Ssummary, notes on source, response assignment

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Before beginning the assignment, read the article, using the strategic approach, underline/highlight/jot notes in the margin.

Then without looking at the source, write a one-paragraph summary of the article stating only what the article says, not any of your reactions or comments about it. The goal of summary is to distill and synthesize study details and results or the argument made, including main claims.

Then record your notes, following the suggestions on the assignment. Be sure to number each note--and include page numbers from the article so you can find references easily. Don't include your response in this section.

Then respond to most of your notes, referring to each by number. Again, refer to the assignment for suggestions.

Journal of Research in Personality 74 (2018) 66–77 Contents lists available at ScienceDirect Journal of Research in Personality journal homepage: Full Length Article Dual identity and psychological adjustment: A study among immigrant-origin members Shiyu Zhang, Maykel Verkuyten ⇑, Jeroen Weesie Ercomer, Faculty of Social and Behavioral Sciences, Utrecht University, The Netherlands a r t i c l e i n f o Article history: Received 23 May 2017 Revised 19 January 2018 Accepted 13 February 2018 Available online 14 February 2018 Keywords: Dual identity Group identifications Well-being Immigrants a b s t r a c t This study examines immigrants’ psychological adjustment by focusing on ethnic and national identification, by using a Latent Profile Analysis to identify identity profiles, and by examining psychological outcomes at a same time point and over time (average 3-year interval). Among a national sample of immigrant groups in the Netherlands (Wave 1, N = 1939), four identity profiles were identified: ethnic identity, national identity, equal-medium dual identity, and high dual identity. For four indicators of psychological adjustment (life satisfaction, depressive symptoms, emotional loneliness, and social loneliness) and at the first and second wave (Wave 2, N = 848), a robust pattern was found: high dual identifiers had better psychological adjustment compared to people with one of the other three profiles. Ó 2018 Elsevier Inc. All rights reserved. 1. Introduction Migration poses important and multifaceted psychological challenges for immigrants and their children. The process of adapting to a new society can affect immigrants’ psychological adjustment, including life satisfaction, depression and loneliness. One key challenge is to combine subgroup identities with commitments to the nation-state. The research on dual identity suggests that it is possible to have varying degrees of identification with one’s ethnic minority group and the national category simultaneously: e.g., African-American, Indian-British, or Turkish-Dutch. However, it has also been argued and demonstrated that trying to develop and maintain a dual identity can involve the difficult task of reconciling loyalties, cultural worldviews and normative expectations which induces stress and psychological conflicts (Hirsh & Kang, 2015; Rudmin, 2003). In the current study we focus on ethnic and national identification and we want to make a contribution to the growing psychological literature on the positive health implications of social identities (Cruwys, Haslam, Dingle, Haslam, & Jetten, 2014; Haslam, Jetten, Postmes, & Haslam, 2009; Jetten, Haslam, & Haslam, 2012). We examined the relation between dual group identification and psychological adjustment among national adult samples of the two largest and similar immigrant-origin groups in the Netherlands (of Turkish and Moroccan origin). We used ⇑ Corresponding author at: Ercomer, Department of Social and Behavioral Sciences, Utrecht University, Padualaan 14, 3584 CH Utrecht, The Netherlands. E-mail address: (M. Verkuyten). 0092-6566/Ó 2018 Elsevier Inc. All rights reserved. separate measures of ethnic identification and national identification and we investigated psychological adjustment at the same time point and at a later time point (around three years later). A similar pattern across time would indicate that the associations of group identifications with psychological adjustment are relatively stable and enduring (Meeus, 2016). 1.1. Group identifications Hutnik (1991; see also Deaux, 2006) argued that immigrant minority individuals face two central identity issues: (1) to develop a sense of host national belonging, and (2) to maintain a sense of belonging to one’s ethnic community. Similar to Berry’s acculturation model (1997), the combination of these two group identifications results in four possible profiles: dual identity (high national and ethnic identification), national identity (high national identification only), ethnic identity (high ethnic identification only), and disengagement (low ethnic and low national identification). Such a two-dimensional model is widely used in the literature but there also are some questions regarding its conceptualization and operationalization. For example, the model does not conceptualize the possibility that a person is neutral to both groups (Rudmin, 2003). Further, disengagement requires distancing oneself from both the ethnic community and the national community. This might go against the fundamental need to belong (Baumeister & Leary, 1995; Del Pilar & Udasco, 2004) and therefore would only be an option for highly individualistic people (Bourhis, Moïse, Perrault, & Senécal, 1997). Additionally, meaningful subdivisions S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 within the dual identity orientation might exist (Schwartz & Zamboanga, 2008). For instance, immigrants can feel a sense of belonging to both communities but maintain a relative emphasis on their ethnic identity (Roccas & Brewer, 2002; Schwartz & Zamboanga, 2008). In their research among Turkish migrants in Germany, Simon and Ruhs (2008, p. 1355) argued that ‘‘[a]gainst the backdrop of a strong Turkish identification, a moderate level of German identification may already acquire sufficient selfrelevance to prompt a sense of dual identity”. In other words, dual identity does not necessarily have to imply similarly high levels of identification with both the ethnic community and the host nation. There are different ways to investigate dual identity (see Celenk & Van de Vijver, 2014; Nguyen & Benet-Martínez, 2007). Statistically, this can be done by using median or midpoint splits on the separate scales for ethnic and national identification (Berry & Sabatier, 2011; Ward & Kennedy, 1994). This approach is criticized for the possibility that identification orientations are ‘created’ which for the people themselves might have little subjective meaning (MacCallum, Zhang, Preacher, & Rucker, 2002; Schwartz & Zamboanga, 2008). Another approach is to use four sets of items that directly assess the four profiles (Berry, Phinney, Sam, & Vedder, 2006; Berry & Sabatier, 2011). A possible problem with this approach is that immigrants can score high on several profiles at the same time, although these are supposed to be conceptually different (Rudmin & Ahmadzadeh, 2001). In addition to these variable-centered approaches it is possible to use a person-centered approach. Person-centered analyses investigate how particular variables group within individuals rather than how characteristics are related to each other, as with variable-centered approaches. The advantage of a personcentered analysis is that it examines how each individual’s levels of ethnic and national identification relate to each other. Arguably, this corresponds best with the proposition of individual differences in identification profiles (Bergman, Magnussen, & El-Khouri, 2003). Together with the use of national samples this allows us to identify the types of profiles that exist and the proportion of immigrantorigin individuals adopting them. We performed exploratory Latent Profile Analysis (LPA) to identify the optimal number of empirically existing identity profiles. This data-driven approach clusters individuals into different subgroups based on their levels of ethnic and national identification (Collins & Lanza, 2010). However, because we used Hutnik’s model (1991; see also Berry, 1997) as a theoretical starting point we also performed a confirmatory LPA analysis to investigate whether the theoretically proposed four profiles fit the data and correspond to the findings of the exploratory LPA. Thus, our first aim was to try to find empirical evidence for the distinction between the four identification profiles. We had two general expectations about the profiles that are most likely to emerge. First, given that people have a fundamental need to belong (Baumeister & Leary, 1995), detaching from one’s ethnic identity as well as the national identity (i.e., disengagement) was expected to be the orientation that is the least likely to be adopted. Second, immigrants rarely relinquish their ethnic identity but rather add a sense of host national belonging to their ethnic belonging (Barker, 2015; Fleischmann & Verkuyten, 2016). Furthermore, research among Turkish Dutch and Moroccan Dutch demonstrates continuing high levels of ethnic identification (Verkuyten, 2005). Therefore, we expected that the main profiles will be dual identity and ethnic identity - and not national identity - because these imply a high level of ethnic identification. 1.2. Group identification and psychological adjustments In general it is argued and found that identification with both cultural groups (dual identity) has psychological advantages for 67 ethnic minorities over identification with just one (e.g., Dimitrova, Aydinli, Chasiotis, Bender, Van de Vijver, 2015; Fleischmann & Verkuyten, 2016; Ng Tseung-Wong & Verkuyten, 2013; Nguyen & Benet-Martínez, 2007; Phinney, Berry, Vedder, & Liebkind, 2006; Ward & Kennedy, 1994). There are several reasons why more enduring, internalized group identifications might have positive implications for psychological adjustment. Group identification implies a sense of shared group membership that provides a basis for social support and satisfies basic psychological needs (Vignoles, 2011). Research has shown that group identification provides people with a sense of belonging, a sense of meaning and purpose, a sense of control and agency, and a source for selfaffirmation, and that need satisfaction mediates the relationship between group identities and psychological well-being (Cruwys et al., 2014; Greenaway, Cruwys, Haslam, & Jetten, 2016; Steffens, Haslam, Schuh, Jetten, & Van Dick, 2016). Maintaining strong group identities has a positive effect for well-being and the acquisition of new group identities can also have beneficial effects. Meaningful new group memberships imply gains in the number of group identifications and this improves psychological well-being (see Greenaway et al., 2015, 2016). In the current study we examined the association between the identity profiles and three main indicators of psychological adjustment (life satisfaction, depression and loneliness) among large immigrant-origin samples in the Netherlands. Considering the importance of group identifications for psychological well-being, as well as the beneficial effects of identifying with multiple groups and previous findings on the positive psychological correlates of dual identity, we expected individuals with dual identity to have higher life satisfaction and lower feelings of depression and loneliness compared to individuals having one of the other identity profiles. When dual identifiers do indeed display better psychological adjustment, this can be because the statistical effects of national identification and ethnic identification are additive (two main effects) or multiplicative (a positive interaction effect). For gaining a further understanding we therefore also considered the interplay between the association of ethnic identification and national identification with immigrants’ psychological adjustment. In a variable-centered approach, an additive effect means that both ethnic identification and national identification have separate statistical main effects on psychological adjustment, and there is evidence for this in several countries (Berry et al., 2006; Birman, 1998; Fleischmann & Verkuyten, 2016). A multiplicative effect implies that both group identifications reinforce each other whereby the combination of the two (statistical interaction) sets the dual identity profile apart from the other profiles. 1.3. To summarize The current study aims to make a contribution to the research on dual identity and psychological adjustment by investigating (a) life satisfaction, depression and loneliness as three important aspects of psychological adjustment, (b) by looking at psychological adjustment over time, and (c) by using large samples of the two main immigrant-origin groups in the Netherlands. Using both exploratory and confirmatory person-oriented analyses we first identified the optimal number of identity profiles and we expected the dual identity and ethnic identity orientations to be most likely. Second, we examined the associations between the identity profiles and psychological adjustment and we expected dual identifiers to have better psychological adjustment than individuals adopting other identification orientations. To examine whether dual identity has a more enduring, robust association with psychological adjustment we considered the same adjustment outcomes at the same time point and also at a later time point. Thus, in 68 S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 addition to a cross-sectional analysis we used a so-called longitudinal prediction model in which the predictor variable (group identifications) was measured earlier in time than the predicted outcome. We did not examine changes over time because an adequate modelling of change requires more than two data points (Meeus, 2016). We used national samples of the two largest immigrant-origin groups in the Netherlands - of Turkish and Moroccan origin - that have a similar migration history, similar religion, and similar socioeconomic disadvantages. Because of these similarities we examined the identity profiles and psychological adjustment of both groups together. Turks and Moroccans have a history of labour migration dating back to the end of the 1960s when Dutch industry started recruiting migrant labour on a large scale. In the mid-1970s, a process of family reunification began, as first the Turks and later the Moroccans were joined by their wives and children. Nearly all of the Turks and Moroccans self-identify as Muslims (Maliepaard, Lubbers, & Gijsberts, 2010) and both groups occupy the most disadvantaged position in Dutch society in terms of educational attainment, labour market position, housing, and experiences with discrimination (Gijsberts & Dagevos, 2009). People with a Turkish or Moroccan background constitute the two largest immigrant-origin groups in the Netherlands with around 390,000 people each. In examining our predictions it was important to take various possible confounding variables into account (Nguyen & BenetMartinez, 2013). Immigrants with higher socioeconomic status may have better psychological adjustment (Gallo, Bogart, Vranceanu, & Matthews, 2005) and be more integrated because of their success in school and work (Alba & Nee, 1997). Further, immigrants who perceive more ethnic discrimination may emphasize their ethnic minority identity and may also have worse psychological adjustment (Pascoe & Richman, 2009). Therefore, the current study included perceived discrimination and socioeconomic status as control variables. We also controlled for gender (Weissman & Klerman, 1985), age (Ryff & Keyes, 1995), immigrant generation and length of stay in the country (Abouguendia & Noels, 2001; Gokdemir & Dumludag, 2012), and ethnicity (Liebkind & Jasinskaja-Lahti, 2000) because these variables might be related to group identifications and also to psychological adjustment. 2. Method 2.1. Data and sample We use data collected by the Netherlands Longitudinal Lifecourse Study (NELLS) (De Graaf, Kalmijn, Kraaykamp, & Monden, 2014). The NELLS is a national panel study focusing on social cohesion, inequality, and norms and values, and full details of the sampling measures and the data are publicly available (De Graaf et al., 2014; Data collection for wave 1 started in January 2009 and finished in May 2010, with a break in the summer of 2009. For wave 2 it started in January 2013 and finished in December 2013. On average, there was a three-year interval between the two waves. In wave 1, a two-stage stratified sampling was applied with first the sampling of thirty-five municipalities and then respondents within these municipalities. Incentives (5-euro webshop gift voucher) was offered to participants to maximize the response rate. In the first wave, 2301 people of Turkish (49%: 32% first genera tion + 17% second generation) and Moroccan (51%: 32% first genera tion + 19% second generation) immigrant-origin participated. Only 38% of these respondents participated in the second wave. The refusal of further participation and the difficulty of locating participants after three years were the two most important reasons for this high attrition rate. The current analyses utilized two samples. First, wave 1 data (W1 sample) were used to identify participants’ identification orientations, and 1939 participants did not have any missing data on the items measuring ethnic and national identification (310 participants had missing data on all eight items and 52 had missing on one or more item). Only these participants were included in the analysis. We did not handle missing data using procedures such as imputation because this can bias the LPA analysis which identifies latent profiles from the pattern of item responses. In the second wave (W2 sample) no questions about ethnic identification were asked so these data could not be used for identifying patterns of group identifications. However, the same measures of psychological adjustment were used in both waves which allows us to examine the association between the identifications and psychological adjustment cross-sectionally as well as over time. There were 848 respondents who also participated at W2 and provided information on the psychological outcome variables. We compared the group of participants who stayed in the study (stay) and those who dropped out in the second wave (drop-out). The demographic composition of both groups was similar for age (stay = 30.72, dropout = 31.15, t(1937) = 1.07, p = 0.29) and ethnicity (percentages of Moroccans: stay = 48.9%, drop-out = 50.9%, v2(1) = 0.791, p = 0.37), but the participants who dropped out were more likely to be male (percentages of male: stay = 43.6%, drop-out = 49.3%, v2(1) = 6.12, p = 0.012), first generation immigrants (percentages of first generation: stay = 59.9%, drop-out = 67.4%, v2(1) = 11.67, p = 0.001), and to have a lower level of education (percentages of college-and-above education: stay = 25.4%, drop-out = 19.4%, v2(1) = 9.98, p = 0.002). The stayed participants were similar to the drop-out participants for national identification (stay = 3.72, drop-out = 3.72, t(1937) = 0.04, p = 0.97) and depression (stay = 1.36, drop-out = 1.39, t(1931) = 1.30, p = 0.195), but the participants who dropped were more likely to have higher ethnic identification (stay = 4.10, drop-out = 4.18, t(1937) = 2.46, p = 0.014), lower life satisfaction (stay = 7.20, drop-out = 7.07, t(1899) = 2.90, p = 0.004), higher emotional loneliness (stay = 2.00, drop-out = 2.0 6, t(1931) = 2.18, p = 0.029), and higher social loneliness (stay = 1.94, drop-out = 2.00, t(1932) = 2.43, p = 0.015). 