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. Author manuscript; available in PMC: 2022 Jan 1.
Published in final edited form as: Am J Orthopsychiatry. 2020 Nov 5;91(1):109–119. doi: 10.1037/ort0000482

Acculturation and Ethnic Group Differences in Well-Being Among Somali, Latino, and Hmong Adolescents

Eunice A Areba a, Allison W Watts b, Nicole Larson b, Marla E Eisenberg c, Dianne Neumark-Sztainer b
PMCID: PMC8475720  NIHMSID: NIHMS1738157  PMID: 33151733

Abstract

Research addressing the linkages between acculturation and markers of adolescent well-being across multiple ethnic minority groups is limited in scope and breath, even though children of immigrant origin are the fastest growing population. We examined cross-sectional relationships between acculturation and substance use, socio-emotional well-being and academic achievement. Somali, Latino and Hmong adolescents provided data as part of the EAT 2010 (Eating and Activity in Teens) cohort study (N=1,066). Acculturation was based on nativity, language usually spoken at home, and length of residence in the United States. Chi-square, ANOVA and regression models were used to test for differences in adolescent well-being by acculturation and ethnic group, and interaction terms were added to models to test effect modification by ethnicity. Hmong adolescents had the highest mean acculturation scores (4.4±1.5), whereas Somali adolescents (2.2±1.8) were the least acculturated. Independent of ethnicity, acculturation was positively associated with marijuana (OR: 1.38: CI: 1.25, 1.53) and alcohol use (OR: 1.12: CI: 1.02, 1.22), and was negatively associated with academic achievement, based on grade point average (β= − 0.07: CI: − 0.12, − 0.03). Interaction effects indicated significant differences by ethnicity only for academic achievement; significant associations between acculturation and academic achievement were evident only for Somali and Latino youth. Prevention programming should include supports for multilingual and multicultural learners and account for cultural assets within immigrant origin families that maintain and nurture protective factors as adolescents acculturate and transition into young adulthood.

Keywords: Acculturation, Immigrant, Adolescent, Somali, Hmong, Latino, Mental Health, Academic achievement, Substance use

Acculturation and related concepts

The number of first-and second-generation immigrant adolescents in the U.S. (i.e., those who are foreign-born or have at least one foreign-born parent and are birthright citizens) increased by 51% between 1994 and 2017, that is one quarter of all children (Child Trends, 2018; Migration Policy Institute, 2017). Reflecting increasing diversity in racial, ethnic, socioeconomic and cultural composition of the population, children in immigrant families are the fastest growing group of all adolescents in the U.S. (Hernandez et al., 2008; National Center for Education Statistics, 2019). Their diverse characteristics, including language, family migration histories, levels of acculturation and education may present unique challenges to their psychosocial outcomes and transition to young adulthood. A vast literature demonstrates relationships between acculturation and mental health (Bhui et al., 2012; Lawton & Gerdes, 2014; Lincoln et al., 2016), substance use (Burgess et al., 2014; Epstein et al., 2001; Kulis, 2009; Pokhrel et al., 2013) and academic achievement (Nair et al., 2018; Santiago et al., 2014; Thai et al., 2010). Longitudinal studies indicate that adolescent substance use can persist into young adulthood (Schuler et al., 2015; Wilkinson et al., 2016) and disparities are evident along levels of academic achievement and socioeconomic status (Widome et al., 2011).

Acculturation is the process through which sociocultural (e.g. dietary, language preferences, cultural identity) and psychological (e.g. self-esteem, general sense of well-being) changes occur when persons of different backgrounds interact (Berry, 1980). Young people who are involved in both their heritage culture and the majority culture (integrated) have the most positive emotional well-being, are well adjusted in school and in the community at large (Berry et al., 2006; Schwartz et al., 2010). However, adolescent experiences and development occur within a socioecological context (e.g. geo-political contexts of reception and global factors) that influence how adolescents acculturate (Suárez-Orozco et al., 2018). Many immigrants of color often face discriminatory actions that curtail their options for acculturation; regardless of explicit or implicit actions, discrimination has been associated with symptoms of depression, anxiety, self-harm, and substance use (Kulis, 2009; Lorenzo-Blanco & Unger, 2015; Lorenzo-Blanco et al., 2011; Rios-Salas & Larson, 2015; Rivas-Drake & Stein, 2017). Further, adolescents who are targets of discriminatory attitudes including stereotypes, xenophobia and islamophobia are less likely to align themselves to the larger majority society (APA, 2012; Berry et al., 2006).

