Elsevier

Social Science & Medicine

Volume 184, July 2017, Pages 15-22
Social Science & Medicine

Ethnic-group socioeconomic status as an indicator of community-level disadvantage: A study of overweight/obesity in Asian American adolescents

https://doi.org/10.1016/j.socscimed.2017.04.027Get rights and content

Highlights

  • Low ethnic-group SES may capture community-level disadvantage for Asian Americans.

  • Adolescents in low SES ethnic-groups are at high risk of overweight/obesity.

  • Foreign-born adolescents in low-SES ethnic groups are at the highest risk of overweight/obesity.

Abstract

Asian American children and adolescents are an under-investigated subpopulation in obesity research. Informed by a wide socioeconomic diversity among Asian American ethnic groups, this study explored ethnic-group socioeconomic status (SES) as an indicator of community-level disadvantage that may influence overweight/obesity in Asian American adolescents. We hypothesized that ethnic-group SES was inversely associated with overweight/obesity in Asian American adolescents. Multiple logistic regression models were fitted using a sample of 1525 Asian American adolescents ages 12–17 from pooled 2007–2012 California Health Interview Survey (CHIS) data. Age, gender, nativity, individual-level SES (income and education), and two lifestyle variables (fast food consumption and physical activity) were controlled for. We found that adolescents in high- or middle-level SES ethnic groups were far less likely to be overweight/obese than those in low-SES ethnic groups. Further, these relationships were more pronounced for foreign-born adolescents but not significant for U.S.-born adolescents. Ethnic-group SES may be a meaningful indicator of community-level socioeconomic disparities that influence the health of Asian Americans and, potentially, other populations with high proportions of immigrants of diverse socioeconomic and ethnic backgrounds.

Introduction

With the understanding that individual-based explanations of ill health are insufficient, community contextual factors have received a great deal of research attention in recent decades. Neighborhoods with predominantly low-income and racial minority residents have been a key focus in this paradigm. Poverty and associated social and physical attributes in such neighborhoods have been linked to poor health outcomes including greater mortality, adverse mental health, greater incidence of chronic health issues, and adverse child health (Diez Roux andMair, 2010, Pickett and Pearl, 2001).

While low neighborhood socioeconomic status (SES) has been well-established as a reliable indicator of community-level concentrated disadvantage, it has been underexplored in Asian American health research. In studies that have, it was not a significant predictor for Asian American health (Cook et al., 2015, Gee et al., 2007). Research focus on neighborhood effects on health for Asian Americans has shifted to co-ethnic concentration or density, i.e., residential concentration of a single racial or ethnic group (Becares et al., 2012). Informed mostly by Chinese- and Korean-American experiences, Asian ethnic neighborhoods are seen as positive educational and occupational environments that encourage upward mobility among residents (Zhou and Kim, 2006), serving as an appropriate case for investigating heterogeneity in neighborhood effects across contexts (Logan, 2011, Walton, 2012). However, as was the case for the larger body of literature on co-ethnic density (Becares et al., 2012), findings from Asian-specific research are mixed, with some reporting no significant association between co-ethnic density and health risk behavior such as drinking (Cook et al., 2015), and other studies finding adverse (Hong et al., 2014) or positive effects of co-ethnic density on mental health (Mair et al., 2010). Co-ethnic density, therefore, is not yet established as a reliable significant community-level predictor of Asian American health.

Despite strong evidence in the health disparities paradigm linking socioeconomic disadvantages to health, there is limited understanding of disadvantage as it affects Asian Americans. Past research indicates that SES measures may not be equivalent across racial groups (Williams and Mohammed, 2009). It has been suggested that Asian American experiences may be qualitatively different from other U.S. racial groups, given that established markers of SES such as education and income, on the individual- or neighborhood-level, have not sufficiently assessed the effects of social position on Asian American health (de Castro et al., 2010, Gee et al., 2009). Alternative indicators of individual-level SES such as perceived economic opportunities and subjective SES have been identified as predictors of Asian American health (de Castro et al., 2010, Gong et al., 2012). However, little is known about community-level disadvantage that may uniquely influence Asian American health. This is a notable gap in the current literature.

To address this gap, we explore ethnic-group SES as an indicator of community-level disadvantage (or advantage) that may significantly affect Asian American health—specifically, overweight or obesity in adolescents. We operationalize this concept by the degrees to which Asian ethnic groups in the U.S. are exposed to community-level deprivation. This concept is informed by the wide socioeconomic diversity among Asian ethnic groups representing over 20 national origins in the U.S. alone (Zhou and Xiong, 2005). Some ethnic groups (such as Asian Indian, Japanese, and Chinese, mostly large and more-established in the U.S.) have incomes and educational levels that exceed national averages, while others (e.g., Hmong, Cambodian, and Vietnamese) have the lowest incomes and educational levels (United States Census Bureau, 2010–2014). Asian ethnic groups in the U.S. thus command a varying degree of resources, with some groups having a significant level of human or economic capital and others arriving as refugees with scant resources. The socioeconomic resources ethnic groups command are documented to be integral to the well-being of Asian immigrants, as they often draw upon ethnic resources such as business or labor market information, subsidized loans, and ethnic customers and institutions (Light and Bonacich, 1988, Zhou and Xiong, 2005). With about 60% of Asian Americans being foreign-born (United States Census Bureau, 2010–2014) and many of the rest being born into immigrant families, ethnic resources are likely to have important effects on their well-being.

The concept of ethnic-group SES is also grounded in the theory of segmented assimilation. This theory suggests that children of immigrants assimilate into different socioeconomic segments of American society with different sets of norms and behaviors, depending upon the economic, human, and social capital available to their parents and communities (Portes and Rumbaut, 2001). This theory also points to the importance of these resources in some ethnic groups that serve to insulate adolescents from health risk behaviors (Nagasawa et al., 2001, Zhou and Kim, 2006). Implied in this theory is the notion of socioeconomic disparities across Asian subgroups.