2.2. Measures 2.2.1. Ethnic and national identifications The two group identifications were measured only at the first wave. National identification was assessed by four items that are commonly used in social psychological research (see Verkuyten & Martinovic, 2012): ‘‘I feel at home in the Netherlands”; ‘‘I strongly identify with the Netherlands”; ‘‘I really feel connected with the Netherlands”; and ‘‘My Dutch identity is an important aspect of myself”. Ethnic identification was measured with four comparable items: ‘‘I am proud of my ethnic background”; ‘‘I identify strongly with my ethnic group”; ‘‘I really feel connected with my ethnic group”; and ‘‘My ethnic identity is an important aspect of me”. Participants responded on 5-point scales, ranging from 1 ‘‘strongly agree” to 5 ‘‘strongly disagree”. In the introduction to these questions it was explained that ‘‘with ethnic background we mean the country where you or your parents were born”. This introduction was used to assure that the respondents were thinking about their Turkish or Moroccan background (Fleischmann & Verkuyten, 2016). The responses were reverse coded so that a higher score indicated a higher level of group identification. A Confirmatory Factor Analysis (CFA) was conducted to validate these two measurements. This is necessary for the confirmatory LPA and for using the two identifications as two continuous predictors. The CFA was performed on the eight items with ethnic and national identification being specified as two separate factors. S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 Because responses on ethnic identification were skewed in the direction of high identification, the maximum likelihood estimation with robust standard errors (MLR) was used. The model had a reasonable fit, LRv2 (19, N = 1939) = 156.658, p < 0.001; RMSE A = 0.061; CFI = 0.972; TLI = 0.959; SRMR = 0.026. In general, RMS EA < 0.05, CFI and TLI > 0.95, and SRMR < 0.08 are considered to indicate a good fit (Wang & Wang, 2012). Standardized factor loadings of national identification ranged from 0.70 to 0.87, and for ethnic identification from 0.71 to 0.93. This model was compared with a one-factor model in which the eight items loaded on a single factor. The two-factor model had a better model fit, Satorra-Bentler Dv2 (1, N = 1939) = 510.423, p < 0.001, which demonstrates that the four items of ethnic identification (a = 0.91) and the four items of national identification (a = 0.86) assessed two separate constructs. 2.2.2. Psychological adjustment Life satisfaction was assessed in terms of aggregated domain life satisfaction and by using ten items in both waves. On 10point scales (1 = ‘‘very unsatisfied”, and 10 = ‘‘very satisfied”) respondents were asked to indicate how satisfied they were with ten aspects of their life: work, income, level of education, relationship or marriage, family life, family-work balance, social life, neighborhood, leisure time, and apartment or house. In the second wave an eleventh option ‘‘not applicable” was available, which was coded as missing in the current analyses.1 The items assessed people’s satisfaction in different life domains and while life satisfaction can represent the average satisfaction across life domains, satisfactions in various domains are not necessarily reflections of an underlying psychological construct. The scale was regarded as a formative rather than a reflective measure. Thus, CFA was not performed and the average score of the ten items was taken to indicate respondents’ level of general life satisfaction (a = 0.82 for W1, and 0.87 for W2). Depressive Symptoms was assessed in both waves with sixteen items of the Center for Epidemiologic Studies Depression (CES-D) scale (Radloff, 1977). CES-D is one of the most widely used instruments for assessing depressive symptoms, both among the general population and clinical samples (Schroevers, Sanderman, Sonderen, & Ranchor, 2000; Shafer, 2006). CES-D originally consists of 20 items and the 16 negatively worded items included in the NELLS survey relate to the dimensions of depressed affect, somatic symptoms, and interpersonal problems (see Shafer, 2006). Respondents reported how frequently they experienced sixteen symptoms in the past seven days (1 = ‘‘rarely or never; less than a day” to 4 = ‘‘usually or always; 5 to 7 days”). A CFA was performed on the 32 items from the two waves simultaneously. A three-factor structure (i.e., depressed affect, somatic symptoms, and interpersonal problems) was specified in both waves. A Multi-trait Multi-method (MTMM) structure via correlated uniqueness was specified to take into account that items were measured in two waves. Furthermore, measurement invariance across the two waves was tested. Given that the responses on this measure were skewed in the direction of low depressive symptoms, the MLR estimation was used. The model representing scalar invariance, with all factor loadings and intercepts being the same across two waves, had a good fit, LR v2 (462, N = 1934) = 1587.823, p < .001; RMSEA = 0.035; CFI = 0.926; TLI = 0.921; SRMR = 0.038, and it did not fit worse than the configural model,2 1 The percentage of response ‘‘N.A” ranged from 40% (family-work balance) to 1% (neighborhood). The relatively high number of missing is understandable because the scale measures various aspects of life which are not all relevant to everyone (e.g., when one does not have a job or lives alone rather than with one’s family). For the items that should be relevant to everyone, such as ‘‘social life”, ‘‘neighborhood”, ‘‘leisure time”, and ‘‘apartment/house”, the percentages of missing are low (<4%). Eight respondents who reported ‘‘N.A.” on all items were not included in the analysis. 2 The configural model fit: LR v2 (433, N = 1934) = 1586.385, p < 0.001; RMSEA = 0.037; CFI = 0.924; TLI = 0.913; SRMR = 0.036. 69 Satorra-Bentler Dv2(29, N = 1934) = 34.453, p = 0.223. In the scalar-invariance model, all standardized factor loadings were sufficient, ranging from 0.53 to 0.83 in W1, and from 0.57 to 0.84 in W2. Thus, the CES-D measure was adequate in the current sample: the factor structure replicated what has been widely found (Shafer, 2006) and the measurements in the two waves were highly comparable. Yet, although this measure consists of three sub-dimensions, it is standard to construct a single total score (e.g. Chwastiak, Ehde, Gibbons, Sullivan, Bowen, & Kraft, 2002; Crawford, Cayley, Lovibond, Wilson, & Hartley, 2011). This approach was supported by the high correlations between the factors, ranging from 0.77 to 0.93 at W1 (a = 0.94), and from 0.74 to 0.93 at W2 (a = 0.95). Thus, an average score of the sixteen items was taken as an indicator of the level of depression. To correct for skewness, a reciprocal transformation was used and then reverse coded.3 The transformed depression score was normally distributed and ranged from 0 to 0.75. A robustness check was performed to investigate whether different conclusions would be drawn if the three sub-dimensions are considered separately. This analysis showed a similar pattern of findings for the three subscales as for the overall score and therefore we only report the findings for the overall score. Loneliness was assessed in both waves by a shortened version of the De Jong Gierveld Loneliness Scale (De Jong-Gierveld & Van Tilburg, 2006). Six items were used that measure two dimensions of loneliness; emotional loneliness (e.g. ‘‘I often feel rejected”) and social loneliness (e.g. ‘‘There are enough people I feel closed to”, reverse scored). Participants indicated on 4-point scales whether these situations apply to them (1 = ‘‘very applicable” to 4 = ‘‘not at all applicable”). A CFA specifying emotional and social loneliness as two separate factors was fitted on the twelve items from the two waves with a MTMM structure via correlated uniqueness. Measurement invariance across the two waves also was examined. The model representing partial scalar invariance (5 scalar and 1 metric item) had a good fit, LR v2 (51, N = 1935) = 82.909, p = 0.003; RMSEA = 0.018; CFI = 0.994; TLI = 0.992; SRMR = 0.029, and was not worse than the configural one,4 LRDv2 (9, N = 1935) = 15.605, p = 0.076. In this model, standardized factor loadings were high, ranging from 0.61 to 0.82 at W1 and from 0.64 to 0.84 at W2. Given that the correlations between the two subscales were small in both waves (W1 0.34; W2 = 0.31), we examined emotional loneliness and social loneliness separately. Cronbach’s alphas of the emotional and social loneliness subscales were 0.76 and 0.78 for the first wave, and 0.82 and 0.82 for the second wave. 2.2.3. Control variables We controlled for gender (0 = female; 1 = male), age at wave 1 (continuous), immigrant generation (0 = first generation; 1 = second generation), ethnicity (0 = Turks; 1 = Moroccan), and length of stay in the Netherlands (age at W1 minus age of arrival). Furthermore, educational attainment at W1 was used as an indicator of socioeconomic status (Ostrove, Adler, Kuppermann, & Washington, 2000). It was coded as an ordinal variable5 (low, medium, and high) and the low education category was taken 3 ‘‘Transformed depression” = 1 – (1/‘‘original depression”). In both waves the skewness before the transformation was 1.9 and after the transformation it was in both waves 0.7. The correlations between the untransformed score and the transformed score were 0.943 and 0.941 for wave 1 and wave 2, respectively. 4 The configural model fit: LR v2 (42, N = 1935) = 67.304, p = 0.008; RMSEA = 0.018; CFI = 0.995; TLI = 0.993; SRMR = 0.022. 5 Three variables were used to construct the variable ‘‘education attainment”. For the respondents who already completed their education, their highest level of completed education was used. For the respondents who were still in school, the education levels that they were following were used. For the respondents who were educated outside the Netherlands, their education attainments were matched with the level of education in the Dutch system. Ten respondents had missing data on education attainment. 70 S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 as the reference group. In addition, at W1 perceived discrimination was assessed by six items. These items ask about how often respondents experienced discrimination because of their ethnic background in six settings: ‘‘applying for a job or internship”, ‘‘at work”, ‘‘at school, in class”, ‘‘on the street, in shops, on public transportation”, ‘‘organization, club, sports”, and ‘‘nightlife, nightclubs”. Three response options were available: ‘‘1 = no, never”, ‘‘2 = yes, occasionally”, and ‘‘3 = yes, quite often”. Similar to the life satisfaction measure, this scale was regarded as a formative rather than a reflective scale (a = 0.81). An average score was taken across the six items as an indicator of perceived discrimination (M = 1.34, SD = 0.41). 2.3. Analysis Using the eight items of national and ethnic identification, we conducted Latent Profile Analyses (LPA) on the W1 sample6 to identify groups of respondents displaying similar patterns on the eight items (identity profiles). LPA provides model fit indices allowing the optimal number of latent profiles to be chosen by comparing these indices. In the current study, five criteria were considered for the model selection; AIC, BIC, Bootstrap Likelihood Ratio Test (BLRT), entropy, and how interpretable the profiles are theoretically (Wang & Wang, 2012). The model with a lower value of AIC and BIC is preferred. BLRT compares the fit of models with k and (k 1) profiles. A significant result suggests that the model with k profiles is better than the one with (k 1) profiles. In case of inconsistency between the suggestions given by the model indices, BLRT and BIC are recommended to be the best indicators (Nylund et al., 2007). Entropy indicates the certainty with which the subjects can be classified into the profiles. Assigning individuals to different profiles and using these for the analyses is appropriate only when entropy and certainty are high. Entropy above 0.8 is regarded as high and above 0.6 is considered medium (Clark, 2010). We conducted both confirmatory and exploratory LPA.7 The difference between the two analyses is that the exploratory analysis freely estimates the means of the items in the extracted profiles, whereas in the confirmatory analysis the means of the items in the profiles are specified based on theoretical reasons. It should be noted that LPA is mostly used for exploratory purposes because it discerns the best fitting pattern of inter-correlations between the items. The confirmatory method allows researchers to test theoretically hypothesized profile patterns (Finch & Bronk, 2011). A series of confirmatory LPA (Finch & Bronk, 2011) was first estimated based on Hurnik’s (Berry’s, 1997) theoretical model of four identification orientations, as this is our theoretical starting point. However, there is no single way of translating this theoretical model into a confirmatory LPA model. Therefore, we examined three possible model specifications (see Table 1). The difference between the three models concerns the way in which each identity profile is defined in relation to the other profiles. Concerning the model specification 1, the values of the corresponding items of national identification were constrained to be equal between dual identity and national identity, and between ethnic identity and disengagement; the values of the corresponding items of ethnic 6 In a simulation study, Nylund, Asparouhov, and Muthen (2007) tested different indicators (e.g., AIC, BIC, BLRT) under three different sample sizes (n = 200, 500, 1000). The reliability of the indicators increase as the sample sizes increases. When n= 1000 and for a continuous 8-item model, BIC and BLRT correctly identified the k class model 85% and 95% of times, respectively. Our current sample contains 1939 respondents and we also have an 8-item model. This means that our sample size has sufficient power to detect the number of latent profiles correctly. 7 The variances of the items were constrained to be the same across the profiles. This is because we do not have theoretical reason to doubt that immigrants in one profile would have more varying responses on the items than immigrants in another profile, so we follow the default LPA setting which helps with model convergence. identification were constrained to be equal between dual identity and ethnic identity, and between national identity and disengagement. For model specification 2, the average score of the four items of national identification was constrained to be equal between dual identity and national identity, and between ethnic identity and disengagement; the average score of four item of ethnic identification was constrained to be equal between dual identity and ethnic identity, and between national identity and disengagement. The model specification 3 included one constraint on top of specification 2. The average score of national identification was set to be equal to the average score of ethnic identification in the dual identity profile and in the disengagement profile. The crux of the three model specifications is that the value of national identification and of ethnic identification is constrained to be either high or low, and the three specifications differ in how ‘‘high” and ‘‘low” were estimated. Subsequently, a series of exploratory latent profile models were estimated (Collins & Lanza, 2010) using the responses of the eight identification items and with no constraints set for the profile extraction. We estimated models identifying two, three, four and five latent profiles, respectively. The optimal number of profiles was determined by comparing the model fit indices and the exploratory models were further compared to the three models of the confirmatory LPA. The profiles identified by the best-fitting model were accepted as the empirically most likely ones. To compare the psychological adjustment of participants with different identity profiles, the participants were assigned to the most fitting latent profile based on the classification probabilities (posterior probabilities). This is regarded as reasonable if entropy is high (Wang & Wang, 2012).8 All analyses were conducted in Mplus version 7.3 (Muthén & Muthén, 1998-2012). 