Additionally, due to differing rates and ways of acculturation between young people and their parents, adolescents have to navigate and balance the expectations of their heritage culture and receiving or majority cultures, resulting in acculturative stress (Juang & Meschke, 2017; Portes, 2006). Empirical evidence on the associations between acculturation and adolescent outcomes vary widely and findings have been inconsistent. In this study, we focus on three groups of growing ethnic minority immigrant/ refugee origin youth (IROY) to strengthen the evidence base and enable health care providers, educators and other youth-serving professionals to better meet their unique needs.

Culture and ethnic identity

Ethnic identity can develop by drawing upon one’s cultural background and specific lived experiences according to their self-identified ethnic group membership (Helms et al., 2005). For the ethnic minority adolescent, a strong and secure ethnic identity contributes positively to academic success and mental health (Rivas-Drake et al., 2014) and self-esteem (Phinney, 2001). Some aspects of ethnic identity, including the adolescent’s own assessment of, and attitude toward the ethnic group, also known as belongingness, have been linked to lower involvement in risky behaviors such as drug use (Rivas-Drake et al., 2014). Further, migration and acculturative stressors (i.e. the loss of familiar social ties, struggles of resettlement, incongruent languages, marginalization, poverty) are often superimposed on normal adolescent developmental milestones; given these influences, IROY face unique threats to their health and establishment of healthy behavior habits (Lincoln et al., 2015; Patton et al., 2016).

Immigration, acculturation and health behaviors and well-being

Due to the likelihood of exposure to trauma, poor mental health may be elevated in adolescents with refugee and immigrant backgrounds (Cleary et al., 2018; Ellis et al., 2008). Factors such as length of stay in the U.S., discrimination, parental trauma and nativity have been significantly associated with poor mental health outcomes in adolescents (Ellis et al., 2008; Sangalang et al., 2017; Warner et al., 2008). However, English language acquisition was found protective for mental illness among Oromo and Somali youth (Halcón, 2004). Overall, depression is prevalent among adolescents and could increase the likelihood of substance use and academic underachievement (National Research Council, 2009).

Greater orientation towards U.S. cultural norms in adolescents is often associated with negative outcomes such as psychological distress (Torres, 2010) and depressive symptoms (Lorenzo-Blanco et al., 2011), while integration of both receiving and heritage cultures is associated with positive psychosocial outcomes, such as high self-esteem (Nguyen & Benet-Martínez, 2013) and fewer symptoms of mental illness (Bhui et al., 2012).

Acculturation, mental health and substance use

About 50% of lifetime mental disorders are diagnosed in mid-adolescence and 75% in young adulthood (Kessler et al., 2007), and internalizing disorders such as depression and anxiety can precede substance use disorders in adolescence (O’Neil et al., 2011). Additionally, early substance use negatively affects learning and memory and is a strong predictor for development of later substance use disorders and other mental illnesses (NIDA, 2014). Previous studies indicate that acculturative stress, a lower heritage cultural orientation and parent-youth acculturation discrepancy are risks for substance use and mental illness (Epstein et al., 2001; Rivas-Drake et al., 2014; Rivas-Drake & Stein, 2017; Unger et al., 2009; Unger. et al., 2014), while extended family structures confer some protection for substance use (Areba et al., 2017). A study on smoking among adults of Southeast Asian heritage, including Hmong indicated that longer length of stay in the U.S., and a less than high school education were predictive of tobacco use (Constantine et al., 2010). Although the exact mechanism of how acculturation is linked to adolescent health outcomes has not been established, acculturative stress and self-esteem have been found to partially mediate the association between ethnic identity and academic achievement and externalizing behavior in Latino adolescents (Schwartz et al., 2007).

Acculturation and academic achievement

Researchers contend that experiences and cultural contexts influence academic outcomes. For instance, adolescents who identify more with U.S. cultural values attain higher educational achievement (López et al., 2002; Vang, 2004), but adolescents who are less acculturated to U.S. values experience more institutional barriers, have less academic success and are more likely to drop out of school (Martinez et al., 2004). Conversely, majority cultural values are associated with low grades (Santiago et al., 2014). English proficiency, obligations to and reliance on family had positive effects on youth academic achievement (Roche et al., 2012). In essence, greater acculturation may translate to negative outcomes; however, results are inconsistent and dependent on group and context. For example, although aggregate data indicates that compared to other states, Minnesota performs well on standardized testing, it has one of the nation’s widest achievement gaps. Minnesota has significantly high, persistent and growing education disparities across race/ ethnic groups and socio-economic status (Grunewald & Nath, 2019), with IROY having some of the lowest educational outcomes in all domains (MDE, 2019).

