Health-compromising behaviors among a multi-ethnic sample of Canadian high school students: risk-enhancing effects of discrimination and acculturation.

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Health-Compromising Behaviors Among a Multi-Ethnic Sample of Canadian High School Students: Risk-Enhancing Effects of Discrimination and Acculturation a

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Catherine Brown , Donald Langille , Julian Tanner & Mark Asbridge a

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Dalhousie University , Halifax , Nova Scotia , Canada

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University of Toronto at Scarborough , Scarborough , Ontario , Canada Published online: 22 May 2014.

To cite this article: Catherine Brown , Donald Langille , Julian Tanner & Mark Asbridge (2014) HealthCompromising Behaviors Among a Multi-Ethnic Sample of Canadian High School Students: RiskEnhancing Effects of Discrimination and Acculturation, Journal of Ethnicity in Substance Abuse, 13:2, 158-178, DOI: 10.1080/15332640.2013.852075 To link to this article: http://dx.doi.org/10.1080/15332640.2013.852075

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Journal of Ethnicity in Substance Abuse, 13:158–178, 2014 Copyright # Taylor & Francis Group, LLC ISSN: 1533-2640 print=1533-2659 online DOI: 10.1080/15332640.2013.852075

Health-Compromising Behaviors Among a Multi-Ethnic Sample of Canadian High School Students: Risk-Enhancing Effects of Discrimination and Acculturation


CATHERINE BROWN and DONALD LANGILLE Dalhousie University, Halifax, Nova Scotia, Canada

JULIAN TANNER University of Toronto at Scarborough, Scarborough, Ontario, Canada

MARK ASBRIDGE Dalhousie University, Halifax, Nova Scotia, Canada

This article examines whether acculturation and experiences of discrimination help to explain observed ethnic disparities in rates of three health-compromising behaviors: interpersonal violence, drinking, and cannabis use. Data were drawn from a crosssectional survey of 3,400 high school students from Toronto, Canada, sampled in 1998–2000. Multivariate ordinary least squares and logistic regression models tested for baseline differences in the health-compromising behaviors by ethnic identity. Subsequent models adjusted for control measures and introduced acculturation and discrimination measures. Results confirm that experiences of discrimination and acculturation are risk enhancing, whereas active cultural retention appears to protect ethnic youth from participation in health-compromising activities. KEYWORDS acculturation, adolescents, Canada, cannabis use, discrimination, drinking, violence

This research was supported by a grant from the Social Sciences and Humanities Research Council (SSHRC) of Canada. Address correspondence to Mark Asbridge, PhD, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia, Canada B3H 1V7. E-mail: [email protected] 158

Health-Compromising Behaviors

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INTRODUCTION By 2017, between 19% and 23% of the Canadian population will be ethnic minorities, whereas in Toronto, Canada’s largest urban center, more than half of residents will be from ethnic minorities, primarily of South Asian and Chinese descent (Statistics Canada, 2005). As ethnic minority populations grow in North America and throughout the Western world, understanding both the distribution of health across ethnic populations and the health effects associated with the integration of ethnic groups into a multicultural society is critical. Two factors that shape the health and well-being of the population are exposure to violence and substance use. An important body of research has explored patterns of adolescent involvement in these activities in ethnically diverse populations (Chedebois et al., 2009; Feldman, Harvey, Holowaty, & Shortt, 1999; Jayakody et al., 2006), as well as in specific ethnic groups such as African Americans (Caldwell, Schmeelk-Cone, Chavous, & Zimmerman, 2004; Martin, Tuch, & Roman, 2003; Pugh & Bry, 2007), Latinos (Gil et al., 2000; Hokoda et al., 2007; Okamoto, Ritt-Olson, Soto, Baezconde-Garbanati, & Unger, 2009; Romero, Martinez, & Carvajal, 2007; Smokowski & Bacallao, 2006), Asian Americans (Cook, Hofstetter, Kang, Hovell, & Irvin, 2009; Hahm, Lahiff, & Guterman, 2003; Park, 2008), and Aboriginals (Fiaui & Hishinuma, 2009). The literature generally acknowledges that patterns of violence, drinking, and cannabis use differ among ethnic groups but fails to explain the processes behind this divergence (Cheung, 1990–1991; Soriano, Rivera, Williams, Daley, & Reznik, 2004). This article aims to better understand the underlying processes that might explain observed ethnic disparities in these three health-compromising behaviors, focusing on a multi-ethnic sample of school-based adolescents from Toronto. Attempts at understanding health disparities in multi-ethnic populations, particularly those that include a large proportion of recent immigrants, have resulted in a number of theories. Two important approaches that have emerged to help explain ethno-cultural variations in health have focused on acculturation and discrimination. Acculturation refers to the process by which ethnic group members begin to learn the norms, beliefs, and behaviors of a new host culture, often leading to the loss of ethnic identity (Gordon, 1964). The process of acculturation is not linear and exists on a continuum whereby individuals balance the maintenance of traditional culture with the adoption of host cultural practices (Berry, 2001, 2006; Brug & Verkuyten, 2007; Dona & Berry, 1994). This includes the outright rejection of traditional culture (e.g., assimilation) or host culture (e.g., segregation), as well as the celebration (mosaic or multiculturalism) or rejection of both cultures (Berry, 2001, 2006). Discrimination speaks more directly to the lived experiences of ethnic individuals in a host society. Interpersonal

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discrimination refers to discriminatory interactions, both conscious and unconscious, between individuals (Karlsen & Nazroo, 2002), but also manifests through day-to-day interactions with varying social structures.


