摘要：Objectives. We assessed whether associations between education and 2 health behaviors—smoking and leisure-time physical inactivity (LTPI)—depended on nativity and age at immigration among Hispanic and Asian young adults. Methods. Data came from the 2000–2008 National Health Interview Survey. The sample included 13 345 Hispanics and 2528 Asians aged 18 to 30 years. Variables for smoking and LTPI were based on self-reported data. We used logistic regression to examine education differentials in these behaviors by nativity and age at immigration. Results. The association of education with both smoking and LTPI was weaker for foreign-born Hispanics than for US-born Hispanics but did not vary by nativity for Asians. Education associations for smoking and LTPI among foreign-born Hispanics who had immigrated at an early age more closely resembled those of US-born Hispanics than did education associations among foreign-born Hispanics who had immigrated at an older age. A similar pattern for smoking was evident among Asians. Conclusions. Health-promotion efforts aimed at reducing disparities in key health behaviors among Hispanic and Asian young adults should take into account country of residence in childhood and adolescence as well as nativity. An extensive literature has established the existence of a social gradient in health, whereby health improves with each increment in socioeconomic status (SES). 1 , 2 Although most health outcomes show social gradients, research has increasingly suggested that SES may not have the same effect on health for all US populations. 3 – 6 In particular, researchers have found more modest socioeconomic differentials in health outcomes and related health behaviors for foreign-born populations than for corresponding US-born populations. 4 , 5 , 7 One explanation for this pattern proposes that weaker social gradients in health and health behaviors among the foreign-born are rooted in lifestyle-related norms and practices in sending countries for US immigration, which may continue to shape outcomes along socioeconomic lines after arrival. 4 We sought to extend the research in this area by assessing whether the relationship between education and some health behaviors depends not only on nativity but also on country of residence during childhood and adolescence. Although a recent study found that the association between subjective social status and mood dysfunction among Asian immigrants varied by age at immigration, 6 to our knowledge no research has examined patterns for objective measures of SES and health behaviors. The results of this analysis may improve understanding of differences between social gradients in health behaviors in US populations and may inform efforts to target interventions to groups at higher risk for unhealthy practices. Our conceptual framework is informed by several areas of research. Numerous studies suggest that some health behaviors, such as smoking, are heavily influenced by early life experiences. 8 – 10 In addition, disparities in some health behaviors begin to form in childhood and adolescence, both within and outside the United States. 10 – 13 Mechanisms that shape health behaviors by SES (e.g., access to and affordability of unhealthy lifestyles among individuals with lower versus higher SES, variation in norms and sanctions surrounding particular practices by SES) may operate differently in the sending countries for US immigration. Finally, research on acculturation suggests that as immigrants enter new contexts, their health behaviors shift toward patterns observed among native-born populations, a process that may be especially influential during childhood and adolescence. 14 – 17 Although these changes may affect immigrants across the socioeconomic spectrum, they may also vary by SES if young immigrants adopt the health behaviors of native-born youths with similar socioeconomic backgrounds. We focused our analysis on education gradients in smoking and leisure-time physical inactivity (LTPI). The identification of consistencies in the influence of education, nativity, and age at immigration across health behaviors may inform a more comprehensive approach to addressing disparities. We selected these behaviors for study because of their associations with education and nativity and because both are shaped in part by mechanisms operating during childhood and adolescence. 11 , 18 – 20 Additionally, smoking and physical inactivity are among the leading actual causes of death in the United States. 21 We examined associations between these health behaviors and education, rather than income or occupational status, because education may better represent SES for individuals who do not work consistently in the paid workforce, an issue that is particularly relevant for immigrant populations. 5 , 22 , 23 Education also provides an indicator of the family socioeconomic environment during childhood and adolescence. We focused on young adults (aged 18–30 years) partly because of limitations on data available to determine age at immigration (explained in detail in the Methods section). However, patterns in young adulthood may provide insights into patterns for related health outcomes in older populations. We first determined whether differences in education gradients in smoking and LTPI by nativity (documented for adults of all ages) were evident among young adults. 4 , 5 If education gradients in smoking and LTPI are influenced by exposures in early life, then variation by nativity should be evident by young adulthood. Second, and more important, we investigated whether associations between education and both smoking and LTPI among foreign-born young adults who immigrated in childhood or adolescence more closely resembled associations among the US-born than was the case for the foreign-born who immigrated after adolescence. We focused on Hispanics and Asians because these groups include large immigrant populations. Finally, we assessed whether patterns varied by Hispanic and Asian subgroup and by gender.