Present study

Previous studies on immigrant and refugee origin youth have examined acculturation, adaptation and effect of perceived discrimination (Berry et al., 2006), youth development and student-teacher connections (Allen et al., 2016) and exposure to trauma and mental health needs (Betancourt et al., 2017). Mental health illness and substance use disorders are key contributors to disability in young adulthood (Rivas-Drake, 2017). Given the increase of multicultural societies, adequate data are needed to document health advantages and inequities among IROY to inform prevention programming.

Many studies report findings on aggregated race and ethnic group data; a model that conceals differences between heterogeneous ethnic subgroups and often leads to erroneous inferences (Minnesota Department of Health, 2014, March ; Rumbaut, 1994). In particular, the outcomes of Somali or Hmong adolescents cannot be deduced from data reported for Black/African American and Asian/Pacific Islander adolescents respectively, but these broad classifications are frequently used. Further, pan-ethnic labels negate important differences such as when, why and how individuals migrate to the U.S. In Minnesota, approximately 71% of Latinos are of Mexican descent, in 2011–2017, 8.1% had lived in the U.S. between 0–5 years and only 28.7% for more than 20 years (Minnesota Compass, 2017). In comparison, the Hmong community started resettling as refugees in the U.S. after the end of the war in Vietnam in the 1970s (Minnesota Historical Society, 2015); similarly, due to the ongoing intractable civil war that peaked in 1991 in Somalia, many Somalis continue to resettle as refugees (Minnesota Historical Society, 2016).

With these considerations in mind, our study had three aims. First, we investigated health behaviors for three domains of well-being: substance use (i.e. alcohol, marijuana and cigarette use), socio-emotional health (self-esteem, symptoms of depression) and academic achievement (grade point average) among Somali, Hmong, and Latino adolescents in Minnesota. Second, we examined how acculturation (assessed as nativity, language use, and length of stay in the U.S.) is associated with the three domains of well-being. Finally, we explored whether ethnic group membership moderated the associations between acculturation and adolescent well-being. We hypothesized that (a) health behaviors and well-being would greatly differ across the three groups, and (b) adolescents who are more acculturated would report lower levels of socio-emotional health but higher academic achievement and higher rates of substance use involvement in comparison to those who are less acculturated.

METHODS

Study design and population

The EAT 2010 (Eating and Activity in Teens) study was designed to examine psychological, social and behavioral aspects of adolescent weight-related health. As part of this study, self-reported data on acculturation, health behaviors, and aspects of well-being such as substance use, social-emotional health, and academic achievement were collected. Adolescents were recruited from 20 public middle and high schools in the Minneapolis-St. Paul, Minnesota, metropolitan area that serve socioeconomically, racially, and ethnically diverse communities. Surveys were completed by 2,793 adolescents during the 2009–2010 academic year. In the present study, our total analytic sample of 1,066 youth was comprised of students from three ethnic groups: Somali (n=114), Hmong (n=480) and Latino (n=472).

Parental/guardian consent and student assent were sought prior to youth participation in the study. Among students who were present on the day of the survey, 96.3% had parental consent and chose to participate, we do not believe that there was a specific pattern or reasons for those who chose not to participate. Surveys were administered by trained research staff during two class periods that were typically 45–50 minutes in length, participants took a total of 90 −100 minutes to complete the survey. We allowed participants to complete the survey in two class sessions to avoid burn out and survey fatigue. We also wanted to ensure enough time for all youth to complete the survey, which was particularly important for adolescents who are multilingual and whom English is not their mother language. For those who completed their surveys early, activities (e.g., worksheets) were provided. Upon completion, participants were given a $10 gift card. All study procedures were approved by the research boards of the participating school districts and the University of X IRB.

Adolescent survey development

The EAT 2010 survey is a 235-item self-report instrument. Survey development was guided by a review of previous Project EAT surveys (Neumark-Sztainer, Story, Perry, & Casey, 1999; Neumark-Sztainer et al., 2002), a comprehensive literature review, and a theoretical framework based on an ecological perspective and social cognitive theory (Bandura, 1986; Glanz et al., 2015). A draft of the EAT 2010 survey was pilot tested with 56 adolescents of diverse backgrounds to examine the acceptability and relevance of measures, and was also reviewed by a team of researchers representing expertise across multiple health-related disciplines. The survey was further tested with 129 middle and high school students to examine the test-retest reliability of measures over a one-week period. The internal consistency of scales was examined in the full sample.