ACCULTURATION AND HEALTH-ASSOCIATED BEHAVIORS Acculturation remains one of the dominant hypotheses explaining health-compromising behaviors among ethnic minority individuals (Soriano et al., 2004). The ‘‘Simple’’ or ‘‘Unidimensional Acculturation’’ model suggests that adolescents from a minority culture spend time with their highly accultured and native-born peers, leading to greater exposure and access to native youth culture. As such, a failure to identify with an ethnic minority culture may represent a health risk for certain groups (Kopec, Williams, To, & Austin, 2001). In Canada, the age-standardized mortality ratio among all ethnic minority groups is significantly lower than that of Canadians who do not identify with an ethnic group, but this benefit weakens as the number of years since immigration increases and disappears entirely for Canadian-born ethnic minorities, with the exception of Chinese individuals (Wilkins, Tjepkema, Mustard, & Choinie`re, 2008). This effect has also been observed with respect to specific health-risk behaviors. For aggression and violent behavior, ethnic identity, as it relates to feelings of affirmation and belonging, has shown to be protective of violence in Samoan adolescents (Fiaui & Hishinuma, 2009). With respect to drinking, Asian Americans who were born in the United States and spoke English at home were significantly more likely to drink alcohol than their foreign-born counterparts who did not speak English at home (Hahm et al., 2003). Similarly, stronger ethnic identity in Black university students (Pugh & Bry, 2007) was associated with significantly lower alcohol consumption. Generally, this model assesses acculturation on one dimension by measuring the strength of identification with the minority culture, using measures such as participation in cultural events or years lived in the host culture. Acculturation can also negatively affect health-related behavior through a stress process where acculturation leads the individual to rebellion, delinquency, and=or drug use (Berry, 2006). Although evidence of an association of acculturative stress and violence has been demonstrated in adults, Soriano et al. (2004) noted that little evidence exists for adolescents. This stress may be particularly strong in adolescents for several reasons: (a) the formation of ethnic identity largely occurs during adolescence; (b) acceptance by peers is especially important in that phase of development; (c) parental pressure around minority values and traditions, including language, conflicts with the majority culture; and (d) increased perceptions of racial and ethnic discrimination and prejudice during adolescence (Sabatier, 2008).



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More evidence has emerged in support of this model. Romero et al. (2007) found that bicultural stress is a stronger predictor for both violence and alcohol consumption than for socioeconomic factors or ethnicity in Latino eighth graders. Similarly, Mexican American students who experience higher level of acculturative stressors, such as family acculturation conflict or conflicted ethnic loyalty, demonstrated more tolerant attitudes toward dating violence (Hokoda et al., 2007). One study of Latino youth found that parent-adolescent cultural conflict was the strongest risk factor for aggression; however, adolescent culture-of-origin involvement displayed a small, direct, inverse relationship with aggression (Smokowski & Bacallao, 2006). Limited evidence also exists suggesting that cultural minority adolescents who are marginalized, alienated, or suffering from acculturative stress are at particularly high risk for alcohol and cannabis use (Chedebois et al., 2009; Gil, Wagner, & Vega, 2000).

PERCEPTION AND EXPERIENCES OF DISCRIMINATION ON HEALTH A growing body of evidence underlines that experiences and perceptions of racism and discrimination in society have major health consequences (Pascoe & Smart Richman, 2009). In their study of blood pressure and experiences of racial discrimination in the United States, Krieger and Sidney (1996) found that reported experiences of racial discrimination and responses to unfair treatment greatly contributed to Black=White disparities in blood pressure. Karlsen and Nazroo (2002) also found that experiences of racism and the perception of racism in wider society were independently associated with poorer self-reported health in the United Kingdom. Furthermore, a study of experiences of racial discrimination among ethnic minority individuals in New Zealand provides strong evidence of a dose-response relationship between the number of reported types of discrimination and all five health measures considered (Harris et al., 2006). The World Health Organization (2004) highlighted the role of racism and discrimination as a key contributor to social exclusion, with inclusion being an important social determinant of health. Hyman (2009) suggested that racism and discrimination were important determinants of immigrant health, contributing to health inequalities directly through an individual’s response to stress related to acculturation, such as increased alcohol and drug abuse, self-harm, and delays in seeking healthcare in the short term and high-blood pressure, aggression, and cardiovascular disease in the longer term. Furthermore, racism and discrimination experienced by visible minorities may indirectly increase health inequalities through interaction with other determinants of health, such as disproportionate levels of poverty,


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inadequate housing, and difficulty finding employment. Experiences with discrimination are commonplace for many youth: one study of African American students found that 82% experienced at least one racially discriminatory episode (median ¼ 7 episodes) over 5 years (Caldwell et al., 2004). Adolescents may manifest negative feelings from their experiences of discrimination through different internal or external mechanisms. Aggression and violence may represent the externalization of acculturative stress by serving as a physical manifestation of stress. A large cohort study of African American high school students found that experience with racial discrimination was the strongest predictor of violent behavior, including being in a fight and carrying or using a weapon (Caldwell et al., 2004). In contrast, substance use may represent the internalization of discrimination by serving as a coping mechanism and repression of stressful feelings. A large study of African American workers found that after adjusting for socioeconomic factors, experiences with discrimination were significantly associated with problem drinking, especially escapist drinking (Martin et al., 2003). Notably, this study identified school as the greatest source of discrimination over the workers’ lifetimes. Other studies have confirmed that perceived discrimination is associated with increased risk of alcohol use in Asian adolescents (Park, 2008) and alcohol and cannabis use in Latino adolescents (Okamoto et al., 2009).