3. Results 3.1. Descriptive findings The descriptive findings are presented in Table 2. The average score of participants’ ethnic identification did not correlate with their national identification. The pattern of correlations between ethnic and national identification and the psychological outcomes were rather similar across the two waves and overall indicate that higher group identifications were associated with higher psychological well-being. 3.2. Latent profile analysis The log likelihood value, AIC, BIC, Bootstrap Likelihood Ratio Test (BLRT) and entropy of the three model specifications of the confirmatory LPA are presented in Table 3 (bottom part). The model fit of these three specifications did not differ much and the estimated profile sizes of the specifications were similar. For specification 1, the percentages of respondents in the dual identity, national identity, ethnic identity, and disengagement profiles were 50%, 15%, 26%, and 10%, respectively. The corresponding percentages were 49%, 15%, 26% and 10% for specification 2, and 43%, 12%, 33%, and 11% for specification 3. For the exploratory LPA, models with two, three, four, and five latent profiles were compared to identify the profile that provided the best fitting model and interpretable results. As shown in Table 3, the findings indicate that a 4-profile solution fitted the 8 We did not include the outcome variables as a part of the LPA estimation because LPA solutions are sensitive to the inclusion of outcomes variables (Wang & Wang, 2012). The analysis would be problematic as the solution changes as different outcome variables are included. 71 S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 Table 1 A Conceptual representation of the item means or average item means of national and ethnic identification of the profiles for the three confirmatory LPA specifications. Specification 1 Specification 2 National Items Dual identity National ident. Ethnic ident. Disengagement Ethnic Items 1 2 3 4 1 2 3 4 H1 H1 L1 L1 H2 H2 L2 L2 H3 H3 L3 L3 H4 H4 L4 L4 H5 L5 H5 L5 H6 L6 H6 L6 H7 L7 H7 L7 H8 L8 H8 L8 Specification 3 National Average score of 4 items Ethnic Average score of 4 items National Average score of 4 items Ethnic Average score of 4 items H1 H1 L1 L1 H2 L2 H2 L2 H1 H1 L1 L1 H1 L1 H1 L1 Note. ‘‘H” and ‘‘L” refer to high and low, respectively. The three specifications are independent from each other. For example, H1 of the specification 1 is not equal to H1 of the specification 2 or 3. However, within each specification, the same subscript indicates that the values are equivalent. Table 2 Correlations, means, and standard deviations (SD) for the main variables. W1 Sample (N = 1939) 1 1 2 3 4 5 6 7 – National Ident. Ethnic Ident. Discrimination Life Satisfaction Depression Emotional Loneliness Social Loneliness 2 3 4 5 6 7 Mean SD Range – 0.11*** 0.02 – 0.17*** 0.09*** 0.16*** – 0.08*** 0.07** 0.17*** 0.32*** – 0.12*** 0.03 0.07** 0.28*** 0.40*** – 0.15*** 0.12*** 0.08*** 0.27*** 0.24*** 0.26*** – 3.72 4.15 1.34 7.13 0.21 2.03 1.97 0.74 0.78 0.41 1.01 0.20 0.64 0.60 1–5 1–5 1–3 1–10 0–0.75 1–4 1–4 0.02 W2 Sample (N = 844) 1 2 3 4 5 6 7 Mean SD Range 1 2 3 4 5 6 7 – – – – – – 0.07 0.13*** 0.08* – 0.11** 0.07 0.08* 0.35*** – 0.08* 0.03 .04 0.25*** 0.43*** – 0.10** 0.08* 0.04 0.27*** 0.22*** 0.25*** – – – – 7.22 0.22 1.98 1.94 – – – 1.29 0.21 0.69 0.64 – – – 1–10 1–0.75 1–4 1–4 National Ident. (w1) Ethnic Ident. (w1) Discrimination (w1) Life Satisfaction (w2) Depression (w2) Emotional Lonel. (w2) Social Lonel. (w2) Note. All constructs were measured by more than one item; for each construct, average scores over the corresponding items were calculated for each individual. The upper panel reports Means, Standard Deviations, and correlations of variables at Wave 1 (W1). The lower panel reports Means and Standard Deviations of variables at Wave 2 (W2), as well as the correlations between predictor at W1 and outcome variables at W2. * p < 0.05. ** p < 0.01. *** p < 0.001. Table 3 Comparison of the exploratory and confirmatory latent profile analysis models. Exploratory LPA 2-profile 3-profile 4-profile 5-profile Confirmatory LPA Specification 1 Specification 2 Specification 3 LogL # parameter AIC BIC Entropy BLRT 18333.9 17179.6 16648.4 Does not converge 25 34 43 36717.8 34427.2 33382.7 36857.1 34616.5 33622.2 0.902 0.934 0.905 – 0.00 0.00 27 39 37 34499.435 34498.959 34988.540 34649.823 34716.186 35194.627 0.861 0.862 0.842 – – – 17222.718 17210.479 17457.270 Note. LogL = Log likelihood value; # parameter = number of free parameter; BLRT = bootstrap likelihood ratio test. In bold is the LPA model that is accepted. The 4-profile solution is the preferable model. data best and that the assignment of respondents to the different profiles had high certainty (entropy). The four-profile solution of the exploratory LPA had a smaller AIC and BIC than the three specifications of the confirmatory LPA. Moreover, given that a constrained k-profile solution is a nested model of the general k-profile solution (Finch & Bronk, 2011), it was possible to statistically compare the fit of the 4-profile exploratory model with the 4-profile confirmatory model using Chi-square tests. The likelihood ratio tests indicated that the exploratory 4-profile solution had a better fit (exploratory vs. confirmatory specification 1: LRDv2 (16, N = 1939) = 574.3, p < .001; exploratory vs. confirmatory specification 2: LRDv2 (4, N = 1939) = 562.1, p < .001; exploratory vs. confirmatory specification 3: LRDv2 (6, N = 1939) = 808.9, p < .001). Thus, all model indices suggest that the 4-profile solution of the exploratory LPA was the preferable model. Therefore this solution was used as the final model identifying the identity profiles of the respondents. Fig. 1 presents the means of the eight items and the four profiles of this model. Profile 1 was labelled ‘ethnic identity’ (13%) because it contained individuals whose national identification was the lowest of all four groups and whose ethnic identification was one of the highest. Profile 2 (15%) represents individuals whose national identification was relatively high while their ethnic identification was the lowest among all four groups. This profile was labelled ‘national identity’, but it is noteworthy that the national identification of these individuals was not substantially higher than the other 72 S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 Fig. 1. The four latent profiles from the exploratory analysis and based on scorings on the four items for national identification and the four items for ethnic identification. profiles. Profile 3 (47%) contained individuals whose national identification was relatively high while their ethnic identification was at a medium level. Furthermore, both identifications were similar and around the neutral mid-point of the scale. This option was labeled ‘‘equal-medium dual identity”. Finally, profile 4 (25%) involves individuals whose national identification as well as ethnic identification were the highest of the four groups. To highlight the difference with the equal-medium dual identity we labeled this as ‘‘high dual identity”. As expected these findings show that there were no respondents with a disengagement profile and that equal-medium dual identity was most often adopted, followed by high dual identity and then national identity and ethnic identity. For the restricted sample of respondents who not only participated in the first wave but also in the second one, these percentages were similar (48%, 22%, 16%, and 13%, respectively). 3.3. Psychological adjustment To examine psychological adjustment we compared both crosssectionally (in W1) and over-time (in W2) the psychological outcomes of respondents with the different identification profiles (in W1). A general linear model was estimated on the W1 sample and the W2 sample, respectively. Gender, age, immigrant generation, length of stay, ethnicity, education attainment, and perceived discrimination were included as control variables. Life satisfaction, depression, emotional loneliness, and social loneliness were examined as separate outcomes. The findings are summarized in Table 4 and the Wald tests reported are joint tests which indicate whether there is an overall difference between the profiles. The results show that the type of profile was a significant predictor for seven out of eight psychological adjustment outcomes; life satisfaction at both waves, depressive symptoms at both waves, social loneliness at both waves, and emotional loneliness at W1. Post hoc comparisons with Bonferroni corrections (separately for each dependent variable with p < 0.008 level) indicated that with one exception all the significant differences were between the high dual identity orientation and the other three orientations, and that these other orientations did not differ significantly from each other. Thus, in the W1 sample, respondents with a high dual identity had a significantly higher level of life satisfaction, a lower level of depressive symptoms, a lower sense of emotional loneliness, and a lower sense of social loneliness, than ethnic, national and equal-medium dual identifiers (for the latter there was no difference for depressive symptoms). To illustrate these findings, Fig. 2 presents the results for life satisfaction for individuals with different identity profiles. When the identity profiles at W1 were used to predict respondents’ psychological adjustments at W2, respondents with a high dual identity profile did not differ from the ones with an ethnic identity profile on all indicators of psychological adjustments (Table 4).9 However, high dual identifiers continued to have a higher level of life satisfaction and a lower level of social loneliness than those with a national identity profile. In addition, respondents with a high dual identity profile had a higher level of life satisfaction and a lower level of depressive symptoms than the ones with an equalmedium dual identity profile. Further, respondents with equalmedium dual identity showed a lower level of social loneliness at W2 than those with the national identity profile. We calculated the effect size r to quantify the magnitude of the differences between the profiles. Given that most of the significant differences were found between the high dual identifiers and the others, the high dual identity profile was taken as the reference group. As can be seen in Table 4, most of the significant effects were small with an effect size around 0.10 (Cohen, 1988). Although more significant differences were found when psychological adjustment was examined with the larger sample at W1, compared to the smaller sample at W2, the effect sizes were quite comparable across the two waves. This suggests that the differences in 9 We did not control for psychological adjustment at Wave 1 because our focus was not on changes in adjustment predicted by identity profiles. Rather we examined whether there was a robust, consistent relationship between identifications at Wave 1 and psychological adjustment at Wave 2. 73 S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 Table 4 Summaries of the general linear models using the acculturation profiles to predict psychological adjustment. N W1 Profiles Ethnic ident. National ident. Equal-Medium dual identity High dual identity (reference) Life satisfaction W2 W1 Depression W2 Emotional loneliness W1 W2 W1 Social loneliness W2 W1 W2 M ES M ES M ES M ES M ES M ES M ES M ES 247 294 916 113 139 411 7.02a 7.00b 7.09c 0.09 0.11 0.10 7.22 6.92a 7.19b 0.06 0.14 0.09 0.23a 0.23b 0.20 0.07 0.08 0.05 0.23 0.23 0.23a 0.09 0.09 0.10 2.10a 2.08b 2.04c 0.07 0.07 0.07 1.96 2.06 1.99 0.03 0.07 0.05 1.96a 2.07b 2.02c 0.07 0.12 0.13 1.94 2.10ab 1.92a 0.04 0.11 0.03 482 185 7.34abc – 7.50ab – 0.18ab – 0.17a – 1.94abc – 1.90 – 1.83abc – 1.87b – Wald TEST (df = 3) Profiles 30.21*** 16.03** 15.78** 11.07* 15.27*** 4.68 42.77*** 11.28* Parameter estimate of controls Gender (male) Generation (2nd) Ethnicity (Moroccan) Educ (Medium) Educ (High) Age Length of stay Discrimination 0.03 0.03 0.01 0.15** 0.14* 0.02** 0.01* 0.42*** 0.04 0.00 0.09 0.21 0.17 0.00 0.00 0.33** 0.08*** 0.01 0.02 0.01 0.01 0.00 0.00 0.10*** 0.06*** 0.00 0.01 0.04* 0.05** 0.00 0.00 0.07*** 0.11** 0.02** 0.09** 0.09** 0.19*** 0.01* 0.01* 0.17*** 0.06 0.04 0.00 0.10* 0.22*** 0.01* 0.01* 0.13* 0.05 0.03 0.10*** 0.09** 0.26*** 0.01 0.01* 0.13*** 0.10* 0.04 0.05 0.20*** 0.34*** 0.01* 0.01* 0.08 Notes. For the means of the psychological adjustment of the profiles, the control variables take their mean levels in the W1 sample and the W2 sample for the first- and the second-wave analyses, respectively. M = Mean. ES = Effect Size (effect size of the differences between each of the three profiles and the reference profile ‘‘high dual identity”). a, b, c indicate where there is significant difference between the mean levels in post hoc comparisons (p <0 .008, Bonferroni correction). Educ (Medium) is the dummy variable of education attainment (medium vs. low education). Educ (High) is the other dummy variable of education attainment (high vs. low education). * p < 0.05. ** p < 0.01. *** p < 0.001. Fig. 2. The four identity profiles (at Wave 1) and general life satisfaction at Wave 1 and 2. psychological adjustment between respondents having different identity profiles remained similar across the two waves. 3.4. Additional analysis: national identification and ethnic identification For further understanding the nature of the high dual identity profile we examined the associations of ethnic identification and national identification on psychological adjustment. The beneficial effects of the high dual identity might be the result of an additive effect or a reinforcement (multiplicative) effect. The former would imply that ethnic and national identification have independent statistical main effects on psychological adjustment, while the latter implies a significant interaction effect between ethnic and national identification. In stepwise multiple regression analyses, ethnic identification and national identification as two continuous (centered) predictors together with the control variables were first entered in the regression equation, and in Step 2 the interaction between both identifications was added. The results are presented in Table 5. Apart from the association of national identification with life satisfaction and the association of ethnic identification with emotional loneliness (at W2), both higher ethnic identification and higher national identification were independently associated with better psychological adjustment. Furthermore, only one out of eight interactions had a significant effect (on emotional loneliness). These findings are most clearly in line with an additive model in which higher ethnic identification as well as higher national identification are separately associated with better psychological adjustment. Note. All predictors are centered at their mean levels. Educ (Medium) is the dummy variable of education attainment (medium vs. low education). Educ (High) is the other dummy variable of education attainment (high vs. low education). National*Ethnic refers to the interaction between national and ethnic identifications. * p < 0.05. ** p < 0.01. *** p < 0.001. 0.11 0.03 0.05 0.19*** 0.34*** 0.01* 0.01* 0.06 0.08** 0.08** 0.11 0.02 0.08** 0.09* 0.19*** 0.01* 0.01* 0.17*** 0.06** 0.04* 0.07** 0.11 0.02 0.08** 0.09** 0.19*** 0.01* 0.01* 0.16*** 0.06*** 0.04* 0.07 0.00 0.01 0.03 0.05** 0.00 0.00 0.06** 0.03** 0.02* 0.01 0.07 0.00 0.01 0.03 0.05** 0.00 0.00 0.06** 0.03** 0.02** 0.08 0.01 0.02 0.01 0.01 0.00 0.00 0.10*** 0.01* 0.02*** 0.01 0.08 0.01 0.02 0.01 0.01 0.00 0.00 0.10*** 0.01* 0.02*** 0.05 0.01 0.10 0.19 0.16 0.00 0.00 0.32* 0.10 0.22*** 0.10 0.05 0.01 0.10 0.20 0.16 0.00 0.00 0.31* 0.13 0.22*** 0.04 0.05 0.02 0.14** 0.14* 0.02** 0.01 0.41*** 0.19*** 0.14*** 0.06 0.04 0.05 0.02 0.14** 0.14* 0.02** 0.01 0.41*** 0.20*** 0.14*** Gender (male) Generation (2nd) Ethnicity (Moroccan) Educ (Medium) Educ (High) Age Length of stay Discrimination National Identif. Ethnic Identif National * Ethnic Step2 Step2 Step1 *** Step2 *** Step1 Step1 Step1 *** Step2 *** Step1 *** Step2 *** 0.06 0.04 0.04 0.11 0.21** 0.01* 0.01* 0.11 0.05 0.05 0.06 0.04 0.04 0.10 0.22** 0.01* 0.01* 0.11 0.05 0.05 0.05 0.04 0.02 0.08** 0.08** 0.25*** 0.01* 0.01* 0.12** 0.13*** 0.11*** 0.04 0.02 0.08** 0.08** 0.26*** 0.01* 0.01* 0.12** 0.10** 0.11** 0.03 * Step1 W2 Step2 Step1 Step1 Step2 Social loneliness W1 W2 Emotional loneliness W1 W1 W2 Depressive symptoms W1 W2 Life satisfaction Table 5 Coefficients of regression analyses using national identification and ethnic identification as continuous variables to predict psychological adjustment. 