STUDENT CASE STUDY—WILSON
Trends in Immigrant Adolescent Health in New York City:
“Becoming an American Can Be Bad for your Health”
Case Study for AAC&U STIRS Project
Katie B. Wilson, Instructor of Interdisciplinary Studies, Stella and Charles Guttman Community College, New York, NY
Imagine . . . .. . . that you have just finished college with a degree in Public Health and that you land a Program Analyst job in the New York City Department of Health and Mental Hygiene (NYCDOHMH) in the division of Health Promotion and Disease Prevention. You took this job because of its strong focus on immigrant health issues, which was your concentration in college. The NYCDOHMH has reported that soon after arriving in New York City, the health of many immigrant groups declines. The approach of the NYCDOHMH has been to analyze trends across neighborhoods, identify the contributing forces, and design interventions to improve health. Your first task at your new job is to read through this case study, analyze the issues, and make recommendations using the evidence-based public health approach adapted by the Centers for Disease Control (CDC).
Introduction
This case study explores health issues experienced by immigrant teens adapting to life in urban America, particularly adolescent girls from Mexico who have immigrated to New York City. You will examine perspectives in public health, anthropology, and even history. Ultimately, by the end of the case study, you should understand, connect, frame, and analyze the story of a young, Mexican woman named Maria who moved to New York City then generate innovative and concrete suggestions for multi-level interventions, using scientific thinking and evidence-based reasoning. Though Maria’s story is fictional, it is representative of thousands of immigrant teens whose stories are similar.
The case study is presented in five parts and will be discussed over several class sessions. In Part One (A), you will be asked to prepare for the first class session by reading a New York Times article and answering some questions about your relevant prior knowledge. In Part One (B), you will read Maria’s story and will be asked to reflect on her experiences. In Parts Two through Five you will analyze various dimensions of adolescent health and immigration, as well as potential approaches to preventing health issues as adolescents assimilate into US urban culture.
Case Study Instructions
This case study will take approximately five class sessions to complete. Your instructor will indicate exactly how the five parts will be tackled and when assignments will be due. If you have access to an electronic device (laptop, tablet, etc.) it will be very helpful for both collecting data and completing online research. All work must be typed, unless otherwise indicated by your instructor. Throughout the case study, you will see boxes labeled, “Key Questions.” You are required to answer these questions. Other boxes are labeled, “Reflect,” which, though written answers are not required, you should have thought through these questions in preparation for class discussions. There are also “Readings” and “Videos” that you can access via the hyperlink within each part of the case study. Just click on the title of the reading or video and you will be sent to the appropriate site or document. Supplementary handouts might be supplied by your instructor. The final outcome is a two-page (minimum) public health report and additional assignments (i.e., paper, presentation, etc.) that might be assigned by your instructor.
Learning Objectives
By exploring this case study, you will be able to:
Part One—UNDERSTAND: Preparation and Meet Maria
· Reflect on your knowledge about adolescent health issues in the United States
· Examine your prior knowledge about the history of immigration in the United States
· Begin to critique the systems within which Maria exists and how she might be helped
Part Two—CONNECT: Adolescent Health
· List the most prevalent adolescent health issues in the United States
· Discuss issues in adolescent development
· Define: public health, epidemiology, health disparity, overweight, obesity, diabetes, depression, risk factors
Part Three—FRAME: History of Immigration in the United States and New York City
· Describe, briefly, the history of immigration in the United States and relate it to immigration trends shown graphically
· Define: assimilation, acculturation, social capital
· Analyze and interpret data relating to immigrant adolescent health
· Demonstrate parallels between Maria’s experiences and research-based evidence on immigrant health
Part Four—ANALYZE: Maria’s Story
· Analyze the contributing forces in Maria’s life
· Illustrate the social ecological framework using Maria’s story
· Relate elements of Maria’s story to data in the New York City (NYC) Department of Health Report
Part Five—SOLVE: Evidence Based Solutions
· Evaluate the nature of adolescent immigrant health issues using the evidence-based public health framework
· Synthesize findings into a multi-dimensional recommendation for solutions
Part One―UNDERSTAND: Preparation and Meet MariaDay One àDirections
In preparation for the first class session, please do the following:
1. Answer the six questions, labeled “KEY QUESTIONS, Part One (A)—Prior Knowledge,” listed below.
2. Read the Background section on pages 3–4.
3. Complete the reading, “Health Toll of Immigration,” listed on page 4.
4. Watch the video, “Becoming American,” listed on page 5. This short clip is from a California Newsreel series called Unnatural Causes. You will watch a more comprehensive version of the film in Part Three of the case study.