THE CURRENT ARTICLE Using data from a multi-ethnic sample of Toronto high school students, this article examined the comparative utility of these two hypotheses: on the one hand, that higher levels of acculturation will increase the risk of involvement in health-compromising behaviors, such as alcohol and cannabis consumption and violence, whereas on the other hand experiences of discrimination in everyday life enhance involvement in health-compromising behaviors. We suggest that the relationship between experiences of acculturation and discrimination on patterns of violence and substance use in adolescents will have both direct and indirect effects. An examination of both acculturation and experiences of discrimination move beyond approaches that use only passive measures of ethnic identity and that fail to explore the lived experiences of being an ethnic individual on health and well-being (Bhopal & Donaldson, 1998; Cheung, 1990–1991). To understand their potential risk-enhancing effects for violence and substance use, we treat acculturation and discrimination as mediator variables (Baron & Kenny, 1986; Kraemer, Stice, Kazdin, Offord, & Kupfer, 2001). Structuring our analysis this way allows us to test whether any observed disparities in health-related behaviors across ethnic groups are instead due to differing ethnic group patterns in acculturation and experiences of discrimination.


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METHODS


Participants The data for this article were drawn from the Toronto Youth Crime and Victimization Survey, a cross-sectional survey of Toronto adolescents administered between December 1998 and May 2000. A total of 3,400 youth from 30 high schools in the Metropolitan Toronto Area completed the selfadministered questionnaires. The original focus of the Toronto Youth Crime and Victimization Survey was to investigate adolescents’ perceptions of safety and security issues and their encounters with crime, both as victims and offenders. Parents or guardians provided informed consent for participation in the study. Questionnaires were anonymous and administered to selected classrooms during school hours. The survey took approximately 45 minutes to complete. The response rate was 83%.

Measures Cheung’s (1990–1991) framework stresses that for future research on ethnicity and alcohol=drug use proper analysis of ethnicity must avoid broad racial categories; he proposed that studies of ethnicity should use specific, culturally meaningful units that necessitate large samples. Although far from perfect, this approach enables an examination of more clearly defined ethno-cultural groups and avoids inappropriate use of broad racial categories (i.e., Hispanic, non-Hispanic White, Black, Asian)—either instead of ethnicity or, worse still, as a proxy for ethnicity (Bhopal & Donaldson, 1998). Racial categories are far from homogeneous, and it is problematic to use such broad categories because within-group differences, in many instances, may exceed between-group variations. Whenever possible, analytic studies should use ethnicity rather than race (Cheung, 1990–1991). We adopt Isajiw’s (1999) definition of ethnic identity as ‘‘persons who share the same distinct culture or who are descendants of those who have shared a distinct culture and who identify with their ancestors, or their culture or group’’ (p. 19). We constructed ethnic identity from a question on respondent’s self-perceived ethnicity: People are often identified as belonging to a particular ethnic or cultural group. To which ethnic or cultural groups do you see yourself belonging? Considering ethnic identity as broadly as possible given the data, we constructed 12 distinct ethnic groups: Canadian, Western European (including United Kingdom, France, Denmark, Sweden), Eastern European (including Russia, Ukraine, Poland), Southern European (including Italy, Portugal, Greece, Spain), Chinese, South Asian and East Indian (including Pakistan, Sri Lanka, India), South-East Asian (including Cambodia, Indonesia, Vietnam, Philippines), West Asian and Middle Eastern (including Lebanon, Iran, Egypt, Armenia), South American


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(including Central and South American, Latin America), Caribbean (including Jamaica, Barbados, Trinidad and Tobago, Guyana), African, and Other ethnic identity (remaining ethnic groups including Canadian First Nations, Jewish, Japanese). Our dependent variables were self-reported involvement in violence, weekly drinking, and weekly cannabis use. Violent behavior was measured as a scale (as z-scores) of past 12-month involvement in carrying a hidden weapon such as a gun or knife in public, using physical force on another person to get money or other things, attacking someone with the idea of seriously hurting that person, hitting or threatening to hit a parent or teacher, getting into a physical fight with someone, and taking part in a fight where a group of friends were up against another group (a ¼ 0.81). Weekly drinking and weekly cannabis use were based on the following question: ‘‘How often have you used alcohol (cannabis) in the past 12 months?’’ These responses were collapsed into a dichotomous measure—weekly use and less than weekly use—with the aim of focusing on problematic and harmful consumption levels. Mediator measures were divided into acculturation measures and discrimination measures. The first acculturation measure was time spent in Canada and is based on whether the adolescent was born in Canada and in what year he or she moved to Canada. From this, we derived whether an adolescent had spent most or all of his or her life in Canada versus the country of his or her birth or another country in which he or she lived. Our other acculturation measures tapped into active cultural retention, based on the questions ‘‘How often do you attend an ethnic or cultural event?’’ and ‘‘How much do you like ethnic music?’’ Both measures were dichotomized, with an affirmative response as representative of active involvement in cultural retention. These measures of acculturation have been considered previously in studies of ethnic populations (Cheung, 1993; Isajiw, 1999). For discrimination, we used two measures of past year experiences of either verbal or physical discrimination: ‘‘How often in the past 12 months have you been teased or verbally threatened (physically assaulted) because of your ethnicity or race?’’ Responses were dichotomized (i.e., yes or no) to indicate experiences of discrimination. To capture the relative contribution of ethnic identity and mediators in explaining past year violence, drinking, and cannabis use among adolescents, we included seven control measures known to be associated with violence and substance use in adolescents. These measures are gender, age (in years), father’s and mother’s educational attainment (measured as whether they obtained a university degree), family intactness (measured as whether the adolescent is in a two-parent family), school grades (measured as receiving mostly ‘‘A’’ grades), and academic stream (measured as whether the adolescent was in an advanced versus general academic stream).