0.11** 0.03 0.05 0.20** 0.34*** 0.01* 0.01 0.05 0.08** 0.08** 0.02 S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 Step2 74 4. Discussion Using large national samples from the Netherlands we examined dual identity and psychological adjustment among members of two similar immigrant-origin groups. Group identities constitute an important source of psychological well-being in the face of life difficulties and challenges (Cruwys et al., 2014; Haslam et al., 2009) and we aimed to make a contribution to the growing number of studies on the positive health implications of social identities (Jetten et al., 2012). Using a person-oriented approach we first set out to identify the identity profiles of the respondents and four profiles were found. As expected disengagement (or individualization) in which individuals do not identify with their ethnic group and also not with the host nation did not emerge as a separate profile (Lee, Chen, He, Miller, & Juon, 2013). In addition, more than one form of dual identity was detected (Schwartz, Unger, Zamboanga, & Szapocznik, 2010). In fact, the largest group of respondents (47%) showed comparable moderate (or neutral) levels of ethnic and national identification. The prominence of this ‘equal-medium dual identity’ profile is in line with other research (e.g. Ng Tseung-Wong & Verkuyten, 2013) and supports Rudmin’s (2003) argument that people can be relatively neutral to both groups or cultures. This finding indicates that dual identity does not have to imply high levels of group identification which might account for some of the divergent findings in the literature. Group identification may be related to a wide range of psychological outcomes and we focused on life satisfaction, depression and loneliness as key aspects of psychological adjustment. Because of the longitudinal nature of the data we were able to examine the associations between the identification profiles and these outcomes at the same time point as well as with a prediction model over time (Meeus, 2016). Controlling for important variables such as discrimination and immigrant generation, the overall pattern was very clear: individuals with ‘‘high dual identity” showed higher life satisfaction, fewer depressive symptoms, and less emotional and social loneliness, compared to individuals with one of the other three profiles. Importantly, the overall pattern was similar in the over-time analysis: individuals with high dual identity at the first wave had higher life satisfaction, fewer depressive symptoms and less social loneliness at Wave 2 than those with a national identity and equal-medium dual identity profile. Although due to the reduced sample size some of the findings were not significant in the second wave, the comparable effect sizes across the two waves lent support to this interpretation of a similar pattern. These findings suggest that the psychological benefits of adopting the high dual identity are rather stable and enduring (Meeus, 2016). It has been argued that dual identity is psychologically the most healthy one because it provides immigrants with ‘‘the best of both worlds” (Berry et al., 2006; Nguyen & Benet-Martinez, 2013). However, others have argued that combining two cultural identities and dealing with different normative expectations can be stressful and lead to experiences of identity conflict (Hirsh & Kang, 2015). There is empirical evidence for both lines of reasoning (Nguyen & Benet-Martinez, 2013; Rudmin, 2003; Yoon, Langrehr, & Ong, 2011) and this might be due to the existence of different forms of dual identity. We identified two forms, namely high dual identity and equal-medium dual identity. The former group of individuals demonstrated the best psychological adjustment which supports the reasoning about positive psychological implications of dual identity. The latter group of individuals did not significantly differ from those who had a national identity profile or an ethnic identity profile, and this is more in agreement with the reasoning that developing a dual identity might be difficult and stressful. S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 Apparently, the benefits of moderately identifying with both one’s ethnic community and the host society does not outweigh the stress of standing in-between two cultures. As a result, equal-medium dual identifiers are not better adjusted psychologically than those who distance themselves from one side and strongly identify with the other. In contrast, for respondents who highly identify with both groups, the benefits seem to outweigh the burdens with higher psychological adjustment as a result. Future studies could examine this interpretation further by considering immigrants’ feelings about how conflicting or integrated their ethnic and national identities are. For example, the constructs of bicultural identity integration (Benet-Martínez & Haritatos, 2005) and identity compatibility (Martinovic & Verkuyten, 2012) might be useful for developing a further understanding of the processes involved in the two different dual identity profiles. The positive findings for high dual identity are in line with a growing body of research that shows that a person’s sense of social identity provides psychological resources for addressing challenges and adversities (Haslam et al., 2009). This research, conducted in different populations and contexts, has demonstrated that group identification has positive effects on well-being and health (see Cruwys et al., 2014; Haslam et al., 2009). Furthermore, this research has suggested that group identifications are additive in the sense that identification with a greater number of meaningful groups predicts higher psychological well-being. An additive pattern was also found in our additional analyses in which we used ethnic identification and national identification as separate predictors of psychological adjustment. Both group identifications were found to be positively and independently associated with adjustment and the interaction between both identifications did not predict adjustment (with one exception). This suggests that the psychological benefits of high dual identity should be understood in terms of the number of meaningful group memberships rather than in terms of the positive effects of one identity being reinforced by another identity. 75 & Benet-Martinez, 2013). Thus, our results show that ethnic and national identification matter on top of other important correlates of immigrants‘ group identifications and psychological adjustment. Third, the current study was conducted in the Netherlands and among two immigrant-origin groups. Similar to all nation-based research, including the many studies in the USA, this means that it is unclear to what extent our findings generalize to other national contexts and to groups with different migration histories and different disadvantaged positions in the host society. For example, the psychological benefits of dual identity might depend on living in a country with multicultural policies or whether a country defines itself as a settler or non-settler society (Berry et al., 2006). In a context in which members of immigrant-origin groups face systematic and pervasive discrimination it might be healthier to only identify with one’s ethnic minority community in which a sense of self-esteem, purpose, belonging and social support is found. The role of group identities is contextually bound and this means that the type of psychological resources that identities afford will depend on the social context (Verkuyten, 2005). Yet, this does not imply that there is no stability and that depending on the situation people constantly re-define and change their group identities. Individuals are motivated to maintain meaningful group memberships with the associated internalized group identities. For example, research has shown that there is considerable trait-like stability in ethnic identity (see Meeus, 2011; Quintana, 2007) and group identifications tend to be more enduring because the broader societal context in which they are located are relatively stable (Reynolds et al., 2010). Fourth, we examined psychological adjustment and not the equally important domain of sociocultural adjustment. The processes of adjustment in both domains might differ and the adjustments in one domain (e.g., lower feelings of social loneliness) might also influence adjustments in the other domain (e.g., lack of behavioral problems). Thus, future research could examine identity profiles in relation to both psychological and sociocultural adaptation. 4.1. Limitations 5. Conclusion The current study has some limitations. First, the direction of influence between the identity profiles and psychological adjustment remains unclear. It is commonly theorized that group identifications have implications for psychological adjustment and there is experimental evidence for this (Jetten et al., 2012). However, it also is possible that people who are psychologically betteradjusted feel more attached to the host society and their ethnic community. Nevertheless, the fact that the psychological differences between respondents with different identity profiles was found not only at the same time point but also (approximately) three years later, provides some confidence in the hypothesized pattern of influence. Yet, it should be acknowledged that there was a large percentage of dropouts with less than half of the original sample participating in the second wave. However, the demographic composition, the mean level of psychological adjustment, as well as the findings (i.e. effect sizes) for the four identity profiles were quite comparable between the sample that completed both waves and the sample that completed only the first wave. Second, it should be noted that all ethnic and national identity items and most of the adjustment measures were worded in the positive direction. This might mean that, for example, acquiescence bias has played a role in the pattern of findings. Further, the size of the associations between ethnic and national identification and the identity profiles with the psychological adjustment variables were modest. One reason for this is that we took various possible confounding variables into account, such as discrimination (Nguyen Using large national samples of two immigrant-origin groups in the Netherlands, we examined identity profiles in terms of ethnic identification and national identification. The findings indicate that four profiles exist: ethnic identity, national identity, equal-medium dual identity, and high dual identity. Compared to the three other profiles, high dual identifiers had, at the same time point and over time, higher life satisfaction, lower depression and less social and emotional loneliness. The three other profiles did not differ much in psychological adjustment. This pattern of results supports the usefulness of differentiating between two forms of dual identity which helps to reconcile the somewhat inconsistent findings about the role of dual identity for psychological adjustment. The findings further support the social identity claim that social identifications can have benefits for psychological well-being and that identification with a greater number of meaningful groups is associated with higher well-being. Note Contributions of the three authors: Shiyu Zhang conducted the analysis and wrote the methods and results sections. Maykel Verkuyten wrote the Introduction and Discussion sections. Jeroen Weesie supervised and performed some of the statistical analyses. The study was not pre-registered. 76 S. Zhang et al. / Journal of Research in Personality 74 (2018) 66–77 References Abouguendia, M., & Noels, K. A. (2001). General and acculturation-related daily hassles and psychological adjustment in first-and second-generation South Asian immigrants to Canada. International Journal of Psychology, 36(3), 163–173. Alba, R., & Nee, V. (1997). Rethinking assimilation theory for a new era of immigration. Internal Migration Review, 31(4), 826–874. Barker, G. G. (2015). 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Journal of Immigrant & Refugee Studies, 12:331–352, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1556-2948 print / 1556-2956 online DOI: 10.1080/15562948.2013.848007 Factors Influencing the Acculturation of Burmese, Bhutanese, and Iraqi Refugees Into American Society: Cross-Cultural Comparisons FERN R. HAUCK Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA ELSBETH LO and ANNE MAXWELL University of Virginia School of Medicine, Charlottesville, Virginia, USA P. PRESTON REYNOLDS Division of General Medicine, Geriatrics, and Palliative Care, Center for Biomedical Ethics and Humanities, University of Virginia, Charlottesville, Virginia, USA We examined the acculturation experiences of Burmese, Bhutanese, and Iraqi refugees living in central Virginia based on the model of acculturation developed by J. W. Berry. We identified themes in examining the effects of English language proficiency, level of social support, financial stability, and expectations about and satisfaction with life in the United States on acculturative stress. Language difficulty and barriers to accessing education, employment opportunities, and health care caused stress in all cultural groups. Nearly all refugees were happy they had immigrated due to the personal freedom, safety, and hope for the future they found in the United States. KEYWORDS Acculturation, refugees, barriers to health care, social support, stress The displacement of refugees continues to be a worldwide problem in the 21st century. The United States admitted close to 76,000 refugees in 2012, with 70,000 projected for 2013 (Proposed Refugee Admissions for FY 2013, 2012). As such, caring for refugees has become a common experience for Address correspondence to Fern R. Hauck, MD, MS, Department of Family Medicine, University of Virginia School of Medicine, P.O. Box 800729, Charlottesville, VA 22908. E-mail: 331 332 F. R. Hauck et al. health care professionals. Treating refugees, who have often experienced war, poverty, and political suppression, requires that health care providers and agencies develop and apply a specific set of skills to care for the unique emotional and physical conditions of these patients. Most of the published literature exploring the immigrant experience does not specifically examine the challenges faced by refugees resettling in the United States, whose reasons for flight are nonvoluntary. Furthermore, much of refugee research has focused on Southeast Asian refugees who arrived at the end of the 20th century; meanwhile, current groups of refugees are coming from a greater number of countries and arriving in the context of a different set of U.S. resettlement policies (Allen, 2009). This study examines the experiences of refugees from Burma (Myanmar), Bhutan, and Iraq living in Charlottesville, Virginia. These three groups are among the newest refugees arriving in the United States and other resettlement countries; thus, the literature devoted to these specific groups is still limited. The goal of this study is to better understand the stressors that recent refugees experience during the acculturative process, specifically those arriving from Burma, Bhutan, and Iraq, so that clinicians who provide care to them are better prepared to address their conditions. LOCAL RESOURCES Since opening its doors in 1998, the Charlottesville chapter of the International Rescue Committee (IRC) has resettled close to 2,000 refugees, assisting approximately 150 to 200 new refugees a year. The University of Virginia (UVA) International Family Medicine Clinic (IFMC) was established in 2002 to provide comprehensive care to the growing immigrant and refugee populations in central Virginia. All refugees arriving in Charlottesville receive initial health screenings at the local health department and then are referred to the IFMC for ongoing primary health care. The services provided by the IRC ensure that all refugees are scheduled to see a primary care physician (PCP) at the IFMC; however, continuity of care results from a combination of the clinic’s outreach and patients’ interest in continuing their care. REFUGEE GROUPS IN CHARLOTTESVILLE In the last 5 years, immigrants from Burma, Bhutan, and Iraq have made up the largest proportion of refugees who have settled in Charlottesville, consistent with national settlement patterns. Of the 80,000 refugees who resettled in the United States in 2011, the largest three populations were the Burmese (16,972), Bhutanese (14,999), and Iraqis (9,388—although significantly fewer than the 18,016 admitted in 2010) (FY11 Refugee Admission Statistics, 2012; Acculturation of Refugees 333 FY10 Refugee Admission Statistics, 2010). The Burmese refugees consist of several ethnic minorities, including Karen, Karenni, Chin, and Kachin. During the time this study was conducted, the IFMC provided care to 286 Burmese, 162 Bhutanese, and 177 Iraqi patients. THEORETICAL FRAMEWORK In his 1997 article “Immigration, Acculturation, and Adaptation,” J. W. Berry describes acculturation as the changes that occur when two different cultural groups come together (1997). In our study, we use the term acculturation to explore the experiences of the refugee populations as they attempt to integrate into American society. We use the term acculturative stress to indicate the reduction in health status due to physical, psychological, and social stressors that refugees experience during their acculturation process (Berry, Kim, Minde, & Mok, 1987). Berry’s framework of the acculturation process includes variables both at the group level and the individual level to explain differences in resulting stress and eventual adaptation (2003). Moderating factors at the group level include characteristics of the society of origin and society of settlement. Individual-level variables are divided into preexisting individual characteristics (e.g., education, health, language, expectations, and migration motivation) and those that arise during acculturation (e.g., social support, coping strategies, and resources). STUDY AIMS This project builds upon a pilot study conducted in 2009 designed to explore the process of acculturation and resulting stress, as existing literature has suggested that acculturative stress may be associated with poor health outcomes (Dhooper & Tran, 1998). In the current study, we pose the same research question as the pilot study: “What factors influence the acculturation of refugees who resettle in Charlottesville?” In following with Berry’s framework, we aim to identify risk factors and protective factors in refugees by identifying the preexisting individual-level variables that influence acculturative stress. We also explore the moderating factors that arise during the acculturation process, which further elucidate the differences in refugees’ level of stress and adaptation in the United States. METHODS The IFMC maintains a database of all refugee patients seen in clinic. Potential study participants were selected from the database using the following 334 F. R. Hauck et al. parameters: age 18 years and older; country of origin listed as Burma, Bhutan, or Iraq; and date of arrival on or after July 1, 2005. Two medical students were involved in study recruitment, data collection, and data analysis. Between June and August of 2010, 23 Burmese, 16 Bhutanese, and 24 Iraqi potential study participants were contacted by phone, and if they agreed to participate, were scheduled for an in-person interview. Due to potential issues with limited English language proficiency, recruitment was conducted using professional telephone interpreters (CyraCom Company, Tucson, AZ) for Burmese, Karen, Arabic, and Nepali speakers. The study was approved by the University of Virginia Institutional Review Board for Social and Behavioral Sciences. Interviews were conducted privately and lasted approximately 1 hour each. Telephone interpreters were accessed for limited-English-proficient patients. Participants were informed that they could terminate the interview at any time. A scripted questionnaire was used, consisting of 34 questions regarding their employment and education history, expectations and experience of life in the United States, changes in cultural practices and identity following resettlement, social support systems, and levels of perceived stress (Appendix 1). The interviewers assessed participants’ English-language ability and categorized them as fluent, moderately proficient, or minimally proficient. Those who chose to complete the interviews in English were categorized as fluent. Participants who self-identified as not speaking any amount of English or who were unable to answer basic questions about their name, age, and country of origin were categorized as being minimally proficient in English. Those who could answer a few questions in English but still required the use of an interpreter were categorized as moderately proficient. Participants who completed the interview were compensated for their time with a $20 gift card to a local store. All interviews were recorded. Tapes were transcribed with removal of all identifiers, and then they were erased. The interviewees’ responses were analyzed qualitatively, looking for common themes among and across cultural groups. “Majority” or “common theme” was designated for responses that were present in over 50% of cases. “Few” or “minor theme” was designated for responses that were recorded between two and five times within a refugee group. Common themes were identified and organized into categories using a grounded theory approach (Strauss & Corbin, 1990). RESULTS The study population comprised 46 individuals from Burma (n = 15), Bhutan (n = 15), and Iraq (n = 16). The social and demographic characteristics of the study participants are summarized in Table 1. 