FOREIGN VERSUS U.S.-BORN BLACK ADULT OBESITY AND DEPRESSION: AN ANALYSIS OF ENDURING PATTERNS AND MECHANISMS

Abstract

Foreign-born Blacks have better health outcomes than U.S.-born Blacks. The extent to which the health status of foreign-born Blacks change with increased exposure to the U.S. socio-cultural environment is less known than for other immigrant groups. Two prominent theories used to understand foreign and U.S.-born health disparities are the immigrant health paradox theory and immigrant health assimilation theory. The literature is conclusive that foreign-born Blacks have better health outcomes than U.S.-born Blacks, but this dissertation questions the appropriateness of framing this pattern as an immigrant health paradox due to the better socioeconomic status (SES) of foreign-born Blacks, relative to U.S.-born Blacks in general. The literature has been inconclusive on the extent to which immigrant health assimilation describes the health trajectories of foreign-born Blacks with increased duration of residence of the first generation in the U.S. or in comparing the first generation to subsequent generations. This dissertation interrogates the utility of immigrant health assimilation theory to describe the health trajectories of Black immigrants. Specifically, the dissertation focuses on the health outcomes of body mass index (BMI), obesity, depressive symptoms and depressive disorder. The sample of the dissertation includes foreign and U.S.-born Blacks generally, first generation foreign-born Afro Caribbeans, second and third generation U.S.-born Afro Caribbeans and U.S.-born African Americans. Collectively the three papers of this dissertation confirm a healthy immigrant effect for the health outcomes studied, when comparing the foreign-born to U.S.-born Blacks generally or African Americans specifically. In these comparisons first generation foreign-born Blacks have better socioeconomic status than the U.S.-born or African Americans. There is an immigrant health paradox for the health outcomes studied when comparing foreign born Afro Caribbeans to U.S.-born Afro Caribbeans, where U.S.-born Afro Caribbeans have better SES than the foreign-born. The dissertation does not find support for immigrant health assimilation. For BMI and obesity, the foreign-born Black trajectories compared to U.S.-born Blacks indicates patterns of no convergence or divergence. Intergenerationally, while first generation foreign-born Afro Caribbeans had lower obesity rates than second and third generation U.S.-born Afro Caribbeans, U.S.-born Afro Caribbeans had higher rates of obesity than African Americans. A similar intergenerational pattern was found for depressive disorder. Immigrant health assimilation theory predicts convergence of health outcomes between U.S.-born Afro Caribbeans and African Americans, not worse outcomes. The dissertation uncovers two mechanisms that help to explain the observed health trajectories of foreign-born Blacks. The lower first generation foreign-born Afro Caribbean obesity rates compared to second and third generation U.S.-born Afro Caribbeans is explained by differential rates of return on characteristics: the same characteristics provide more obesity protection for the foreign-born than the U.S.-born. Also perceived discrimination was informative in explaining variations in depression. U.S.-born Blacks reported higher levels of perceived discrimination than the foreign-born and foreign and U.S.-born Black women experienced higher depressive symptoms with increased perceived discrimination than men.