Measures

Ethnicity was assessed with the questions, “Do you think of yourself as Hispanic or Latino” (yes/no) and “Is your background any of the following? a) Hmong, b) Cambodian, c) Vietnamese, d) Laotian, e) Somali, f) Ethiopian, g) Other and h) None of the above” (test-retest agreement=92%). Ethnic groups of interest comprised of adolescents of Latino, Somali, and Hmong ethnic descent, which are some of the largest ethnic minority groups in Minnesota (Minnesota State Demographic Center, 2015). Other ethnic groups in the sample were not of an adequate sample size for analyses.

Acculturation was assessed with three items adapted from the National Longitudinal Survey of Adolescent Health (Harris, 2009) and the World Organization Study of Health Behavior in School Children (Yu et al., 2002). Students were asked to indicate: (i) their nativity (U.S.-born or foreign-born); (ii) their length of residence in the U.S. (<1 year, 1 <5 years, 5 to <10 years, ≥ 10 years or always) (Gordon-Larsen, Harris, Ward, & Popkin, 2003) and (iii) language usually spoken in their home, (English only, a language other than English, or English plus another language). Responses for each construct were coded 0 – 2 (test-retest agreement=93–99%), and scores were then summed to generate a total composite index of 0 – 6. The composite acculturation measure was the sum of nativity (0=foreign-born, 2=U.S.-born), years in the U. S. (0 = <5years, 1= 5-< 10 years, 2= ≥ 10 years), and language spoken at home (0=language other than English, 1= English plus another language and 2=English only).

Substance use was assessed by one item for each of the three substances of interest: tobacco, alcohol, and marijuana. Students were asked if they had used any (i) cigarettes (test-retest r=0.81), (ii) beer, wine, hard liquors (test-retest r=0.84) or (iii) marijuana (test-retest r=0.76) in the past year. The five response options were: (a) never; (b) a few times; (c) monthly; (d) weekly; and (e) daily. Responses were dichotomized to none or any use in the past year due to skewness in each distribution. In addition to testing use of each substance separately, they were combined into a dichotomous variable contrasting those who used any of these substances with those who had used none.

Socio-emotional wellbeing was assessed by measuring both depressive symptoms and level of self-esteem. Depressive symptoms were assessed with the Depressive Mood Scale, a six-item scale developed by Kandel and Davies (1982). Students indicated in response to each item how much an issue (e.g., “feeling too tired to do things”, “having trouble going to sleep or staying asleep”) had bothered or troubled them during the past year. Each item was rated on a 3-point scale: 1= “not at all”; 2= “somewhat”; and 3 = “very much.” Responses were summed across items. Total scores ranged from 6 to 18, with higher scores indicating higher levels of depressive symptoms (Cronbach’s α=0.83, test-retest r=0.75). The reliability and validity of the scale have been established by Kandel and colleagues and others (Kandel, Raveis, & Davies, 1991; Patten, Choi, Gillin, & Pierce, 2000).

Self-esteem was assessed by a six-item modified version of the Rosenberg Self-Esteem Inventory (Rosenberg, 1965). For the EAT 2010 survey, the original scale was reduced to six items to reduce participant burden; in particular, two positive and two negative items were omitted (Neumark-Sztainer et al., 2002; Neumark-Sztainer et al., 2006). Students indicated their level of agreement with each of the following statements: (i) “on the whole, I am satisfied with myself, (ii) “I feel that I have a number of good qualities,” (iii) “at times I think I am no good at all,” (iv) “I am able to do things as well as most other people,” (v) “I wish I could have more respect for myself,” and (vi) “I certainly feel useless at times.” Items were rated on a four-point scale from 1= “strongly disagree” to 4= “strongly agree,” and responses were summed across items (reverse-scored as appropriate). Total scores ranged from 6 to 24, with higher scores indicating higher self-esteem (Cronbach’s α=0.77, test-retest r=0.69).

Academic achievement was assessed by adolescents’ response to the statement “Mark the two grades you get most often.” Responses included A, B, C, D and F or incomplete. If participants recorded only 1 grade, then that grade was used in the analysis. Letter grades were converted to a numerical grade point average (GPA) and assigned the following values, A = 4.0, B = 3.0, C = 2.0, D = 1.0, and F or incomplete = 0, with the two grades averaged into a single GPA (test-retest r=0.88). Nineteen students who reported an A and F, A and D, or B and F (i.e., combinations of grades that were discrepant by more than 2 letter grades) were set to missing for this item.