Ethnic group SES, therefore, concerns ethnic resources more-advantaged groups can draw upon from their specific ethnic communities. Conversely, it captures the additional hardships or barriers more-disadvantaged groups may experience from having limited resources, which may be associated with disproportionate burden of ill health. Somewhat akin to neighborhood SES, an established contextual predictor of health for disadvantaged populations, ethnic-group SES may be a meaningful indicator to capture community-level advantage (or disadvantage) for Asian Americans beyond the individual-level. Our investigation centering on ethnic-group SES has great potential to advance disparities research as it concerns the health of Asian Americans and, potentially, other populations with high proportions of immigrants of diverse socioeconomic and ethnic backgrounds.

Overweight or obesity in Asian American children warrants research attention. Childhood obesity, a current global issue, is linked to a host of health, behavioral, and psychological problems including: chronic health conditions such as Type 2 diabetes and asthma (Daniels et al., 2005), and developmental problems such as low self-esteem and poor academic performance (Judge and Jahns, 2007, Storch et al., 2007). Also, overweight children are more likely to be obese or overweight as adults and at high risk for associated adult health problems such as hypertension, Type 2 diabetes, and certain cancers (Dietz, 1998). Obesity is becoming more prevalent among Asian Americans, which increased 102% in 2002–2012, far higher than a 35% increase in whites, and Asians also tend to develop metabolic syndrome at lower body mass index (BMI) than other populations (Yi et al., 2015). As childhood obesity or overweight is a precursor of adult health problems, it is important to identify the profiles of Asian subgroups at high risk of childhood obesity to inform targeted interventions.

Asian American children and adolescents are an under-investigated subpopulation in obesity research. The small body of literature on Asian American childhood obesity, mostly using a single ethnic group sample (mostly Chinese, and to a lesser degree, Hmong) focused on individual-level predictors such as gender and U.S. nativity (Popkin and Udry, 1998), parental acculturation (Chen et al., 2011, Jain et al., 2012), and maternal education (Chen et al., 2011). There is little information about the specific profiles of the subgroups of Asian American children at high risk of obesity or overweight. To our knowledge, only one study (Cook et al., 2016) used a representative sample of diverse Asian ethnic groups to identify two Asian ethnicities (Filipino and Southeast Asian) that are associated with high risk of overweight in adolescents. This same study also found multiplicative interactions between ethnicity and individual-level SES; the odds of being overweight or obese were far higher than all other Asian adolescents for those in two ethnic groups with the lowest average per capita incomes (i.e. Southeast Asian and Vietnamese) and who also had low family incomes. These findings point to high risks of overweight or obesity for those in low-SES Asian ethnic groups.

Informed by these prior findings, we aimed to formally test the hypothesis that ethnic-group SES was inversely associated with overweight or obesity in Asian American adolescents. In doing so, we also drew upon past research that established low individual- and community-level SES as key predictors of childhood obesity (Carroll-Scott et al., 2013, Murasko, 2011, Singh et al., 2008). Our investigation of low ethnic-group SES as a predictor of overweight or obesity in Asian American adolescents explores this disparities thesis in the context of Asian ethnic communities, i.e., their wide socioeconomic diversity.

We also examined whether the association between ethnic-group SES and adolescent overweight or obesity varied by nativity status, as foreign-born adolescents may have closer ties to and are more influenced by their ethnic community than U.S.-born adolescents. Children's nativity status is an important contextual factor that moderates the effects of various ecological factors (e.g., school, family, and peers) on health behaviors (Gil et al., 2000, Prado et al., 2009).

Section snippets

Data

A sample of 1525 Asian American adolescents ages 12–17 from pooled 2007–2012 California Health Interview Survey (CHIS) data was used. Utilizing a county-based, stratified sampling design, CHIS conducts a household survey that randomly selects adults, adolescents, and children. With the permission of the adult parents/guardians, adolescents were interviewed. CHIS uses a landline sample administered through a Computer-Assisted Telephone Interview system with random-digit dialing, and since 2007,

Sample characteristics

Demographic characteristics of Asian American adolescents in our CHIS sample are provided in Table 1. Slightly over two-thirds (68%) were born in the U.S. Over half of Asian American adolescents had family incomes of 300% of the FPL or higher (56%) and a parent or a guardian with a 4-year college or an advanced degree (57%). As for Asian ethnicity, Chinese was the largest ethnic group in the sample (27%), followed by Vietnamese (17%), Koreans (15%), and Filipinos (12%). Southeast Asians were

Discussion

Our findings support our hypothesis that ethnic-group SES is inversely associated with overweight/obesity in Asian American adolescents. Adolescents in high- or middle-level SES ethnic groups were far less likely to be overweight or obese than those in low-SES ethnic groups. These relationships were more pronounced for foreign-born adolescents but not significant for the U.S.-born, suggesting that the effects of ethnic-group SES may attenuate as the socioeconomic or cultural ties with the

Conclusions

This study has a number of important strengths. Weighted representativeness of the data is one of them. Though a proxy, the use of a quantitative measure to characterize the differences in SES across Asian ethnic groups allowed us to conceptualize a new layer of disparities for Asian Americans to enhance nuanced understanding of social determinants influencing their health, with great potential to advance disparities research as it concerns the health of Asian Americans (and other populations

Acknowledgements

This study was supported by the the Robert Wood Johnson Foundation grant No. 72376 and the National Institute on Alcohol Abuse and Alcoholism grant R03AA025205 (Cook, PI).

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