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Statistical Analysis We followed an analytic strategy used by Baron and Kenny (1986) for exploring the mediating effects of acculturation and discrimination on the relationship between ethnic identity and health-related behaviors. To follow this framework requires first uncovering the presence of disparities in violent behavior, weekly drinking, and weekly cannabis use among youth of differing ethnicity. On determining the unique ethno-specific behavioral ‘‘starting’’ points, we introduced discrimination and acculturation measures to discover their mediating effects. It may be that ethnicity is uniquely related to particular mediating factors, such that certain ethnic adolescents are affected while others are not. Violence was estimated with a series of ordinary least squares regression models and we used logistic regression to estimate models for weekly drinking and cannabis use. All models used the robust cluster variance estimators to address intracluster correlation across schools. A change in the direct relationship between ethnic identity and a health-related behavior, from significant to nonsignificant, was indicative of a mediating effect and suggests that much of the disparity across ethnic groups was indirect. We found no evidence of multicolinearity in all our models as the tolerance and variance inflation factors for all measures were well within acceptable levels. All analyses were conducted with the Stata version 11.0 computer program.

RESULTS Descriptive Statistics Table 1 provides demographic information for the 3,296 adolescents. Less than one-tenth of adolescents classified themselves as Canadian (9.4%). About 40% identified with one of the three European ethnicities, and nearly 30% identified with one of the four Asian ethnicities. The remaining adolescents identified as South American (3.3%), Caribbean (10.7%), African (3.0%), and Other (2.7%). On average, respondents were 16.6 years old and evenly split between sexes. About one third (31.5%) of adolescents had fathers who attended university, and 26.9% had mothers who attended university. More than 75% of adolescents came from an intact family. The majority of students were in the advanced educational stream, and 32.1% of adolescents achieved mostly ‘‘A’’ grades. Table 2 shows the percentage and mean for health outcomes and mediators by ethnic identity. The rate of physical violence varied significantly across ethnic groups (F ¼ 4.15, p ¼ 0.00). South Asian and East Indian and Chinese youth engaged in the least physical violence, whereas adolescents who identified as South American and Caribbean engaged in the highest levels of physical violence. On average, Canadian adolescents engaged in slightly more physical violence than most ethnicities.

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TABLE 1 Descriptive Statistics for All Variables


Measures Ethnic identity South Asian and East Indian Canadian Western European Eastern European Southern European Chinese South-East Asian West Asian and Middle Eastern South American Caribbean African Other Ethnicity Sociodemographics Age, years Female Father university Mother university Two-parent family Education Mostly ‘‘A’’ grades Advanced stream Acculturation Most life spent in Canada Attend ethnic=cultural events Listen to ethnic=cultural music Racial=ethnic discrimination Experienced verbal abuse Experienced physical abuse Health outcomes Physical violence (z-score) Weekly drinking Weekly cannabis use

No.

Percent=Mean

Range

348 312 535 258 509 382 196 108 108 352 100 88

10.5 9.4 16.2 7.8 15.4 11.6 5.9 3.3 3.3 10.7 3 2.7

0–1 0–1 0–1 0–1 0–1 0–1 0–1 0–1 0–1 0–1 0–1 0–1

3331 1700 1073 917 2609

16.6 50.1 31.5 26.9 76.7

13–20 0–1 0–1 0–1 0–1

1092 2642

32.1 78.2

0–1 0–1

2230 1410 2186

67.2 64.8 42

0–1 0–1 0–1

2240 546

67 16.3

0–1 0–1

3288 497 354

0.002 14.6 10.4

2.2–31.0 0–1 0–1

On average, 14.6% of adolescents drank weekly (Table 2). The proportion of adolescents who drank weekly varied significantly across ethnic groups (v2 ¼ 129.4, p ¼ 0.00). The percent of weekly drinking was lowest among adolescents who identified as South Asian and East Indian (4.0%) and West Asian and Middle Eastern (5.5%) and it was highest among Western European (23.3%) and Other (21.6%) youth. A total of 16.7% of Canadian youth drank weekly. These findings were consistent with those reported elsewhere. A recent study noted that 16% to 19% of 15-year-old Canadians report drinking alcohol at least once per week (Child and Adolescent Health Research Unit [CAHRU], 2008). On average, 10.4% of adolescents used cannabis weekly (Table 2). The percentage who smoked weekly varied significantly across ethnic groups (v2 ¼ 95.7, p ¼ 0.00). The percentage of weekly cannabis use was lowest

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Discrimination experiences

Acculturation

6.8 4 7.1 5.5 17.6 12.7 6 21.6 v2 ¼ 129.4; p ¼ 0.00

0.39 0.53

1.32 0.61 0.29 0.43 F ¼ 4.15; p ¼ 0.00

14.6 16.7 23.3 21.3 19.3

0.57 0.85

0.002 0.15 0.24 0.05 0.03

10.2 10.8 11 27.3 v2 ¼ 95.7; p ¼ 0.00

6.1 4.6

5.2 3.2

10.4 13.8 17.2 9.7 10

67.6 74.1 70.1 70.4 v2 ¼ 130.8; p ¼ 0.00

69.8 66.7

78.8 82.5

67 61.1 54.1 64.9 58.6

21.5 21.5 17.7 12.5 v2 ¼ 33.9; p ¼ 0.00

16.4 14.3

16.7 21.8

16.3 17.7 13.6 15.3 10.5

52.8 69.1 45.8 77.9 v2 ¼ 445.7; p ¼ 0.00

51.6 47.1

62.6 42.6

68.3 74.5 89.9 49.8 88.5

73.8 71.4 76.8 71.6 v2 ¼ 205.8; p ¼ 0.00

73.8 70.1

63 87.9

64.8 54.4 46.8 56.6 65.7

54.2 30.7 44.4 29.9 v2 ¼ 380.7; p ¼ 0.00

47.9 61.7

62.1 76.4

42 40 29.8 33.5 26

Physical Weekly Weekly Most of life spent Attend ethnic Listen to ethnic= No. violence (z-score) drinking, % cannabis use, % Verbal, % Physical, % in Canada, % events, % cultural music, %