335 Acculturation of Refugees TABLE 1 Social and Demographic Characteristics of the Burmese, Bhutanese, and Iraqi Participants Characteristic Age Burmese Bhutanese Iraqis Gender Burmese Bhutanese Iraqis Marital Status Burmese Bhutanese Iraqis Children Burmese Bhutanese Iraqis Length of Time in US Burmese Bhutanese Iraqis Point of Emigration (with no. of individuals) Burmese Bhutanese Iraqis Education Burmese Bhutanese Iraqis Religion (with no. of individuals) Burmese Bhutanese Iraqis English-Language Ability Burmese Bhutanese Iraqis (n) (n) (n) 18–24 4 3 5 Male 5 6 9 Single 4 3 9 No 4 3 9 0–1 years 2 0 5 25–49 9 11 8 Female 10 9 7 Married 9 11 6 Yes 11 12 7 1–2 years 11 13 10 50+ 2 1 3 >2 years 2 2 1 Malaysia-2 Nepal-15 Iraq-8 Elementary school 5 2 2 Thailand-11 Burma-2 Other-8 Jr./Sr. high school 8 8 11 College or higher 1 2 3 None Christian-11 Hindu-4 Muslim-6 Buddhist-4 Buddhist-3 Not specified-4 Moderate 3 3 2 Other-5 None-6 None-3 Minimal 12 7 9 Other 2 1 1 1 3 Fluent 0 5 5 English-Language Proficiency English proficiency was similar in the Bhutanese and Iraqi populations; approximately one-third of the participants were fluent. The average length of premigratory formal education was 8 years for the Bhutanese and 11 years for the Iraqi participants. The majority of these patients reported having studied English in school. According to the Iraqi participants, English classes are compulsory in grades 5 through 12. In contrast, none of the Burmese were 336 F. R. Hauck et al. fluent and all but three were minimally proficient, despite reporting having taken English classes before coming to the United States. According to one participant, English is not taught in Burma until the fourth grade, and the average length of education prior to arrival in the United States was 7 years among the Burmese refugees. The majority of Burmese participants were not satisfied with their English ability. Of the Bhutanese who spoke minimal English, half were satisfied with their English ability. Of those who had intermediate to very fluent English, almost all were satisfied with their language skills. Slightly more Iraqis were dissatisfied than were satisfied with their English-language abilities. The majority of refugees believed that their lack of English proficiency was a barrier to finding a job, communicating with health professionals, and making American friends. Among the Bhutanese, a few respondents specifically mentioned difficulties communicating in medical situations, stating that some physicians do not always use interpreters, even when they cannot understand. The Burmese and Bhutanese cited limited English-language proficiency as one of their greatest stressors, in contrast to the Iraqis, who had a greater proportion of members who were fluent in English. Almost all refugees from each ethnic group expected to attend school or English classes in Charlottesville, but only about one-third were currently participating in any formal educational activities—namely, ESL classes. Of the participants who were initially enrolled in ESL classes, the majority discontinued their studies because of work scheduling conflicts or to take care of small children at home. A few refugees from each group expressed disappointment at their inability to continue language studies. Social Support The Burmese and Bhutanese had strong social ties to their respective local ethnic communities. They also reported having few American friends beyond coworkers, with whom they only interacted in the workplace. Of the three groups, the Burmese community is the largest group of refugees with the longest residence in Charlottesville. All but two Burmese refugees lived near other Burmese families. For those who did not live near other Burmese families, a commonly cited reason was the prohibitive cost of rent; these individuals were living in subsidized housing, located in a different neighborhood. A majority of patients reported sharing resources such as childcare, car rides, and phone use with other Burmese. Patients also said that they commonly visit other Burmese families, celebrate birthdays, and participate in religious activities together. Most of the Bhutanese participants also described other Bhutanese families in the community as an important source of social support. All of the Bhutanese participants in our study reported living near other Bhutanese families. Acculturation of Refugees 337 While two-thirds of Iraqi participants lived near other Iraqis, only half of these interacted with their Iraqi neighbors. On the other hand, nearly all of the Iraqis had American friends from work, school, the U.S. Army, the neighborhood, or IRC volunteers. Over one-third of Iraqis stated that they found Americans very helpful, and even more reported that relationships with their American friends provided a means to manage the stress in their lives. The majority of participants from all three ethnic groups stated they would like more family members to resettle in Charlottesville. However a few Burmese were concerned about newcomers’ ability to survive here, citing struggles such as language difficulty, job scarcity, and finding affordable living accommodations. The Bhutanese commonly expressed desires for family unity or more family members available for financial support. Nearly all Iraqi patients would like more of their family members to resettle in Charlottesville. Most simply wanted to reunite their family, while a few were concerned about their family’s safety: “Because of the situation in Iraq, which is not safe. Daily explosions. Assassinations. I just wish that my family live in safety.” Separation from family members and worries about the safety of loved ones still living in the Middle East were listed as sources of stress among several Iraqi refugees. The majority of Burmese respondents were actively involved in one community church, which holds services in the Burmese language. Some Burmese also reported receiving help from fellow American and Burmese church members. While the majority of Bhutanese participants reported being religious, most reported that location, transportation, and time constraints were barriers to attending a place of worship regularly. Similarly, Iraqis stated that religion was an important part of their life, yet most chose not to attend the sole mosque located in Charlottesville. Some participants from each group reported that their reliance on a higher power helped them to cope with stress. The most commonly cited source of assistance among all of the refugees was the IRC. Burmese and Bhutanese participants commonly relied on other refugees in their community who had lived in America longer. However, one-third of the Iraqis stated they did not go to the IRC for help, instead attempting to independently meet such needs or seeking help from their American friends. The majority of respondents expressed both appreciation for the institutional support they received from the resettlement agency (IRC) and a need for additional support in areas such as health care, Medicaid, education, employment, and financial assistance. A few Burmese refugees reported expecting more help with interpreting services. A common sentiment among Bhutanese refugees was that help from the IRC should have extended beyond six months. 338 F. R. Hauck et al. Financial Support Participants from all three cultural groups reported feeling significant stress arising from their efforts to secure employment and meet their financial obligations—namely, housing and food. Of the Bhutanese refugees, all were employed but one; three Burmese and seven Iraqis were unemployed. Participants commonly felt that their limited English proficiency posed a barrier to accessing employment opportunities. A few Bhutanese refugees also cited their educational backgrounds as a limiting factor to securing better employment. A common theme among Burmese and Bhutanese was that, considering their qualifications and low English proficiency, participants felt satisfied with their work. However, many Burmese and Iraqi participants commonly expressed discontent with the number of family members who had to work to make ends meet. Meanwhile a majority of the Bhutanese reported that their expectations for who in the family would work (e.g., both husband and wife) met their reality. Refugees from all three groups who arrived in the United States near the age of 18 years were unhappy because they needed to financially support the family and, therefore, were unable to continue their education. Most of these individuals were placed in lower grade levels based on their prior education, but had to leave school after they turned 18 in order to work. The majority were unable to obtain high school diplomas or formal education credentials. Overall, the majority of Burmese and Bhutanese found that they could afford to buy the things that they needed, although with some difficulty. In contrast, the majority of Iraqis, both employed and unemployed, did not feel their income was sufficient for their needs. Half of the Iraqi participants reported that they had run out of money or food stamps before they were able to obtain enough food for themselves and the family at least once; more than half of these respondents were employed. A few participants from the Burmese and Bhutanese groups reported similar problems with food security. A minor theme among all three groups was that the eight months of Medicaid insurance provided to refugees upon arrival was inadequate, since many were still financially unstable or unemployed eight months after arrival. For the Burmese and Bhutanese refugees, health insurance coverage was equally divided among employer-based health insurance, Medicaid, and no health insurance. Half of the Iraqi patients had either employerbased health insurance or Medicaid, while the other half were uninsured. Those who were uninsured and employed were either unable to afford the employer-sponsored insurance plans, or were not offered any form of insurance through their work. A few Bhutanese and Iraqi participants stated they were unsure about the future of their insurance coverage and felt Acculturation of Refugees 339 inadequately informed about what to do when their Medicaid coverage was discontinued. Burmese and Bhutanese participants who lacked health insurance reported that they did not access any form of medical care in the United States since they had fewer health problems here. Nearly all of the Burmese and Bhutanese refugees interviewed were unaware of the financial screening process at the University of Virginia Health System, which could have allowed many of the uninsured individuals to receive financial assistance for the medical care they received at the IFMC and throughout the health system. On the other hand, about half of the Iraqis lacking health insurance had applied for financial screening at UVA and received care at significantly reduced cost. A majority of the study participants reported satisfaction with the health care they had received since moving to the United States. The most commonly cited reasons for being dissatisfied were the high costs of insurance, health care, and medications, as well as the lack of insurance coverage; issues related to the quality of care were less often cited. Burmese and Bhutanese patients commonly noted that they did not get sick as often in America and therefore, did not access medical care. About one-third of the Iraqis stated that they felt dental care should be included in medical insurance and benefits. Free dental care is provided to low-income adults at the Charlottesville Free Clinic, but many of the Iraqi patients reported difficulty accessing these services. Expectations and Satisfaction With Life in the United States In spite of the many life stressors participants described facing during resettlement, nearly all of the refugees stated they were glad they had come to America. The majority of Burmese and Bhutanese felt that their expectations of life in their new home had been met. A few Burmese respondents found life in the United States to be better than in Burma, even including one individual who experienced racial violence in his neighborhood here: “Back home when I was in Burma I had problems worse than here. So I think about [how] I [came] to this country and I live a good life.” On the other hand, two-thirds of Iraqi patients stated that their expectations regarding aspects of life in America such as financial assistance, housing, employment, education, and health care differed from reality. Almost all Iraqis expressed satisfaction over feeling accepted and treated equally by Americans: “In [the] Middle East, we do not have a lot of rights. Here you are free. You can do a lot of things. You can feel the freedom.” The Burmese and Iraqis expressed great satisfaction with the personal freedom they found in the United States. For the Bhutanese participants, 340 F. R. Hauck et al. satisfaction with life in the United States appeared to stem from being treated fairly and equally by employers and other American citizens. [In Nepal,] when I go to the village, the villagers say, “Oh, refugee came, refugee came.” They treat me like a second-class citizen. But now in America, I am treated equally. I am treated like a human being. I am very satisfied in America. I [have] my dignity. Among the study participants, the Iraqis were the most satisfied with their personal safety in America, compared to that in their previous country of residence. A major theme among Burmese and Bhutanese participants was a great hope for the future of their children. I don’t think about myself. I don’t think about what can I do for a living, or [finding a better] job. My expectation is for my kids’ education. The most impressive experience is the education for my kids. They can [. . .] learn the things that we never learned before. DISCUSSION English-Language Proficiency We found that refugees with greater English-language proficiency experience less stress in the acculturation process. It is important to discuss Englishlanguage proficiency when examining the acculturation process, as immigrants who are more proficient in the host-country language are more likely to find a job and earn higher wages (Chiswick & Miller, 2002). Among participants who reported feeling satisfied with their language abilities, the majority had received several years of English-language instruction in school prior to migrating, as well as education in their native language. A refugee’s literacy in their native language is related to their ability to learn other written languages in their country of resettlement; thus individuals from agrarian societies where literacy is considered “less necessary” may face more barriers when learning a new language (van Tubergen, 2010). This may explain some of the difficulty for those Burmese and Bhutanese participants who came from labor or farming backgrounds. Language skills have also been found to be better among refugees who had received more premigration education or who migrated from a major city (van Tubergen, 2010), which describes the majority of our Iraqi participants. A specific theme among Bhutanese respondents was that language difficulties contributed to stress during medical encounters. Lipson and colleagues (Lipson, Weinstein, Gladstone, & Sarnoff, 2003) found that refugee patients who were not offered interpreters in appropriate medical situations Acculturation of Refugees 341 worried that they had received incorrect diagnoses and medications. Health care providers should pay careful attention to verify patients’ language abilities and offer interpretation services when appropriate, as language problems can cause refugees significant stress. Completion of an integration course or language classes in the new country has been found to be predictive of better second-language skills (Gonzalez, 2000; van Tubergen, 2010). However, English-language preparation is not a routine part of Overseas Cultural Orientation (2009 Cultural Orientation Technical Assistance Program, 2008) for logistical reasons. According to Susan Donovan, director of the IRC’s Resettlement Support Center in Thailand, once refugees have been approved for resettlement in the United States and have undergone medical and security clearances, little time remains for English instruction. In the 1980s, the Bureau of Population, Refugees and Migration (PRM) funded long-term (6-month) ESL for refugees prior to departure, and this was found to be largely ineffective. Not only did the classes delay departure, but also it was difficult for refugees to learn English outside of the context of an English immersion environment, especially for pre- and nonliterate populations. Currently, a pilot project funded by PRM is underway in Southeast Asia to teach English to refugees for 4 weeks prior to migration (S. Donovan, personal communication, May 31, 2013). Evaluation of this pilot program will help guide future policy. The inability to attend English classes after migration caused significant stress for some of our respondents. Resettlement agencies or local organizations can further support language acquisition by offering intensive English classes during the initial resettlement period. Providing classes with expanded schedules (i.e., day, night, and weekend classes) to accommodate those with time restrictions due to work or childcare may also improve many refugees’ ability to attend English classes after resettlement. Although our participants did not specifically discuss difficulties with learning English secondary to stress, psychological stressors as a barrier to language acquisition are a well-researched topic. A Norwegian study conducted in 2006 compared the verbal memory strategies of immigrants and refugees who had reported positive posttraumatic stress disorder (PTSD) symptoms versus those with no history of PTSD, and showed significant impairment in learning strategies and memory in the PTSD group (Johnsen & Asbjornsen, 2009). These authors also suggest that “memory impairment and the use of ineffective learning strategies may not be related to PTSD symptomatology only, but also to self-reported symptoms of depression and general distress” (Johnsen & Asbjornsen, 2009, p. 68). Van Tubergen found a negative correlation between depression and acquisition of Dutch language among refugees in the Netherlands (2010). Since psychological issues are potential barriers to learning a second language, psychiatric assessment should be considered an important part of initial health screening for new refugees. 342 F. R. Hauck et al. Social Support We found that refugees who have greater social support from family, community, and/or institutional programs throughout the acculturation process experience less stress. Research on refugees from various cultures, age groups, and different host countries have shown the protective effect of social support on individuals’ health and well-being. Many Burmese and Bhutanese participants relied on their family and other members of their ethnic group communities for support. A family experiences loss of a larger support system during migration if only the nuclear family is able to resettle. Fox (1991) describes a shift from “open to closed family systems” (p. 50) when Asian refugee families resettle, leaving them with fewer resources and less emotional support in their new country. The Bhutanese and Burmese refugees had lived in larger family groups in the refugee camps for several years and then separated from these extended family networks to resettle in the United States. Many Burmese participants described socializing and sharing resources with other refugee families; thus, forming these relationships may be a means to “re-open” their family systems. Refugees often experience more successful integration when they maintain ties to their ethnic group both in the host country and in their country of origin (Baird, 2012). The lack of social cohesion among the Iraqi participants may be explained by various factors. Iraqi refugees do not live together in refugee camps prior to migration, but are dispersed among urban cities. Our sample included a number of Iraqis who had lived in Turkey, Lebanon, and Jordan before resettling in the United States. In addition, Iraqi refugees come from various cultural and religious sects that have been in conflict (e.g., Shiite and Sunni). A few of the study participants who immigrated from Iraq were actually Palestinian, which may have contributed to their lack of ties to other Iraqi refugees. On the other hand, the lack of reliance on other Iraqi families may also be a protective factor in itself, as several of the Iraqi participants were fluent in English and had numerous American friends. Respondents from all three refugee groups stated that they would like more family members to resettle in Charlottesville. Fear for the physical and economic security of loved ones back home, especially in high conflict areas such as the Middle East (Jamil, Nassar-McMillan, & Lambert, 2007), is a common sentiment among all refugees. Abe and colleagues (Abe, Zane, & Chun, 1994) have suggested that reunification of refugees with family members may even reduce the likelihood of developing posttraumatic stress disorder. Resettlement agencies could help decrease the acculturative stress experienced by many refugees by making efforts to keep large family units together during migration or to help postmigratory refugees apply for their family members to resettle in the same city. Acculturation of Refugees 343 Religion and spirituality were a source of support for many refugees in our study. A study of Christian Hmong living in Minnesota showed that religious services allowed these refugees to share resources and experiences while connecting individuals to a larger community of Hmong refugees living in the same area (Westermeyer & Uecker, 1997). This experience may be similar to that of the Burmese churchgoers in Charlottesville. Ethnic religious services can provide a culturally safe environment to explore and discuss acculturation issues (Kamya, 2008). Current literature demonstrates the importance of culturally appropriate social services in the resettlement of refugees, such as that provided by the Charlottesville IRC. Meanwhile, Chen, Jo, and Donnel (2004) have shown that immigrants commonly underutilize social services. In our study, however, participants endorsed that the IRC was their major source of assistance and even stated they would have liked help for longer than 6 months. It may be beneficial for the IRC to provide help for a longer period of time while refugees achieve more independence. These additional needs may also be met by other local organizations such as religious institutions, which have provided significant assistance to other refugee communities (Kenny & Lockwood-Kenny, 2011). Financial Support Our third main finding is that refugees who have greater financial stability through employment and who have health insurance and/or access to health care experience less stress. Although the IRC helps new arrivals seek job placement and offers job readiness classes, the recent economic climate had made it more difficult for refugees to secure employment in Charlottesville. The financial instability of refugees after migration has been studied by various researchers. The human capital and social capital theories have often been used to explain these trends; that is, refugees lack employable skills, including language skills and education in the host country, as well as social resources and connections to the labor market (Chiswick & Miller, 2001; Haldey, Zodhiates, & Sellen, 2007). Our participants often echoed these ideas when describing the barriers they faced when looking for work. However, the length of residence in Charlottesville, which may be confounded by the variables mentioned previously such as language skills, appeared to have notable impact on refugees’ employment status. Among our study cohort, the Bhutanese, who had the greatest proportion of employed participants, had all lived in the United States for over 1 year. On the other hand, the Burmese and Iraqi refugees reported having more difficulty securing employment; both of these groups had a larger proportion of individuals who had lived in the country for less than 1 year. 344 F. R. Hauck et al. The general job satisfaction of our participants is somewhat surprising in the context of the downward socioeconomic mobility experienced by many refugees (Dhooper & Tran, 1998). This may be because, for the most part, our respondents had realistic expectations regarding the difficulty of finding employment in the United States, the types of work they would do, and the number of family members who would need to work to support the family. Kenny and Lockwood-Kenny (2011) describe a mix of realistic and unmet expectations regarding such issues within refugee groups. These expectations may vary based on explanations of the resettlement process they receive prior to migration as well as job readiness training in their new host country. Participants who had migrated as older teenagers commonly expressed dissatisfaction with the lack of educational opportunities. Similar experiences have been described for refugees who resettle in other American cities (Kenny & Lockwood-Kenny, 2011). Future employment opportunities might be improved by offering continuing adult education for individuals who migrate between ages 18 to 21 years. The financial difficulty described by our participants most likely reflects the low-paying jobs refugees are able to secure and the high cost of living in the United States. The Iraqi refugees more frequently reported having insufficient income to meet their needs and food insecurity compared with the other two groups, which may be a reflection of differences in pre-migratory financial situations and expectations (discussed in the following section). Many Iraqi refugees had lived in urban, middle-class communities in their country of origin and had higher levels of education and employment and, thus, experienced downward socioeconomic mobility moving to the United States. In contrast, the Burmese and Bhutanese refugees lived primarily in refugee camps, had fewer educational opportunities, worked in the camps, and had lower standards of living prior to resettlement, such that they expressed less dissatisfaction with their new financial situation and were better able to adapt to the financial strains of living in the United States. Lack of health care insurance coverage and access were also major themes among the refugees. Information about the UVA Health System’s financial screening is provided during the IRC’s initial orientation for new arrivals in Charlottesville. However, routine inquiry by social workers and health care providers about each patient’s medical coverage and explanation of the financial screening process would help ensure that refugees are able to receive appropriate health care after Medicaid coverage has ended. Most of the Burmese and Bhutanese participants lived in refugee camps and received lower standards of care prior to arrival in the United States, such that their complaints about the U.S. health care system were more centered on cost and convenience. In contrast, Iraq had a stable, governmentfunded health care system before the 2003 war. The Iraqis expressed greater stress about accessing quality dental and health care, perhaps due to the Acculturation of Refugees 345 greater standard of living and government-supported health care system that was previously available to them. Lipson and colleagues (2003) assert that refugees’ health care needs “include a thorough orientation to the complexity of the U.S. health care system and the choices that are available, ideally before Medicaid coverage ends at 8 months” (p. 870). Emphasis on this portion of the IRC’s orientation may help decrease the stress of navigating a new health care system. Health care providers might also improve refugees’ utilization of dental care by routinely inquiring about dental problems and making referrals to local free or reduced-cost dental clinics. Expectations and Satisfaction With Life in the United States Our final common theme relates to participants’ pre-migratory expectations and current satisfaction with life in the United States. As discussed previously, most of the Burmese and Bhutanese respondents had lived in refugee camps prior to migrating to Charlottesville and thus, were accustomed to a lower standard of living. Meanwhile, several of the Iraqi participants reported having stable jobs and living comfortably prior to the Gulf War in the 1990s and/or the Iraq war in 2003. Jamil et al. (2007) described conflicting feelings among displaced Iraqi refugees, who have “fought against the repression in their country of origin while simultaneously perceiving the new host country, the United States, as responsible for the demise of their homeland” (p. 200). These feelings, along with the socioeconomic downturn they experienced during resettlement, may contribute to expectations for government assistance that exceeds that which they are currently receiving. The satisfaction with personal freedom shared by Burmese and Iraqi refugees is likely related to the oppression these groups previously experienced due to government discrimination and sectarian violence in their home countries. The Bhutanese had lived in the refugee camps in Nepal for at least 17 years before coming to the United States. Therefore they instead experienced nongovernmental discrimination from Nepali citizens regarding their refugee status and were happy to be treated as equals in the United States. The Iraqis’ satisfaction with personal safety in America is most likely due to their exposure to pre-flight violence. Twenty-two percent of Iraqi refugees registered with the United Nations High Commissioner for Refugees (UNHCR) report personal history of trauma—experiences of air bombardments, witnessing shootings or car bombings, loss of someone close to them, and receiving violent threats are fairly common among individuals coming from Iraq (Harper, 2008). Burmese and Bhutanese participants were optimistic about their future generation’s quality of life. Educational opportunities are often a significant motivator for refugees to resettle in the United States (Kenny & 346 F. R. Hauck et al. Lockwood-Kenny, 2011). This aspect did not appear to affect the overall satisfaction and stress experienced by the Iraqi refugees in our study, perhaps because of the higher median level of education among participants and Iraq’s high-performing education system prior to the war. As mentioned throughout our discussion, the three groups examined in our study have very different premigration and migration experiences. Premigration and migration stressors, which often include traumatic experiences and separation from family, significantly influence postmigration experiences and one’s capacity to handle resettlement stress (Lindencrona, Ekblad, & Hauff, 2008). Those who have undergone traumatic experiences prior to migration often experience PTSD and residual sensations of not feeling safe, among other forms of psychological distress during the resettlement period (George, 2012). Future research should further explore the factors influencing acculturative stress for refugees by asking study participants to elaborate on stress experienced in their country of origin and during their migration journey. Details about such premigratory experiences may provide a more comprehensive understanding of risk and protective factors for refugee acculturation (Lindencrona et al., 2008), especially regarding language proficiency, ability to seek social and financial support, expectations for life in the United States, and the overall acculturation process. Although participants cited different stressors during the acculturation process, asking specifically about life in refugee camps and/or prior to migrating to the United States, as well as about their flight experience, could potentially provide more information about ways to improve the resettlement process. Study Limitations Findings from the current study are limited by several factors, including the use of phone interpreters. In particular, the Burmese and Karen interpreters often appeared to translate our open-ended questions into closed-ended questions when the former were not understood. This may have led to inconsistency in questionnaire administration and collection of less in-depth information about the experience of refugee life for the Burmese. Additionally, we had hoped to interview refugees in an approximately equal distribution among those who had immigrated only a few months previously up to those who had immigrated 5 years previously. However, when recruiting participants, we experienced much more difficulty reaching those who had been in the United States for longer periods of time than those who had more recently immigrated, likely related to work commitments and less availability. Therefore, our sample is skewed toward those in the earlier stages of acculturation. The refugee population in Charlottesville is unique in that while other communities have a greater number of health care providers and institutions Acculturation of Refugees 347 that serve the refugee population, the IFMC serves as a medical home for the majority of refugees. However, we do not believe that this invalidates the findings of the study or generalizability to other communities, since this study explores many aspects of resettlement outside of health care. In addition, even with this unique access to primary care services, the refugees interviewed in this study still had major concerns about health care access and affordability. Finally, since these interviews were conducted as a summer medical student research project, we were constrained by these time limitations. Within these constraints, we chose to pursue comprehensive, in-depth interviews rather than seeking more participants for a less detailed study. Thus, our study is subject to the known limitations of a small sample size. Future study with larger numbers of participants is recommended. Nevertheless, we were able to obtain an adequate sample of each refugee group for withinand across-group comparisons, and we have no reason to believe that our responders were biased in a certain direction. The published literature provides no similar studies among these refugee groups for comparison. While the scope of our study does not allow generalization to all members of each refugee group, it uncovers the diversity of the acculturation experience while providing valuable insights that serve as the basis for our recommendations. CONCLUSION It is our hope that understanding the many stressors experienced throughout the acculturation process will enable health care providers across the United States to better address the unique medical and social issues faced by our country’s diverse, and rapidly growing, refugee population. We analyzed our qualitative data and the four emerging themes to identify the individual and group differences among our refugees and their experiences since moving to the United States. As Berry suggests, these themes are influenced by preexisting variables as well as those arising during the acculturation process, specifically in regard to social and financial support. Although refugees’ preflight experiences are beyond our reach, we may be able to modify certain preexisting variables, such as language, education, and expectations, to influence their resulting acculturative stress. We make the following recommendations: 1. Refugee resettlement agencies should evaluate the effectiveness of programs to improve the English-language skills of refugees prior to migration and implement these widely if proven effective. Providing more opportunities for intensive English classes during the initial resettlement period may also improve language proficiency. 