Covariates.

Socioeconomic status (SES), gender and school level were assessed by self-report. SES was measured by a five-level composite variable (test-retest r=0.90) derived from the highest education level of either parent, family eligibility for free/reduced price school lunch, family receipt of public assistance (e.g. food support/stamps, EBT, WIC, TANF or MFIP) and parent unemployment. Levels include low, low-middle, middle, middle high, and high, as described previously (Neumark-Sztainer et al., 2002; Sherwood, 2009).

Statistical analysis

Frequencies and means were calculated to describe participant characteristics and acculturation variables overall and by ethnic group. Chi-square and analysis of variance (ANOVA) tests were used to determine statistically significant differences in means by ethnicity. Differences by ethnic group in adolescent behaviors and well-being (any substance use, cigarette use, marijuana use, alcohol use, depressive symptoms, self-esteem, and academic achievement) were tested with separate linear or logistic regression models, first unadjusted, then mutually adjusting for acculturation, ethnicity, covariates (grade, gender, SES) and clustering of students within schools. Associations between acculturation and adolescent health behaviors and well-being are presented as odds ratios (OR) or regression coefficients and 95% confidence intervals (CI). To compare differences in adolescent health behaviors and well-being across ethnicities, results are presented as an adjusted probability or mean and 95% CI with group differences determined based on the delta method which allows for the estimation and calculation of standard errors (Oehlert, 1992).

It was also of interest to determine if associations between acculturation and adolescent health behaviors and well-being differed between the three ethnicities in our sample (effect modification). An interaction term between ethnicity and acculturation was included in each covariate-adjusted model. Any model with a statistically significant interaction term (p<0.05) was then stratified by ethnicity to illustrate how associations between acculturation and adolescent health behaviors and well-being differed across the ethnic groups.

Missing data ranged across variables from 0 to 5% (mean=1.6%). For all tests, a p-value of 0.05 was considered statistically significant. A Bonferroni correction was calculated for the regression models because of multiple analyses to compare the effect of acculturation across groups. All analyses were conducted with STATA statistical software version 14 (StataCorp., 2015).

Results

Sample Characteristics (Table 1).

Table 1.

Sociodemographic characteristics in overall study sample and by ethnic minority groups

Total
N=1,066		 Somali
n=114		 Hmong
n=480		 Latino
n=472		 p-valuea
Socio-demographic Characteristics % % % %
School Level (n=1,066)
 High School 56.4 73.7 49.7 58.9 p <0.001
 Middle School 43.6 26.3 50.2 41.1
Gender (n=1,066)
 Female 53.7 47.4 54.6 54.2 p=0.360
 Male 46.3 52.6 45.4 45.8
SES (n=1,011)
 Low 51.3 51.4 51.9 50.8 p=0.437
 Low-Middle 24.5 20.2 24.3 25.8
 Middle 15.5 16.5 14.2 16.6
 Middle-High 5.8 8.3 7.2 3.9
 High 2.8 3.7 2.5 2.8
Language usually spoken at home (n=1,064)
 A language other than English only 31.3 38.9 20.9 40.0 p<0.001
 English only 12.1 10.6 8.8 15.9
 English + other language 56.6 50.4 70.4 44.1
Nativity (n=1,063)
 U.S. Born 66.0 18.6 82.3 60.6 p <0.001
 Foreign-U.S. Born 34.0 81.4 17.7 39.4
Years in the United States (n=1,062)
 < 5 years 10.3 33.6 6.3 8.7 p <0.001
 5<10 years 13.2 27.4 4.8 18.3
 ≥ 10 years or always 76.6 38.9 88.9 72.9
Acculturationb (n=1,058), (mean±, SD) 3.8±1.8 2.2±1.8 4.4±1.5 3.6±1.8 p<0.001
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Note:

a

Chi-square and ANOVA tests were used to determine group differences for categorical and continuous variables respectively.

b

Acculturation variable based on nativity (0=non-U.S. born, 2=U.S. born), years in the United States (0=≤5yrs; 1= 5-≥ 10yrs; 2=≥ 10 and Always), and language spoken at home (0=language other than English; 1=English plus another language; 2= English only) to create a continuous variable ranging from 0–6.