Overall mean 3296 Canadian 312 Western European 535 Eastern European 258 Southern 509 European Chinese 382 South Asian and 348 East Indian South-East Asian 196 West Asian= 108 Middle Eastern South American 108 Caribbean 352 African 100 Other ethnicity 88

Ethnic identity

Health outcomes

TABLE 2 Percent and Means for Health Outcomes and Mediators by Ethnic Identity



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among South Asian and East Indian (3.2%) and West Asian and Middle Eastern (4.6%) youth and was highest among adolescents who identified as Other (27.3%) and Western European (17.2%); 13.8% of adolescents who identified as Canadian used cannabis weekly. Few surveys have captured weekly cannabis use among Canadian adolescents; however, one study notes that 15% to 17% of 15-year-old Canadians reported using cannabis at least once per month (CAHRU, 2008). All five measures of acculturation and discrimination varied significantly across groups (p ¼ 0.00). Two-thirds of adolescents had spent more than half of their life in Canada. With respect to cultural retention, 64.8% of adolescents attended ethnic and cultural events and 42% listened to ethnic and cultural music. With respect to experiences of past-year discrimination, 67.0% of adolescents had experienced verbal abuse and 16.3% had experienced physical abuse because of their ethnic identity.

Regression Models for Ethnic Identity and Health-Compromising Behaviors Table 3 provides results of four ordinary least squares regression models of violent behavior on ethnic identity, and Tables 4 and 5 provide four logistic regression models of weekly drinking and weekly cannabis use on ethnic identity. Each unadjusted model (Model 1) examines the association of primary ethnic identity on the health-compromising behavior to obtain a baseline for assessing changes in the likelihood of the health-compromising behavior being attributable to other measures. The adjusted background model (Model 2) introduces the main control measures—age, sex, educational status of parents, family intactness, school grades, and educational stream. The adjusted acculturation model (Model 3) introduces the acculturation mediators time spent in Canada and active cultural retention, whereas the adjusted discrimination model (Model 4) introduces mediators measuring experiences of verbal and physical discrimination. Because adolescents who identified as South Asian and East Indian had the lowest involvement in all health-compromising behaviors, they are the referent category for all regression analyses. VIOLENCE The unadjusted model (Model 1) in Table 3 confirms variation in violent behavior by primary ethnic identity. Relative to South Asian and East Indian youth, adolescents who identified as Canadian (b coefficient ¼ 1.01, p < 0.01), Western European (1.09, p < 0.01), Eastern European (0.90, p < 0.01), Southern European (0.88, p < 0.01), South American (2.17, p < 0.01), and Caribbean (1.46, p < 0.01) had significantly higher levels of violent behavior. The adjusted background model (Model 2) indicates that a limited portion of the variation in ethnic differences in fighting was

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TABLE 3 OLS Regression Models of Violent Behavior on Ethnic Identity and Measures of Sociodemographic Background, Education, Acculturation, and Discrimination


Measures Ethnic identity South Asian and East Indian (ref) Canadian Western European Eastern European Southern European Chinese South-East Asian West Asian and Middle-Eastern South American Caribbean African Other ethnicity Sociodemographics Age Female Father university Mother university Two-parent family

Unadjusted model (Model 1)

Adjusted background (Model 2)

Adjusted acculturation (Model 3)

0.00

0.00

0.00

Adjusted discrimination (Model 4) 0.00

1.01 1.09 0.90 0.88 0.28 0.46 0.32

(3.48) (4.46) (3.41) (2.86) (1.35) (1.68) (0.74)

0.33 0.75 0.76 0.52 0.06 0.15 0.20

(1.12) (3.30) (2.90) (2.11) (0.29) (0.65) (0.45)

0.07 0.19 0.58 0.06 0.15 0.05 0.19

(0.22) (0.72) (1.88) (0.20) (0.59) (0.20) (0.40)

0.53 1.02 0.94 0.76 0.19 0.32 0.37

(1.92) (4.58) (3.63) (3.21) (0.95) (1.18) (0.85)

2.17 1.46 0.57 0.43

(4.42) (5.41) (1.53) (0.89)

1.50 0.87 0.01 0.18

(2.77) (3.08) (0.03) (0.33)

1.35 0.47 0.21 0.29

(2.53) (1.51) (0.51) (0.51)

1.61 0.99 0.15 0.39

(2.93) (3.75) (0.37) (0.77)

(0.63) (11.2) (1.48) (1.06) (3.31)

0.00 1.80 0.36 0.22 0.74

(0.01) (11.2) (1.92) (1.10) (3.67)

0.12 1.91 0.22 0.14 0.94

(2.53) (11.5) (1.23) (0.70) (4.47)

0.04 1.85 0.28 0.21 0.70

0.06 1.65 0.29 0.25 0.67

(1.01) (10.5) (1.57) (1.27) (3.17)

Note. Beta coefficient and t-statistic in parenthesis. p < 0.01. p < 0.05.