5. Answer the three questions, labeled “KEY QUESTIONS, Part One (B)—Background” on pages 4–5.
6. Read “Meet Maria” on pages 5–6.
7. Read Part Two.
8. Read through the rest of the case study so you know what to expect.
Key QuestionsPart One (A)―Prior Knowledge
Before class, answer these questions to the best of your ability, using complete sentences.
1. How would you describe the general health of the average American? Explain.
2. List as many health issues (mental, physical, social, environmental) that you can think of that might be experienced by teenagers in the United States.
3. What do you know about the history of immigration in the United States? In New York City?
4. When/how/why did your family or ancestors immigrate to the United States? Or, if you live somewhere other than the United States, when/how/why did your family move there?
5. Find a definition of assimilation and acculturation. Cite your sources.
6. In two to three sentences, based on your understanding prior to reading this case study, what is your response to the subtitle of this case: “Becoming American is Bad for Your Health.”
Background
According to researchers at the Migration Policy Institute (Nwosu 2014), in 2012:
· 41 million immigrants lived in the United States
· 31.1 million children under 18 living were living in poor families (i.e., with family incomes below 200 percent of the federal poverty threshold) in the United States and almost 9.6 million (or 31 percent) were children of immigrants.
· 17.4 million children under age 18 lived at home with at least one immigrant parent
o Of this total, 2.2 million were children who were born outside the United States to foreign-born parents.
Given these statistics, immigrant children and teens are assimilating into American culture in record numbers. As young immigrants adapt both socially and culturally to living in the United States, there are tremendous implications for the health behaviors that are adopted and the resulting health outcomes (Morse 2005). Specifically, rates of illnesses like diabetes, asthma, and obesity are often disproportionately high in immigrant communities in the United States. Why would this happen? This is a very complex problem that is being tackled by schools, scholars, policymakers, and politicians but has yet to be fully understood. This case study asks that you think critically about the relationship between US culture, society, and health and what immigrants to this country experience while adapting to the American lifestyle. What does the data have to say about US society? And, what are some ways in which US culture and society can better serve immigrant communities?
The family history of all Americans involves movement from one land to another. Immigration into the United States from all corners of the planet continues to this day, as individuals and families move from their homeland to the United States to pursue a new life. While they are met by tremendous opportunities, a beautiful country, and the richness of American culture, they are also met with its complications and struggles. This case explores some of the health implications specifically experienced by adolescents who immigrate to urban regions in the United States. You will analyze data from New York City—the ultimate, urban melting pot in the United States—and think about how the American lifestyle and/or the process of adapting to the American lifestyle is associated with health outcomes.
Reading
Health Toll of Immigration (Tavernise 2013) from the New York Times
· Read the article and annotate while you read (underline, highlight, questions, etc).
· Be prepared to discuss the article in class.
Video
“Becoming American” (California Newsreel 2008), excerpt, “Arriving Healthy”
· Reflect on your opinion about the video.
· Be prepared to discuss the video in class.
Key QuestionsPart One (B)
“Health Toll of Immigration”
7. What does this article tell you about the relationship between immigrating to the United States and health? Include a quote from the article that supports your explanation.
8. Given the perspectives presented in this article, describe the health issues that might be faced by a teenager who has recently arrived in the United States.
“Becoming American”
9. This clip references the idea that immigrants to the United States arrive with good health and then their health declines from “the same social forces that erode the health of all of us.” Explain what the narrator means and list 2–3 examples of social forces.