The sample was approximately evenly split by gender. The mean (± standard deviation [SD]) age of the study population was 14.4 years (± 2.0), with 43.6% in middle school (6th-8th grades) and 56.4% in high school (9th-12th grades). A majority of adolescents in this sample were of low to low-middle SES (75.8%) compared to only 24.1% who were middle to high SES. The ethnic backgrounds of the analytic sample were 10.7% Somali, 44.3% Latino and 45.0% Hmong. Approximately two thirds of the students in the sample were U.S.-born, and 56.6% spoke English and another language at home compared with 12.1% who spoke only English at home. The overall mean acculturation score was 3.8 (±1.8, range=0—6); Hmong adolescents had the highest mean acculturation score of 4.4 (±1.5) and Somali adolescents had the lowest mean acculturation mean score of 2.2 (±1.8).

Substance use and associations with acculturation (Table 2).

Table 2.

Associations between acculturation, ethnicity and substance use (EAT2010)

Any Substance Use Cigarette Use Marijuana Use Alcohol Use
Adjusted Predicted Probabilities (%)
Ethnicity
 Somali 6%a 3%a 3%a 2%a
 Hmong 27%b 6%a 2%a 25%b
 Latino 35%c 13%b 14%b 31%c
p-value a p <0.001 p <0.001 p <0.001 p <0.001
(OR, 95% C.I.) *
Acculturation 1.13 (1.04, 1.22) 1.06 (0.94, 1.19) 1.38 (1.25, 1.53) 1.12 (1.02, 1.22)
 p-value for interaction effect Acculturation*Ethnicity P=1.15 P= 0.006 P=0.15 P=0.31
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Note: Logistic regression used for substance use (any past year). Results expressed as predicted probability adjusted for acculturation, ethnicity, school level, gender, socioeconomic status, and clustering of students within schools

Different superscripts across ethnicity indicate a significant difference at p<0.05.

*

Acculturation was a continuous variable ranging 0–6

Overall, for each substance use behavior examined, and independent of acculturation, Latino adolescents had the highest prevalence of use. There was wide variation in alcohol consumption. For example, at 31%, Latino adolescents had the highest predicted probability for alcohol use, Somali adolescents had a 2% predicted probability of alcohol consumption, and Hmong adolescents had a 25% predicted probability of alcohol use after adjustment for other variables. In adjusted regression models, acculturation was positively associated with greater marijuana (OR=1.38, CI=1.25, 1.53) and alcohol use (OR=1.12, CI=1.02, 1.22), but not with cigarette smoking for the full sample.

Socio-emotional wellbeing and academic achievement and association with acculturation (Table 3).

Table 3.

Associations between acculturation, ethnicity, socio-emotional wellbeing and academic achievement (EAT2010)

Depressive Symptoms
(range 6–18)		 Self-Esteem
(range 6–24)		 Academic Achievement
(range 0–4)
Adjusted Predicted Means
Ethnicity
 Somali 9.44a 18.32a 2.83ab
 Hmong 10.63b 16.16b 3.03b
 Latino 10.30b 17.77c 2.58a
p-value a p <0.001 p <0.001 p <0.001
(β Coefficient, 95% C.I.) *
Acculturation 0.08 (−0.08, 0.17) 0.01 (−0.09, 0.11) − 0.07 (− 0.12, − 0.03)
p-value for interaction effect Acculturation *Ethnicity p=0.71 p=0.93 p <0.001
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Note: Linear regression used for social-emotional health and academic achievement. Results expressed as predicted mean mutually adjusted for acculturation and ethnicity as well as school level, gender, socioeconomic status, and clustering of students within schools

Different superscripts across ethnicity indicate a significant difference at p<0.05.

*

Acculturation was a continuous variable ranging 0–6

Hmong and Latino adolescents experienced slightly higher symptoms of depression, which was significantly different from Somali adolescent depressive symptom experience. Somali adolescents also reported significantly higher self-esteem than their peers. Hmong adolescents had a predicted mean GPA of 3.03, Somalis had a 2.83 mean GPA and Latino adolescents had a mean GPA of 2.58. In adjusted regression models, acculturation was not significantly associated with depressive symptoms and low self-esteem, but each unit of acculturation was inversely associated with 0.07 GPA points.

Moderation of associations between acculturation and measures of well-being (Table 4).

Table 4.

Associations between acculturation, substance use, socio-emotional wellbeing and academic achievement by ethnic group (EAT2010)

Cigarette Use (OR, 95% CI) Academic Achievement (Coefficient, 95% CI)
Ethnicity
Somali 0.85 (0.64, 1.13) −0.19 (−0.26, −0.11)
Hmong 0.99 (0.88, 1.13) −0.04 (−0.08, 0.002)
Latino 1.12 (0.97, 1.29) −0.07 (−0.13, −0.01)
P-value for interaction effect Acculturation*Ethnicity p=0.006 p <0.001
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Note: Results expressed as Odds Ratios and Coefficients (95% CI [confidence interval] mutually adjusted for school level, gender, socioeconomic status, and clustering of students within schools.