explained by these controls. Relative to South Asian and East Indian youth, adolescents with a Western European, Eastern European, and Southern European, South American, and Caribbean ethnic identity were still linked to an increased risk of violent behavior, whereas the association between Canadian youth and past-year violent behavior disappeared. Respondents who were older, female, living within a two-parent family, achieving mostly ‘‘A’’ grades, and studying in an advanced educational stream had significantly lower levels of violent behavior. Adjusting for other covariates, acculturation exhibited strong mediation on ethno-specific z-scores. In the adjusted acculturation model (Model 3), only the association between South American youth and violent behavior remained all other associations were no longer significant. Conversely, discrimination (Model 4) did not mediate ethno-specific patterns of violent behaviors. Here, disparities in ethno-specific violent behavior remained unchanged from the adjusted background model. Although the models indicate only limited mediation was present, they highlight the direct effects of acculturation and experiences of discrimination on violent behavior; however, these effects greatly decreased in the adjusted models. Associations of acculturation and violence were apparent: adolescents

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TABLE 4 Logistic Regression Models of Weekly Drinking on Ethnic Identity and Measures of Sociodemographic Background, Education, Acculturation, and Discrimination


Measures Ethnic identity South Asian and East Indian (ref) Canadian Western European Eastern European Southern European Chinese South-East Asian West Asian and Middle-Eastern South American Caribbean African Other ethnicity Sociodemographics Age Female Father university Mother university Two-parent family Education Mostly ‘‘A’’ grades Advanced stream Acculturation Most life spent in Canada Attend ethnic=cultural events Listen to ethnic=cultural music Racial=ethnic discrimination Experienced verbal abuse Experienced physical abuse R-squared

Unadjusted model (Model 1) 1.00

Adjusted background (Model 2) 1.00


Adjusted discrimination (Model 4)

1.00

1.00

4.77 7.27 6.46 5.68 1.74 1.83 1.40

(6.04) (8.09) (7.49) (8.69) (2.09) (1.58) (0.73)

3.93 7.21 6.41 5.34 1.74 1.69 1.50

(5.19) (8.07) (6.94) (8.21) (1.89) (1.37) (0.87)

2.74 4.49 5.63 3.41 1.49 1.49 1.40

(3.49) (5.69) (6.08) (5.12) (1.29) (1.02) (0.68)

4.09 7.53 6.77 5.66 1.78 1.81 1.55

(5.26) (8.24) (7.31) (8.51) (1.89) (1.52) (0.94)

5.09 3.49 1.52 6.56

(4.82) (4.65) (0.99) (5.98)

4.19 2.82 1.40 6.20

(4.43) (3.61) (0.77) (6.01)

3.66 1.89 1.09 4.14

(4.07) (2.05) (0.18) (4.56)

4.13 2.92 1.44 6.48

(4.29) (3.66) (0.84) (6.14)

1.19 0.51 1.00 1.19 0.85

(5.59) (5.65) (0.01) (1.38) (1.60)

1.28 0.51 1.14 1.25 0.94

(7.22) (5.80) (1.03) (1.71) (0.49)

1.32 0.53 1.21 1.23 0.87

(8.35) (5.49) (1.47) (1.52) (1.19)

1.28 0.53 1.15 1.23 0.96

(6.80) (5.36) (1.12) (1.54) (0.29)

0.37 (10.3) 0.45 (7.06) 0.47 (6.16) 0.45 (6.89) 0.57 (3.78) 0.60 (3.49) 0.60 (4.09) 0.60 (3.52) 2.60 (7.60) 0.70 (3.62)

2.30 (5.90) 0.98 (0.12)

0.49 (5.54)

0.74 (2.28) — 1.61 (3.22)

0.97 (0.22) 1.85 (4.27) 0.05

0.11

0.13

0.12

Note. Odds ratios and z-statistic in parenthesis. p < 0.01. p < 0.05.

who spent most of their life in Canada had significantly higher levels of violent behavior (b coefficient ¼ 0.81, p < 0.01), whereas adolescents who attended ethnic=cultural events (0.57, p < 0.01) and who listened to ethnic=cultural music (1.00, p < 0.01) had significantly lower levels. These bivariate associations diminished in the adjusted acculturation model (Model 3). Here, the association between most life spent in Canada and listening to ethnic=cultural music and violent behavior persisted, whereas the association between attending ethnic=cultural events and violent behavior disappeared. Observed

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TABLE 5 Logistic Regression Models of Weekly Cannabis Use on Ethnic Identity and Measures of Sociodemographic Background, Education, Acculturation, and Discrimination


Measures

Unadjusted model (Model 1)

Ethnic identity South Asian and East 1.00 Indian (ref) Canadian 4.89 Western European 6.36 Eastern European 3.28 Southern European 3.41 Chinese 1.69 South-East Asian 1.99 West Asian and 1.48 Middle-Eastern South American 3.47 Caribbean 3.70 African 2.78 Other ethnicity 11.4 Sociodemographics Age 1.11 Female 0.42 Father university 0.98 Mother university 1.21 Two-parent family 0.60 Education Mostly ‘‘A’’ grades 0.22 Advanced stream 0.45 Acculturation Most life spent in 4.86 Canada Attend ethnic=cultural 0.57 events Listen to ethnic=cultural 0.37 music Racial=ethnic discrimination Experienced verbal 0.94 abuse Experienced physical 2.01 abuse R-squared 0.04

Adjusted background (Model 2)


Adjusted discrimination (Model 4)

1.00

1.00

1.00

(5.48) (5.39) (3.69) (4.03) (1.56) (1.83) (0.89)

3.02 5.11 2.75 2.75 1.53 1.53 1.45

(3.87) (4.75) (3.07) (3.32) (1.18) (1.12) (0.79)

1.76 2.40 2.14 1.39 1.16 1.37 1.24

(1.80) (2.48) (2.01) (1.01) (0.42) (0.77) (0.41)