348 F. R. Hauck et al. 2. Health care providers should routinely assess their refugee patients’ language abilities and ensure that appropriate interpreter services are utilized. 3. Psychiatric conditions should be considered a potential barrier to learning English. Psychiatric assessment should be a part of initial health evaluations of new refugees. 4. Refugee resettlement agencies should attempt to resettle family units to the same location. 5. Continuing adult education for individuals who migrate as young adults may improve future employment opportunities. 6. Resettlement agencies and health care providers should provide intensive orientation to the U.S. health care system and local health care resources, including free or reduced-cost health and dental care services, as applicable to their respective community. 7. Resettlement agencies should continue to provide premigration orientation that emphasizes what to expect in the United States in relation to education, employment, cost of living, health care services, and other factors, so that refugees have realistic expectations of their new life in the United States. ACKNOWLEDGMENTS The student researchers wish to acknowledge 2009 pilot study researchers Sara Bouberhan, Emi Bretschneider, and Krishika Acharya for laying the groundwork for this project. We also thank Kawai Tanabe, MPH, for database and Institutional Review Board assistance. FUNDING This project was supported by Health Resources Services Administration PreDoctoral Training in Primary Care (1 D56HP06547-04-00), the University of Virginia Generalist Scholars Program, and the University of Virginia School of Medicine Medical Student Summer Research Program. REFERENCES Abe, J., Zane, N., & Chun, K. (1994). 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APPENDIX 1: Summary of Interview Questions General introduction Arrival in the U.S. Educational background Employment history Point of emigration Date of arrival in the U.S. Age at arrival in the U.S. Highest grade of school completed Class subjects taken English classes taken prior to coming to the U.S. Jobs held before coming to the U.S. Acculturation of Refugees 351 APPENDIX 1: Summary of Interview Questions (Continued) Expectations vs. Assistance experience of life in the U.S. Housing Employment Transportation Education Health care Expectations regarding assistance from the IRC - Satisfaction with help received from the IRC - Additional areas of needed assistance from the IRC Other sources of help for finding a job, transportation, or financial needs Expectations regarding housing in the U.S. - Description of current housing - Satisfaction with current housing Expectations regarding employment in the U.S. - Current job - Jobs previously held in the U.S. - Reasons for leaving previous jobs - Satisfaction with current employment - Ability to afford necessities such as food, clothes, school supplies, etc. Expectations regarding transportation in the U.S. - Modes of transportation used in Charlottesville - Ability to get around Charlottesville - Forms of transportation used in home country Expectations regarding educational opportunities in the U.S. - Ability to access opportunities - Satisfaction with educational experiences Expectations regarding educational opportunities for other family members in the U.S. - Family members currently attending school - Satisfaction with family members’ educational experiences Expectations regarding health care in the U.S. Satisfaction with health care in the U.S. Current health care provider Ability to access care during time of need Current health insurance - Type of insurance: Medicaid, employer based - Reasons for not having insurance - Use of UVA financial screening process Experiences with going to the pharmacy for medication - Problems encountered at the pharmacy - Not filling a prescription, reasons for not doing so Perceived differences between health care received in the U.S. compared to that received in home country Advice for physicians treating refugees (Continued on next page) 352 F. R. Hauck et al. APPENDIX 1: Summary of Interview Questions (Continued) Cultural shifts Language after resettlement Diet Religion Social support Family Friends Perceived stress Other comments Satisfaction with current level of English-language proficiency - Situations in which English is the primary spoken language - Methods employed to improve English - Importance of maintaining native language Types of food eaten and prepared (native or American food) - Difficulty preparing home food - Food stores frequented - Ability to afford desired types of food - Problems running out of money or food stamps before being able to get enough food for self/family Importance of religion in personal life - Religious practice since coming to the U.S. - Attendance at a local place of worship Number of people living in household Members of household currently working - Expectations regarding which family members would work in the U.S. - Satisfaction with current arrangement Nature of family relationships since coming to the U.S. Plans to resettle more family members in Charlottesville Refugees from the same country living within close proximity - Relationships with other refugees from the same country - Social activities with other refugees - Resources shared with other refugees such as food, computer, phone, or childcare American friends - How American friends were made - Social activities with American friends - Resources shared with American friends - Help received from American friends Perceived treatment by others in the U.S. - Feelings of acceptance or rejection related to being a foreigner Perceived level of stress - Frequency of feeling stress - Causes of stress - Approaches to stress management Perceived level of adjustment to life in the U.S. - Hardest things about life in the U.S. - Easiest things about life in the U.S. - Deviations from expectations about life in the U.S. - Satisfaction with life in the U.S. - Happiness with the decision to come to the U.S. Copyright of Journal of Immigrant & Refugee Studies is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. 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Soc Indic Res (2016) 129:47–59 DOI 10.1007/s11205-015-1090-7 Pre-migration Trauma and Post-migration Stressors for Asian and Latino American Immigrants: Transnational Stress Proliferation Miao Li1 Accepted: 31 August 2015 / Published online: 10 September 2015  Springer Science+Business Media Dordrecht 2015 Abstract Drawing on the stress proliferation theory, this study examined whether premigration trauma exposure is associated with post-migration acculturative stressors among Asian and Latino immigrants in the US. Based on the nationally representative data from the National Latino and Asian American Study, logistic regression models were estimated to assess how the pre-migration trauma exposure predicts multiple forms of the acculturative stress: guilt of leaving family/friends behind, social isolation, communication difficulty, employment difficulty, legal status stress, race- and language-based discrimination. Findings suggested that pre-migration trauma exposure is positively associated with social isolation, communication difficulty, legal status stress, and race-based discrimination for both the Asian and Latino immigrants. Pre-migration trauma exposure predicts higher risks of feeling guilty, employment difficulty, and language-based discrimination only for Asian immigrants. The study informs the public health intervention by highlighting distal risk factors in the pre-migration context as well as its proliferated stressors in the post-migration context. It also provides a basis for understanding the complexities of addressing the global burden of trauma. Keywords Acculturative stress  Asian immigrant  Discrimination  Latino immigrant  Pre-migration trauma  Post-migration stressors Electronic supplementary material The online version of this article (doi:10.1007/s11205-015-1090-7) contains supplementary material, which is available to authorized users. & Miao Li 1 Department of Sociology, Purdue University, 700 W Street, West Lafayette, IN 47905, USA 123 48 M. Li 1 Introduction The fast growth of the Asian and Latino immigrant population in the US has created much incentive for the study of their health issues. Acculturative stresses in the post-migration contexts are generally accepted as major health risks for Asian and Latino immigrants (Gee et al. 2009; Hwang and Ting 2008; Takeuchi et al. 2007; Torres and Wallace 2013; Yoo et al. 2009). Recent life course studies suggested that stressors experienced in the premigration context also have lingering effects on immigrant health (Fazel et al. 2005; Gong et al. 2011; Porter and Haslam 2005; Schweitzer et al. 2006; Torres and Wallace 2013). It is intuitive that immigrants’ health is somehow related to the life circumstances in their countries of origin and destination. But the process through which health stresses proliferates in the transnational contexts has often been overlooked in studies of immigrant health. To address this problem, we need to explicitly focus on the link between the preand post-migration health stressors. One key and widely existing pre-migration condition for Asian and Latino immigrants (and the third-world emigrants in general) arriving in the US is traumatic exposure. Common forms of trauma for immigrants include, but are not limited to, physical/sexual assault, combat/war, natural/man-made disasters, crime victimization, etc. Although the health impact of trauma has been well documented (Fortuna et al. 2008; Marshall et al. 2005; Steel et al. 2002), its role in triggering secondary stressors along the immigrant life course has rarely been examined. The paucity of such studies has several undesirable consequences. First, it limits our understanding of the sources of the post-migration health stressors and the pathways through which pre-migration trauma affects immigrant health. Second, it may lead us to underestimate the full impact of pre-migration trauma because of the overlooked compounding effects of trauma. Third, without considering the traumatriggered transnational stress proliferation, it is difficult to understand why in many cases immigrants see their health unimproved or even deteriorates after settling in a trauma-free environment of the wealthier hosting countries. Finally, intervention programs could be mis-targeting if they were designed to solely address the post-migration stressors without considering their historical connections with the pre-migration exposure. The stress proliferation refers to a process in which an initial stressor in one life domain gives rise to additional stresses in other life domains (Pearlin 1999; Pearlin et al. 2005). For instance, being incarcerated could lead to a series of additional stressors, such as divorce, economic uncertainty, and social stigma (Turney 2014). The stress proliferation process is an important mechanism through which multiple stressors accumulate to harm health. Although any stressful event has the potential to trigger the proliferation of subsequent stressors, traumas stand out for their intensely disruptive nature (Norris 1990) and shattering effect on the victim’s world view (Janoff-Bulman 1992; Janoff-Bulman and Frieze 1983). In the international migration context, pre-migration trauma might be an important source for stress proliferation, triggering a chain of subsequent stressors in the postmigration context. These proliferated stressors may particularly emerge in life domains in which the individual is already vulnerable and, in the case of immigrants, take the form of acculturative stresses. For instance, studies based on small and convenient samples of refugee/asylum-seeker suggested that pre-migration trauma exposure hurts the victims’ capacity in job preparation and employment sustainability in the post-migration context (Hauff and Vaglum 1993), elevates anxiety over legal status (Silove et al. 1998), and triggers adaptation stresses associated with communication difficulty, discrimination, and 123 Pre-migration Trauma and Post-migration Stressors for Asian… 49 isolation (Steel et al. 1999). Built upon these works, this study investigates if and how the post-migration acculturative stresses are predicted by the pre-migration trauma exposure among the Asian and Latino American immigrants, the two fastest growing immigrant communities in the US since the 1960s. As a major threat to immigrant health, acculturative stress originates from the difficulties encountered during the process of settling into a new socio-cultural environment. Acculturative stressors occur in multiple life domains and include: social isolation (Kim and McKenry 1998; Noh and Avison 1996), guilt for leaving family behind (Sandhu and Asrabadi 1994), communication difficulty (Arcia et al. 2001; Zhang et al. 2012), employment difficulty (Aycan and Berry 1996; Noh and Avison 1996), legal status stress (Torres and Wallace 2013), race-based discrimination (Gee et al. 2006; Kessler et al. 1999), and language-based discrimination (Araújo and Borrell 2006; Li 2014; Yoo et al. 2009). This study covered all of these forms of acculturative stressors. Based on the stress proliferation theory outlined above, I hypothesize that immigrants with pre-migration trauma are more likely to report various forms of acculturative stresses in the postmigration context. 2 Methods 2.1 Data Analyses were conducted based on data from the National Latino and Asian American Study (NLAAS), the first nationally representative household survey of Latinos and Asian Americans. Collected between 2001 and 2003, NLAAS survey data include a multistage stratified probability sample of non-institutionalized Latinos (n = 2554) and Asians (n = 2095) aged 18 years and older. The Asian American sample identified four Asian American target survey populations: Chinese, Filipino, Vietnamese, and All Other Asian American. The Latino American sample identified four target survey populations: Cuban, Puerto Rican, Mexican, and All Other Hispanic. The present study uses the subsample of Asian (n = 1639) and Latino immigrants (n = 1629), defined as being born outside of the US. The final analytic sample size varies across models, since in each model cases with missing data for dependent and independent variables were excluded. Analyses were performed between early 2013 and early 2014. All procedures and protocols of the NLAAS were approved by the Institutional Review Boards of the University of Washington, Cambridge Health Alliance, and Harvard University. Further details about the data and sample design can be found in previous documentation (Alegria et al. 2004; Heeringa et al. 2004). 2.2 Measurements 2.2.1 Acculturative Stressors This study examined multiple forms of acculturative stress. Social isolation was ascertained if the respondent reported having limited context with family and friends. Sense of guilt was measured based on the question whether the respondent has felt guilty about leaving family/friends in the country of origin. Employment difficulty was ascertained if the respondent reported having difficult to find work due to Latino/Asian descent. 123 50 M. Li Communication difficulty was ascertained if the respondent reported having felt interaction hard due to difficulty with the English language. Legal status stress was ascertained if the respondent has encountered one or more of the following situations: (1) was questioned about legal status, (2) experienced fear of deportation if go to social/governmental agency, and (3) avoided seeking health services due to fear of immigration officials. Racial discrimination was measured based on whether the respondent sometimes/often felt to be disliked or treated unfairly due to race/ethnicity. Language discrimination was measured with a question asking whether the respondent have ever been treated badly due to poor/ accented English. 