Statistical significance at p<0.05.

*

Acculturation was a continuous variable ranging 0–6

We added an interaction term (acculturation*ethnic group) to the adjusted models to assess if ethnic group membership moderated the associations between acculturation and each dependent variable. Ethnicity significantly modified the associations between acculturation and cigarette use (p=0.006) and academic achievement (p<0.001). When examined more closely in stratified models, the odds of cigarette smoking associated with each unit of acculturation varied from 0.85 to 1.12 across ethnicity, but were not statistically significant for any group. However, greater acculturation was significantly associated with lower academic achievement among Somali (OR, −0.19, C.I.= −0.26, −0.11) and Latino adolescents (OR, −0.07, C.I.= −0.13, −0.01) but not among Hmong adolescents (OR, −0.04, C.I.= −0.08, 0.002). As shown in Tables 2 and 3, ethnic group membership did not significantly modify associations between acculturation and alcohol, marijuana and socio-emotional well-being.

DISCUSSION

Overall, in our examination of acculturation, ethnicity and adolescent well-being, we found significant differences in substance use, socio-emotional health and academic achievement across Somali, Hmong and Latino youth. In general, associations between acculturation and the three domains of well-being were consistent across adolescent subgroups and independent of ethnicity, greater acculturation was associated with higher odds of alcohol and marijuana use and lower academic achievement.

Substance use.

Somali youth reported the lowest involvement whereas Latino youth reported the highest involvement in substance use. We cannot determine specific reasons for the significantly lower rates among Somali adolescents. Somali cultural assets, including extended family ties and Islam, which prohibit substance use among adherents, may confer some protection, a finding similarly reported among Somali youth, who had substantially lower substance use prevalence compared to their peers in grades 9 to 12 (Areba et al., 2017; Giuliani et al., 2010). Somali youth may also be deterred from substance use because as visible minorities (skin color, distinct religious and cultural attire and language) (Suárez-Orozco et al., 2018) who are already marginalized, and face many stereotypes because of their ethnicity and religion, the repercussions are overwhelmingly punitive. Additionally, due to prohibitive cultural and religious norms, Somali youth may underreport substance use.

Acculturation was positively associated with substance use for all youth, consistent with previous studies (Epstein et al., 2001; Lorenzo-Blanco & Unger, 2015; Pokhrel et al., 2013). Interestingly, although Hmong youth were more acculturated compared to their peers, Hmong adolescents had lower rates of substance use involvement compared to Latino youth, contrary to our hypothesis and previous studies. It is possible that cultural assets such as a strong, positive and secure ethnic identity that preserves heritage cultural norms (Rivas-Drake et al., 2014; Suárez-Orozco et al., 2018), norms that don’t support tobacco use (Constantine et al., 2010), communal values and obligations to extended kinship (Rivas-Drake & Stein, 2017), and strict and supportive parenting (Juang & Meschke, 2017) conferred some protection.

Higher levels of substance use may represent a means of coping with acculturative stress and discrimination (Kulis, 2009; Lorenzo-Blanco & Unger, 2015). Due to varied rates and ways of parent- adolescent acculturation, the process can upend family roles, cultural hierarchies and traditions, leading to strained parent (or extended family)-youth relationships (Juang & Meschke, 2017; Sangalang et al., 2017). For some, especially second- and third generation youth, the strain of navigating between adherence to parents’ traditional values and host culture expectations, can increase the risk for substance use (SAHMSA, 2014; Unger et al., 2009).

Socio-emotional well-being.

Latino and Hmong students reported lower self-esteem and higher depressive symptoms compared to Somali adolescents. However, acculturation was not associated with socio-emotional well-being. Prior research indicates that acculturation stressors due to contexts and experiences may contribute to negative mental health outcomes for immigrant and refugee origin youth (Lincoln et al., 2016). In our sample, the non-significant results may indicate a local environment and ethnic communities that nurture resilience among IROY youth, providing some protection from acculturative stressors (Areba et al., 2017; Juang & Meschke, 2017). Perhaps, the stressors have yet to manifest as internalizing symptoms and behaviors due to their age at time of data collection, or that some adolescents are able to function and cope successfully while not displaying or reporting signs of psychological distress (Suárez-Orozco et al., 2018).