3.13 5.34 2.89 2.85 1.55 1.61 1.48

(3.94) (4.80) (3.17) (3.36) (1.19) (1.22) (0.82)

(3.17) (4.04) (3.26) (6.39)

2.14 2.11 2.60 11.1

(1.70) (2.16) (2.18) (6.24)

1.94 1.18 2.43 6.44

(1.47) (0.51) (2.17) (5.00)

2.07 2.20 2.70 11.6

(1.61) (2.24) (2.30) (6.19)

(4.34) (5.99) (0.31) (2.20) (3.00)

1.27 0.46 1.20 1.40 0.54

(5.85) (5.42) (0.97) (2.09) (4.31)

(3.06) (6.37) (0.06) (1.41) (3.37)

1.19 0.42 1.05 1.42 0.64

(6.17) (5.49)

0.26 (5.58) 0.27 (5.47) 0.52 (4.12) 0.47 (4.48)

(9.43)

5.20 (7.71)

(4.01)

0.77 (1.64)

(6.38)

0.64 (3.38)

1.18 0.43 1.09 1.37 0.65

(4.08) (6.03) (0.48) (1.90) (2.80)

0.26 (5.56) 0.52 (3.98)

(0.43)

—

(4.33)

1.52 (2.70) 0.13

0.18

0.13

Note. Odds ratios and z-statistic in parenthesis. p < 0.01. p < 0.05.

bivariate associations between discrimination experiences and violent behavior were even strong experiences of verbal (0.69, p < 0.01) and physical abuse (2.18, p < 0.01) were significantly associated with higher levels of violent behavior in the unadjusted model. However, in the adjusted discrimination model only the association between physical abuse and violent behavior remained (1.54, p < 0.01).

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WEEKLY DRINKING Model 1 in Table 4 confirms extensive variation in rates of weekly drinking by primary ethnic identity. Relative to South Asian and East Indian adolescents, the odds of weekly drinking were significantly higher among adolescents who identify as Canadian (odds ratio ¼ 4.77, p < 0.01), Chinese (1.74, p < 0.05), South American (5.09, p < 0.01), Caribbean (3.49, p < 0.01), Other (6.56, p < 0.01), and from all three European ethnicities—Western (7.27, p < 0.01), Eastern (6.46, p < 0.01), and Southern (5.68, p < 0.01). The adjusted model indicates that a limited portion of the variation in ethnic differences was explained by the control measures. As respondents’ age increases, the odds of weekly drinking significantly increase, whereas female sex, higher grades, and being in an advanced educational stream exhibit significant protective effects on the odds of weekly drinking. Similar to violence, the direct effects for acculturation and discrimination on alcohol exist, although these are diminished in the multivariate models. According to Model 1, adolescents who spent more than half their life in Canada had significantly increased odds of weekly drinking than adolescents who spent more than half their life outside Canada (2.60, p < 0.01). Attending ethnic=cultural events (0.70, p < 0.01) and listening to ethnic=cultural music (0.49, p < 0.01) exhibited a protective effect on the odds of weekly drinking. This direct effect was reduced in the adjusted acculturation model (Model 3). Similarly, young people who had experienced physical abuse discrimination had an increased odds of weekly drinking (1.85, p < 0.01; Model 1). There was no direct association between experiences of verbal abuse and weekly drinking. In the adjusted discrimination model (Model 4), experiences of physical abuse continued to have a positive, though weaker, association with weekly drinking (1.61, p < 0.01). After adjusting for control measures (Models 3 and 4), neither acculturation nor discrimination mediated the association of ethnic identity and weekly drinking.

WEEKLY CANNABIS USE The unadjusted model (Model 1) in Table 5 confirms the extensive variation in rates of weekly cannabis use by primary ethnic identity. Relative to South Asian and East Indian adolescents, the odds of weekly cannabis use were significantly higher among adolescents who identified as Canadian (odds ratio ¼ 4.89, p < 0.01), South American (3.47, p < 0.01), Caribbean (3.70, p < 0.01), African (2.78, p < 0.01), Other (11.4, p < 0.01), and from all three European ethnicities—Western (6.36, p < 0.01), Eastern (3.28, p < 0.01), and Southern (3.41, p < 0.01). Ethno-specific disparities in weekly cannabis use remained largely unchanged despite the introduction of control measures (Model 2), with the exception of the nonsignificant association for South American adolescents. Older adolescents and those whose mothers



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attended university had increased odds of weekly cannabis use, whereas female respondents, adolescents who lived in a two-parent family, those who achieved mostly ‘‘A’’ grades, and those who were in the advanced stream had decreased odds of weekly cannabis use. Direct effects for acculturation and discrimination on cannabis use were present and, similar to the findings for violence and drinking, these effects were diminished in the multivariate models (Models 3 and 4). Adolescents who spent more than half of their life in Canada had significantly increased odds of weekly cannabis use when compared to adolescents who spent more than half their life outside of Canada (4.86, p < 0.01). Attending ethnic=cultural events (0.57, p < 0.01) and listening to ethnic=cultural music (0.37, p < 0.01) exhibited a significant protective effect on the odds of weekly cannabis use. The direct effects of acculturation persisted in the adjusted model for most life spent in Canada (5.20, p < 0.01) and listening to ethnic=cultural music (0.64, p < 0.01) but became nonsignificant for attending ethnic=cultural events. The direct effect of discrimination on weekly cannabis use was weaker than observed for acculturation. In the unadjusted model (Model 1), experiences of physical abuse doubled the odds of weekly cannabis use (2.01, p < 0.01); however, there was no direct association between experiences of verbal abuse and weekly cannabis use. In the adjusted discrimination model (Model 4), experiences of physical abuse increased the odds of weekly cannabis use, although the effect size was diminished (1.52, p < 0.01). After adjusting for control measures (Model 3), acculturation significantly mediated weekly cannabis use. The association between Canadian, Southern European, South American, and Caribbean ethnicity identity and weekly cannabis use became nonsignificant, whereas the association between Western European, Eastern European, African, and Other youth and cannabis use was reduced. In contrast, discrimination did not mediate ethno-specific rates of weekly cannabis use.