Meet Maria
Maria recently moved from a small town outside of Mexico City to Elmhurst, Queens, a neighborhood in New York City with the region’s most highly concentrated immigrant population and a thriving Mexican community. She is 15 and has two younger sisters, ages 12 and 10. The three girls and their mother moved to Queens last year to join their father who had lived there for two years working in a deli. Despite the deep pains of leaving their extended family behind in Mexico, her parents decided to move to NYC, so they could access work and so that the girls could acquire an American education. The family lives in a one-bedroom, government-subsidized apartment on a relatively safe block in Elmhurst, but crime and violence occur throughout the neighborhood on a regular basis. The building is pretty noisy and it’s always breaking down, but her neighbors are friendly. Living in such close quarters with her family doesn’t bother her. In fact, these days, the times that they are all actually in the apartment together are rare. Both of her parents work 10-hour shifts at minimum wage jobs, six days/week. Both parents have very low-level English language skills, but are taking classes on Saturday afternoons at the library. They speak Spanish in the home, but practice English when they remember. Maria looks forward to Sunday mornings when the entire family attends a nearby Catholic church, calls their grandmother back in Mexico, and walks through the park and makes a huge family breakfast. Whenever she talks with her grandmother, Maria is so happy to reconnect but then feels very depressed about the life that she left behind. She notices that her mother seems depressed as well. Additionally, in merely 18 months of living in NYC, Maria’s mother has developed the preliminary symptoms of diabetes, and her father has developed a chronic cough. Maria is becoming worried about her family’s health.
Ana, who is from Ecuador, lives on Maria’s floor and they have become fast friends. They often sit in the stairway and gossip about school, the neighborhood, and music.
Ana: What are you up to this weekend—a guy from my school is having a party on Saturday. Do you want to go?
Maria: I dunno. I have to work all day Saturday and then if I don’t study all night, there’s no way I’m passing my History final on Monday. I love living in New York City, but I’m just always exhausted. Anyways, I have nothing to wear to a party, I am so fat, and none of those people like me.
Ana: You’re being crazy! No one knows you, that’s the problem. You are always working and taking care of your family!
Maria: Whatever. Anyways, my Mom has been fainting after dinner this week and there’s no way I am leaving her side.
During the week, Maria wakes up at 5:00 a.m., leaves the house at 6:30 a.m. to drop her sisters off at a family friend’s house, and commutes for one hour on the subway for a 7:45 a.m. start at her high school. Maria’s school is ranked as a below-average school, but her teachers are caring. Most of her classes emphasize testing, and there are no physical education or health classes. After a full day at school, Maria rushes back to Elmhurst to pick up her sisters at their grade school, make dinner for the whole family, clean the apartment, and complete her homework. Maria averages five hours of sleep a night, and her sleep is often disrupted by noises outside. She is always tired, so she drinks coffee and energy drinks all day. During the week, Maria eats breakfast and lunch at school through NYC’s School Food Program. Maria has a home-cooked meal for dinner during the week, but she ends up eating pizza and soda for lunch and dinner every Saturday and Sunday because of her 8-hour shifts at the Pizza Hut across the street from her apartment. She makes $8/hr. After taxes, Maria’s monthly check is about $350. Her parents depend on $250 of her income to contribute to the family’s bills. The remaining money she uses for her cell phone bill and the occasional outfit.
Despite feeling so stressed and juggling so many family responsibilities, Maria passed her first year of high school with a C average. She excelled in math and science, but because she was still learning English, her marks in history, debate, and English were just barely passing grades. Her reading skills improved dramatically, but her fluency in speaking English and her confidence in writing were challenged. She struggled to “fit in” at school. The other teens in the school seemed so much more mature. She heard her classmates talking about parties with lots of drinking and drugs, and she has heard that pregnancy and STD’s are a big problem at her school. Maria didn’t develop any solid school friendships in her first year and she often felt lonely, insecure, and depressed. Like most teenage girls, Maria was consumed with her appearance. In just one year, she had gained twenty pounds. Her parents said it was probably just a symptom of puberty, but on her 5’2” frame, twenty pounds made a significant difference. Her weight gain added to her feelings of insecurity. Her family did not have health insurance and her parents didn’t trust doctors, so she knew seeking medical help wasn’t an option.