Academic achievement.

Somali and Hmong adolescents reported significantly higher academic achievement than their Latino peers. Acculturation was inversely associated with academic achievement for Somali and Latino youth. Previous studies indicate that U.S. born youth or those who spent more time in the U.S. and speak English had higher academic achievement because of fewer language barriers, and faster adaptation to American cultural norms and the education system (Martinez et al., 2004; Vang, 2004). However, our findings do not fully support this notion. More than 60% of the Latino adolescents were U.S. born, and about 8% had lived in the U.S. for less than five years, yet they reported the lowest academic achievement. Perhaps, as postulated by Phinney et al (2001), because a strong national identity is most predictive of school adjustment, educational settings that embody assimilation and individualistic values are incongruent with and do not support positive sociocultural adjustment (Nguyen & Benet-Martínez, 2013). It is also probable that high levels of youth-parent acculturation gaps (Nair et al., 2018) and maternal traumatic stress (Sangalang et al., 2017) may potentiate less harmonious family functioning and consequently low academic achievement. Finally, many IROY attend poorly funded schools and more are likely to have less experienced teachers (Grunewald & Nath, 2019), few resources, pedagogy that does not meet their needs, low teacher expectations and a segregated student body, impeding their academic achievement and future prospects (Suárez-Orozco et al., 2018)

Strengths and limitations

This study has a number of strengths that enhance our ability to make meaningful inferences from the findings. We used validated measures of well-being, examined multiple measures of substance use and made comparisons across three ethnic groups of adolescents using a population-based sample with adequate sample sizes of each group. Our sample consisted of disaggregated data for Somali and Hmong adolescents, data which are often masked within analyses of broader Black/ African American and Asian categories. Having accurate information on these groups ensures that educators, care providers and policymakers are adequately prepared to address the unique needs of present and future generations of these group of adolescents.

Our study has a few limitations to consider when interpreting the findings and implications presented. First, this study lacked measures of acculturative stress, which is an important contributor to the relationships identified in our sample. The lack of a more nuanced and multidimensional measure means we cannot clearly distinguish between the consequences of the cultural transactions/ changes and the impact of acculturation, especially psychological impacts. However, proxy measures are strongly correlated with existing comprehensive measures, reduce participant burden and facilitate data collection in large studies such as Project EAT (Alegria, 2009). Data on Latino subgroups (e.g. Mexican, Salvadorian) were not available, youth in this study were recruited from a single urban population in the U.S. Midwest; therefore, the generalizability of these findings to other contexts is limited. Lastly, we acknowledge that there may be some concern that these data were collected in 2010. However, variables in our study remain relevant today, particularly given the unique and diverse nature of the U.S. population, immigration policy changes, and continued academic achievement gap.

Conclusion

In the present study, acculturation was positively associated with substance use and negatively with academic achievement. To understand the risks associated with sub-optimal well-being among youth of immigrant origin, future research will need to consider the reason for migration and the social and geo-political context (e.g. public sentiment, political and social contexts of resettlement, and the efficacy of resulting public policies) within which refugee (e.g. Somalis and Hmong) and immigrant (some Latino subgroups) communities reside. These factors may determine both adaptation and youth development, as acculturation options and reception in host communities vary for different groups. Given the ongoing debates and changes in U.S. immigration policy, and increase in xenophobia, racism and islamophobia towards Muslims and Latino communities, focusing future research on youth from other similarly affected groups will be important to identify and mitigate potential cumulative stressors. Further, this will require use of multidimensional measures of acculturation that account for cultural strengths and assets that buffer the effects of acculturative stressors.

Institutions of learning must be inclusive environments; that decrease the likelihood of academic underachievement especially among students who face unique challenges, such as acculturative stress and already contend with poverty. Schools should ensure that youth succeed within and beyond the school context. Greater attention should be focused on providing support for multilingual and multicultural learners (and their families), so that they can successfully navigate adaptation and development. Programming should include culturally relevant pedagogy that situates students within their societies and acknowledge their unique cultural assets and stressors (Suárez-Orozco et al., 2018).

Public Policy Relevance Statement.

Given the vast number of immigrant and refugee origin youth (IROY), it is crucial to identify factors that may impede their healthy development during the critical period of adolescence. To facilitate a successful transition into adulthood and mitigate risks that may curtail their future success. Focusing on acculturation and its associations with health outcomes and contexts within which young people acculturate, including changing immigration policies and societal sentiment towards different IROY groups.

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