DISCUSSION This study investigated whether acculturation and discrimination help shape involvement in violence, as well as harmful levels of drinking and cannabis use. Consistent with other literature, both acculturation and discrimination exhibited strong direct effects on involvement in all three health-compromising behaviors. Moreover, we found strong mediating effects for acculturation on both violence and harmful cannabis use, although experiences of discrimination did not appear to mediate any health-related behavior. With the exception of violence among Western Europeans youth, discrimination experiences did not mediate associations with healthcompromising behaviors either.


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These findings demonstrate that important disparities in healthcompromising behaviors exist among youth and that they are influenced, both directly and indirectly, by acculturation and, to a lesser extent, discrimination experiences. Time spent in Canada and active cultural retention were important mediators of violence and cannabis use. Acculturation findings were generally consistent with the unidimensional acculturation model because adolescents with higher exposure to Canadian culture engaged in similar health-compromising behaviors, whereas adolescents who actively engaged with their minority culture were protected. That active cultural retention is health protective is not a new finding (Kopec et al., 2001; Soriano et al., 2004), although our results also point to a healthy immigrant effect (McDonald & Kennedy, 2004), at least among certain ethnic groups, who exhibited an aversion to health-compromising behaviors irrespective of the role of active cultural retention. Acculturation (and discrimination) did not account for observed ethno-specific disparities in weekly drinking. It is likely that differences in drinking behavior between adolescent ethnic groups were shaped by unmeasured factors, such as peer drinking and other peer-related activities. Conversely, experiences of discrimination directly increased the risk of health-compromising behaviors. Specifically, adolescents who experienced physical abuse because of their ethnicity were more likely to have engaged in violence and harmful alcohol and cannabis use. Again, these finding are consistent with previous studies noting that bicultural stress, as manifest through perceived discrimination, is a stronger predictor of adolescent aggression than adolescent culture-of-origin retention or involvement (Romero et al., 2007; Smokowski & Bacallao, 2006). Experiences of discrimination and perception of racism are known to have serious health consequences by directly and indirectly contributing to health inequalities (Hyman, 2009; Karlsen & Nazroo, 2002; Krieger & Sidney, 1996; Pascoe & Richmond, 2009). An alarming finding is the high levels of discrimination experienced by surveyed youth: two thirds of adolescents had experienced verbal abuse and one sixth had experienced physical abuse due to their ethnicity in the past year. Our observed levels of discrimination experiences were higher than has been reported in other Canadian surveys (McCreary Centre Society, 2009). Although these differences may be partially attributable to the survey sample or how the questions were phrased, experiences of discrimination among adolescents may be underreported in other Canadian surveys, particularly in communities with a high proportion of ethnic minorities. With one exception, discrimination was not found to mediate the association between ethnic identity and health-compromising behaviors. This suggests that physical and verbal abuse, as measured in our study, may not have been sensitive enough to detect mediation. Studies that noted an association between experiences of discrimination and health-compromising



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behaviors used measures of actual and perceived racial=ethnic discrimination (e.g., being stared at, followed in stores, overlooked for job) and exposure to negative ethnic=cultural stereotypes (Caldwell et al., 2004; Romero et al., 2007). The current study also supports previous findings that adolescents may externalize negative feelings from their lived experiences of discrimination through different outlets (Caldwell et al., 2004; Gil et al., 2000; Martin et al., 2003; Okamoto et al., 2009). Some adolescents may externalize their stress through aggression and violence, whereas others may internalize and repress their stressful feelings through escapist substance use. The role of substance use as a stress-coping response to address acculturative stress has been articulated elsewhere (Gil et al., 2000; Martin et al., 2003). This study has several limitations. First, the study design was cross-sectional rather than longitudinal, so we were unable to capture the temporal nature of acculturation and discrimination experiences and can only speak to association rather than causation. Second, our measure of ethnic identity was derived from self-identification and the categories were collapsed on the basis of geography and nationality. These categories were likely too broad to capture the more nuanced role played by specific ethnicity identities. Third, we were unable to capture the strength of the respondent’s ethnic identity, his or her commitment to his or her identity, or his or her ethnic pride. Future research should include measures of the strength of ethnic identity, as well as experiences of discrimination. Fourth, this study did not include all potential confounders in the relationship between ethnic experiences and health-compromising behaviors. Because our adjusted models predicted only a small proportion of the variation in health-compromising behaviors, we clearly have not captured all important correlates. For example, peer and parent connectedness has been noted in the literature as an important factor explaining ethnic variation in alcohol use (Cook et al., 2009). Finally, our study would have been enhanced with a measure of bicultural identity and stressors, which has shown to be protective (Soriano et al., 2004). In our increasingly multicultural global community, developing bicultural self-efficacy may be important to navigate the stresses associated with immigration and acculturation. In brief, this study adds to the growing body of literature on the relationship between ethnic identity and health by highlighting the presence of disparities in health-compromising behaviors and the important role played by the experiences of being an ethnic individual. As Canada and other nations increasingly expose youth to multi-ethnic contexts, an understanding of these disparities is vital to improving adolescent well-being. The promotion of positive cultural buffers, such as attending ethnic events or other forms of active cultural retention, may help individuals cope with bicultural stress, as well as reduce or delay the potential health harms related to such stress.

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