
Children with special health care needs
Yes	18 375	2.61 (2.40, 2.83)	0.53 (0.48, 0.58)
No (Ref)	82 657	1.00	1.00
Family structure
2 parents, biological or adopted (Ref)	65 534	1.00	1.00
2 parents, step family	8137	1.38 (1.21, 1.56)	0.76 (0.67, 0.86)
Single mother	20 430	1.83 (1.66, 2.01)	0.70 (0.64, 0.77)
Other	6931	1.80 (1.56, 2.07)	0.90 (0.79, 1.02)
Children, total no.
1 (Ref)	40 860	1.00	1.00
2	38 424	1.01 (0.88, 1.15)	1.05 (0.93, 1.18)
3	15 460	0.93 (0.84, 1.04)	0.92 (0.85, 1.01)
≥ 4	6288	1.01 (0.94, 1.09)	0.88 (0.83, 0.94)

Note. CI = confidence interval; FPL = federal poverty level; OR = odds ratio. The unweighted sample size was n = 101 032.

^aChild either US or foreign born.

Compared with parents of young children (aged birth–5 years), parents of adolescents (aged 12–14 and 15–17 years) had 30% and 50% greater odds of high aggravation, respectively. Compared with parents in households at or above 400% of FPL, “poor” parents and “near-poor” parents had 80% and 50% greater odds of high aggravation, respectively. Parents of children with special health care needs had almost 3 times the odds of being highly aggravated compared with parents of children without special health care needs. Compared with 2-parent biological or adopted families, 2-parent step families had 40% greater odds of high aggravation; for single-mother and “other” families, the odds were almost 3 times greater. Child’s gender and total number of children in household were not significant risk factors for high aggravation.

In the model for low aggravation, compared with non-Hispanic White US-born children with US-born parents, all Hispanic-parent groups had lower odds of experiencing low aggravation. For other ethnic groups, in households where both parents were foreign born and the child was also foreign born, the odds of reporting low aggravation were lower (odds ratio = 0.58) than in households where both parents and child were US born. Compared with parents of young children (aged birth–5 years), parents of children in all other age groups had half the odds of low aggravation. Parents of sons had slightly smaller odds of experiencing low aggravation than parents of daughters. Parents of children with special health care needs had half the odds of reporting low aggravation than parents of children without special health care needs. Two-parent step families and single-mother households had smaller odds of reporting low aggravation than 2-parent biological or adopted families. Parents with more than 3 children had smaller odds of reporting low aggravation than parents with 1 child.

DISCUSSION

Our study is the first to characterize the significant and large differentials in parenting aggravation among immigrant families. We have found that at the national level, foreign-born parents experienced high levels of aggravation in the family setting. Hispanic households, regardless of where the children were born, experienced very elevated aggravation in parenting. Non-Hispanic Black households, regardless of immigrant status, experienced more aggravation than non-Hispanic White households. The “other” ethnic groups all reported elevated aggravation compared with non-Hispanic Whites, with the exception of households in which 1 parent was foreign born. Our data clearly illustrates that parents’ minority and immigrant status conferred high risk of parenting aggravation. Adolescence, household poverty, “children with special health care needs” status, and nontraditional family structures all conferred additional risks of parenting aggravation.

To put our findings in perspective, it is important to consider the changing demographics of the US immigrant population. Close to one quarter of US children have at least 1 foreign-born parent. Immigrant family type is a complex variable, and the different combinations have been shown to confer differential risks on children’s health care access and utilization outcomes.³⁰ In addition to the differential eligibility for resources, immigrant status can be a proxy for the length of residence in the United States, English proficiency, and degree of acculturation, all factors that affect family dynamics.

According to recent census data, there has been a rapid increase in the number of families composed of undocumented parents with US-born children.⁴⁷About half of these illegal immigrant households comprise couples with children; by comparison, 21% of households of US-born parents and 35% of households of legal immigrants have children. Although we were not able to identify undocumented parents in our study, the high parenting aggravation found among foreign-born parents is likely to be further elevated among these “mixed status” families.

The large effect sizes found in our study are very alarming. In addition to the current problems probably experienced by high-aggravation households, such as child maltreatment, delinquency, school problems, bullying, and gang participation, the long-term consequences of high parenting aggravation can have a sustained impact on children through adulthood.⁴⁸ Moreover, the possible impact on parents, such as depression, lack of parenting self-efficacy, mental health issues, and marital discord, can have high emotional and social costs. Immigrant parents’ limited awareness of health and community resources to alleviate family problems further exacerbates these concerns.⁴⁹ The finding of a relationship between acculturation and family functioning in Hispanic and Asian families was also found in the present study.^50,51 Because of a lack of published studies on parenting aggravation using multivariable techniques, we were unable to compare or confirm our findings with other studies. However, the cross-section survey design of the NSCH poses limitations on drawing causality relationships, and the possibility of reverse causality should also be considered. The properties of the scale have not been specifically validated in non–English-speaking populations, thus opening the possibility that the findings are influenced by cultural and linguistic biases.

Limitations

Additional limitations of this analysis should be noted. The 2003 NSCH was conducted only in English or Spanish. Those immigrant respondents whose primary language is neither English nor Spanish may tend to be more educated and fluent in English than their peers, resulting in a likely underestimate of risk for the actual immigrant populations in the United States. Undocumented immigrants who may be at the highest risk of lacking access probably do not participate in the survey through fear of exposing their illegal status, even though the survey contained no information on citizenship status. This selection bias probably excluded the most underserved populations. The increased use of cell phones may be introducing yet another source of bias, although a recent study has argued that this is very minimal.⁵² In addition, Asians, who comprise 4% of the US population, were not identified in the public use data files of this survey. Instead, they were collapsed into the “other” category. Data on Asians were collected in 7 states, and Asians comprised only 0.8% of the total respondents in the survey. For this reason, it is hard to report on this major group of immigrants with high specificity.

Conclusions

Our study demonstrates the difficult parenting experience in immigrant households, and the need for outreach efforts by clinicians, mental health professionals, school systems, and social workers on interventions that will help improve the parenting experience of immigrant households. There may also be a number of unmeasured factors, such as family structure instability, geographic differences, material hardships, social support, parental well-being, and relationship quality, that contribute to parenting aggravation and were not addressed by our study. Further work in these areas might uncover the underlying causes of high parenting aggravation and lead to the development of effective intervention programs. In our study, the compound variable of race/ethnicity and immigrant family type enabled us to identify essential high-risk groups in the US population. Culturally and linguistically competent interventions can thus be developed to address each unique immigrant group at the national and local level. Resources from relevant public agencies should also be directed to provide assistance to vulnerable immigrant households.