2.2.2 Pre-migration Trauma Pre-migration trauma exposure was measured with the Posttraumatic Stress Diagnostic Scale (PDS) battery of the NLAAS. The items identify respondents’ endorsement of one or more of the following traumatic experiences: combat, peacemaking, unarmed civilian in war zone, civilian in terror zone, refugee, kidnapped, mugged, stalked, beaten, raped, sexually assaulted, exposure to man-made disaster, exposure to major natural disaster, witnessing physical fights at home, life-threatening illness/accident, unexpected death of close others, and seeing atrocities. Respondents were also asked to report the age of exposure to the trauma mentioned above and the age of migration. Based on this information, I created an indicator variable for pre-migration trauma (1 = exposure to any trauma before moving to US; 0 = no trauma exposure before immigration). I control for demographic variables and post-migration trauma exposure. Demographic variables include: age (measured in years), gender (1 = female; 0 = male), employment status (1 = employed at time of interview; 0 = unemployed), education (1 = above high school; 0 = high school or lower), marital status (dummy coded in three categories: Married/living with partner; Divorced/Separated/Widowed; Never Married) and poverty (1 = at or below poverty line; 0 = otherwise). Acculturation measurements include immigration duration and limited English proficiency (LEP). Immigration duration was clapsed into three categories: less than 5 years, 5–10 years, and more than 10 years. Limited English proficiency is dummy-coded such that 1 represents poor or fair English speaking. Models also controlled for post-migration trauma exposure, an indicator variable which was constructed in a similar manner as I did for the pre-migration trauma (i.e., based on the information on age of exposure and age of migration). 2.3 Data Analyses I calculated variable distributions for the Asian and Latino sample separately, stratified by the status of pre-migration trauma exposure. T tests (for continuous variables) and Chisquared tests (for categorical variables) were used to identify statistically significant differences between the pre-migration trauma victims and non-victims. To test the hypotheses, I estimated a series of logistic regression models in which multiple indicators of the post-migration acculturative stress were related to pre-migration trauma exposure, controlling for post-migration trauma exposure and demographic variables. Analyses were conducted separately for Asian American immigrants and Latino immigrants. 123 Pre-migration Trauma and Post-migration Stressors for Asian… 51 3 Results 3.1 Descriptive Statistics Table 1 presents survey-weighted characteristics for the Asian and Latino sample respectively, stratified by the status of pre-migration trauma exposure. Overall, around half of all Asian and half of all Latino immigrants have experienced at least one form of trauma before arriving to US. Such high rate of pre-migration trauma exposure justifies our concern over this key distal risk factor and necessitates detailed investigation of its impact in triggering new health stressors in the post-migration context. For Asian immigrants, pre-migration trauma victims are more likely to report feeling guilty for leaving family/friends behind, social isolation, communication difficulty, employment difficulty, legal status stress, race-based discrimination, and language-based discrimination. For Latino immigrants, pre-migration trauma victims are more likely to report all forms of acculturative stressors except employment difficulty. There are also significant differences in certain demographic characteristics by the premigration trauma status. Asian immigrants with pre-migration trauma are generally older, more likely to be male, more likely to be Vietnamese, less likely to be Chinese, more likely to be divorced/separated/widowed, more likely to speak poor/fair English, and have shorter stay in the US than those without such exposure. Latino immigrants with pre-migration trauma are more likely to speak poor/fair English, more likely to be Cuban, less likely to be Mexican, and have shorter stay in the US than those without such exposure. However, Latino immigrants with pre-migration trauma have a slightly higher level of education. For both the Asian and Latino immigrants, pre-migration trauma victims are more likely to have traumatic experiences after migrating to US than those without any pre-migration trauma exposure (56 vs. 30 % for Asian immigrant, p \ 0.001; 56 vs. 40 % for Latino immigrants, p \ 0.001). 3.2 Logistic Regression Models Table 2 presented the estimated odds ratios and associated 95 % confidence intervals for pre-migration trauma in predicting multiple post-migration acculturative stressors for the Asian and Latino sample, respectively. All models controlled for demographic characteristics and post-migration trauma exposure. For Asian immigrants, pre-migration trauma is significantly positively associated with all forms of post-migration acculturative stressors. Specifically, Asian immigrants with pre-migration trauma are 78 % more likely to feel guilty of leaving family/friends, 71 % more likely to report experiencing social isolation, 76 % more likely to report communication difficulty, 80 % more likely to report employment difficulty, almost 2 times as likely to report legal status stress, 67 % more likely to report race-based discrimination, and more than 2 times as likely to report language-based discrimination. For Latino immigrants with pre-migration trauma exposure, the risk increases by 58 % for experiencing social isolation, 42 % for reporting communication difficulty, 72 % for reporting legal status stress, and 40 % for reporting race-based discrimination. The association between pre-migration trauma and two post-migration stressors, guilty feelings and language-based discrimination, are no longer significant after controlling other covariates in the model. 123 123 26 19.3 14.9 20.1 20.2 Social isolation Communication difficulty Employment difficulty Legal status stress Race-based discrimination Language-based discrimination 57.1 Female Married/cohabiting 74 74.1 0.943 71.4 25.8 Other Latino Marital status 62.3 0.082 0.019 Mexican 30.7 27 47.7 38.02 (13.25) 20 26.7 33.4 28.3 39.5 7.9 Other Asian 0.453 0.000 0.020 0.000 0.000 0.000 0.011 0.000 0.000 12.9 41.9 4.0 36.9 Chinese 18.4 23.9 49.4 44.20 (16.30) 35.4 28.6 21.7 33.6 43.2 0.000 0.000 Puerto Rico 33.6 Filipino 22.8 43.9 Cuban 9.1 20.5 Vietnamese Race 40.44 (13.51) Age Demographic characteristics 15.1 32.6 Guilty leaving family/friends behind Acculturative stress Post-migration health stressors 68.1 36.4 48.6 6.5 8.5 49.2 39.01 (14.93) 27.3 32.3 44.3 34.2 50.5 55.6 20.1 Trauma endorsed No trauma p value No trauma Trauma endorsed Latino immigrants [% or mean (SD)] Asian immigrants [% or mean (SD)] 0.280 0.001 0.000 0.248 0.000 0.644 0.310 0.000 0.069 0.001 0.065 0.000 0.000 0.004 p value Table 1 Weighted sample characteristics for Asian and Latino immigrant by Pre-migration trauma status, National Latino and Asian American Study, United States, 2002–2003 52 M. Li 20.9 36.7 33.8 Below poverty line Unemployed Limited English proficiency 9.4 884 55.9 31.5 30 18.6 19.8 48.3 36.3 24.8 13.54 (3.86) 16.5 0.014 0.000 0.761 0.013 0.019 0.140 0.000 0.920 0.173 0.749 0.183 NLAAS National Latino and Asian American Study, SD standard deviation p values are from significance tests comparing ‘‘no trauma’’ group with ‘‘trauma endorsed’’ group 29.6 More than 20 years 749 11–20 years Sample size 38 32.5 5–10 years Post-migration trauma exposure 16.3 13.2 Less than 5 years Duration of stay 13.62 (3.28) Years of education 5.7 20.4 Never married 13.7 738 39.5 41.2 32.0 14.2 12.5 69.6 37.5 44.3 9.74 (3.52) 14.8 875 55.8 30.8 30.6 17.3 21.4 77.7 35.1 43.7 10.25 (4.21) 17.5 14.4 Trauma endorsed No trauma p value No trauma Trauma endorsed Latino immigrants [% or mean (SD)] Asian immigrants [% or mean (SD)] Divorced/separated/widowed Table 1 continued 0.000 0.001 0.647 0.194 0.001 0.005 0.453 0.853 0.049 0.294 0.763 p value Pre-migration Trauma and Post-migration Stressors for Asian… 53 123 54 M. Li Table 2 Logistic regression odds ratios for pre-migration trauma in predicting Asian/Latino immigrant acculturative stressors, National Latino and Asian American Study, United States, 2001–2003 Post-migration acculturative stressors Odds ratio 95 % CI Sample size Asian immigrants Guilty leaving family/friends behind** 1.78 [1.20, 2.63] 1562 Social isolation*** 1.71 [1.25, 2.33] 1575 Communication difficulty** 1.76 [1.23, 2.52] 1597 Employment difficulty** 1.80 [1.26, 2.56] 1500 Legal status stress*** 1.93 [1.31, 2.84] 1584 Race-based discrimination** 1.67 [1.19, 2.36] 1612 Language-based discrimination*** 2.13 [1.50, 3.03] 1543 Latino immigrants Guilty leaving family/friends behind 1.41 [0.97, 2.07] 1578 Social isolation** 1.58 [1.18, 2.11] 1578 Communication difficulty* 1.42 [1.01, 2.00] 1578 Employment difficulty 1.14 [0.82, 1.59] 1519 Legal status stress*** 1.72 [1.25, 2.37] 1611 Race-based discrimination* 1.40 [1.01, 1.92] 1589 Language-based discrimination 1.37 [0.97, 1.94] 1565 All models control for age, gender, marital status, race, years of educaiton, poverty status, employment status, years in US, LEP, and post-migration trauma exposure * p \ 0.05; ** p \ 0.01; *** p \ 0.001 3.3 Predicting Composite Measures for Acculturative Stress In addition to examining the different types of acculturative stressors individually, I also followed the suggestion from one of the reviewers to evaluate the impact of pre-migration trauma on a composite measure of post-migration acculturative stress. I experimented two ways of creating a composite measure for acculturative stress: (1) a continuous measure summing all indicators of different acculturative stressors and (2) a categorical measure identifying unobserved subpopulations through latent class analysis. Based on the distribution of the summed measure, I estimated a negative binomial regression model for the Asian and Latino sample, respectively. Results show that premigration trauma is positively and significantly associated with this summed measure of stressors for both samples (Asian: b = 0.39, p \ 0.001; Latino: b = 0.22, p \ 0.001), controlling all other covariates (for details, see Supplemental Table 3). I also estimated a mixture model for Asian and Latino sample, respectively. The mixture model uses a latent categorical variable to represent distinct sub-groups with different acculturative stress experiences. It simultaneously predicts the latent categorical variable using pre-migration trauma and other covariates (using a logistic regression model). For Asians, I found that a 3-class structure best fits the data. Individuals of class-1 have very low probability of experiencing any form of acculturative stressors. Individuals of class-2 have high probabilities of experiencing Communication Difficulty, Employment Difficulty, and Legal Status Stress. Individuals of class-3 have high probabilities of experiencing Guilty Feelings, Social Isolation, Race-based discrimination, and language 123 Pre-migration Trauma and Post-migration Stressors for Asian… 55 discrimination. It is somewhat difficult to give a proper label for class-2 and class-3. However, multinomial logistical regression results show that, using class-1 as the reference group, Asian immigrants with pre-migration trauma are significantly more likely to fall in class-2 (OR 2.09, 95 % CI [1.25, 3.51]) and class-3 (OR 5.04, 95 % CI [2.26, 11.24]). It should be pointed out that ethnicity to a large extent overlaps with the latent classes. For example, no Vietnamese fall into class-3 (i.e., the issue of perfect prediction); only 14 Filipinos fall into class-2 and only 27 Chinese fall into class-3. For Latinos, I found that a 2-class structure best fits the data. Individuals of the first class have very low probability of experiencing any form of acculturative stressors. Individuals of the second class have high probabilities of experiencing all forms of stresses except for Guilty Feelings. Logistic regression results show that Latino immigrants with pre-migration trauma are significantly more likely to be in class-2 (OR 1.92, 95 % CI [1.26, 2.93]), controlling all covariates. Results from these mixture models were summarized in Supplemental Table 4. 4 Discussion The notion of stress proliferation has rarely been applied to examine the ‘‘chain of adversity/risks’’ (Ben-Shlomo and Kuh 2002; Price et al. 2002) along the immigrant life course. Based on the first nationally representative data, the study examined how premigration trauma exposure contributes to multiple post-migration acculturative stressors for the Asian and Latino immigrants in the US. Results from bivariate analyses suggested that pre-migration trauma is significantly associated with increased likelihood for reporting all forms of acculturative stressors investigated for Asian American immigrants; and that for Latino immigrants it is associated with increased likelihood for reporting feeling guilty for leaving family/friends, social isolation, legal status stress, and language-based discrimination. Even in the multivariate models controlling for multiple demographic variables and post-migration trauma exposure, pre-migration trauma exposure is still significantly associated with all acculturative stressors for the Asian immigrant sample. However, for Latino immigrants, the association between pre-migration trauma and guilt seemed to be explained by the duration of immigration: Latinos with shorter stays in the US are more likely to report feeling, while those pre-migration trauma victims in general have shorter stay in the US (see Supplemental Table 4). Moreover, the coefficient estimate for language-based discrimination in the Latino sample also became non-significant in the multivariate model. A supplemental analysis showed that such association was largely explained by the limited English proficiency, which was highly prevalent (78 %) among Latino pre-migration trauma victims (see Table 1). It is unclear why pre-migration trauma is associated with post-migration employment difficulty only for the Asian immigrants but not for the Latino immigrants. As was suggested by the data, Latino pre-migration trauma victims do not particularly stand out in term of employment difficulty: the prevalence of employment difficulty is high even among the trauma-free Latinos (28 %). In answering this question, future studies may benefit from focusing on the heterogeneity in terms of work skills and social resources between the traumatized and non-traumatized Asian/Latino immigrants. In sum, despite some slight variations across the Asian and Latino samples, a process of transnational stress proliferation triggered by pre-migration trauma is clearly observed in 123 56 M. Li this nationally representative sample of Asian and Latino immigrants. Findings of this study are largely in line with the hypotheses and previous studies focusing on the refugee and asylum-seeker community. It is also in line with the social psychological literature on the aftereffects of trauma, which suggests that trauma victims are highly perceptive to external stresses/threats due to their ‘‘shattered’’ world views. According to this body of literature, trauma can turn the victim’s world view from positive to negative, such that the victim could incorporate the traumatic experiences to the existing cognitive schema that otherwise cannot account for them. With a shattered cognitive schema, trauma victims tend to have a low sense of control (Magwaza 1999), question the benevolence and justice of the world (Hafer and Choma 2009; Harris and Valentiner 2002; Lilly 2011; Lilly et al. 2010; Magwaza 1999), and live with a chronic sense of guilt (Street et al. 2005). These psychological sequelae can impair immigrants’ ability to navigate through the new sociocultural environment, trigger a sense of separation from family and a sense of guilt for leaving family members behind, and enhance the anxiety over language barriers in communication and vigilance against discrimination in the unfamiliar world of the receiving countries (Birt and Dion 1987; Choma et al. 2012; Crosby 1984; Dalbert et al. 1992; Hafer and Choma 2009; Lipkus and Siegler 1993). Findings of this study imply that the health of trauma victims may not necessarily follow a trajectory of continual improvement as they migrate to a new country where trauma might be absent. Structural disadvantages of immigrants in the hosting country may give rise to opportunities for the past trauma to bear new fruits, that is, proliferated acculturative stressors. This transnational stress proliferation suggests that it would be erroneous to attribute health effects only to the post-migration acculturative stresses apart from the pre-migration exposures. More competent public health interventions targeting the immigrant community should include a careful assessment of the immigrants’ premigration exposure and its connections with stressors under the new conditions of the hosting countries. 4.1 Study Limitations Two limitations of this study, however, need to be mentioned. First, I should acknowledge that the data used is cross-sectional in nature. Such design prevents us from making strong causal inferences. Even though I have retrospectively constructed a measure for premigration trauma antecedent to the post-migration exposure, such recalled data might potentially be biased. Therefore, results from this study should be interpreted with caution. With that said, the recollected data on pre-migration trauma exposure is all we have, given that it is almost impossible to collect such data prospectively. Second, the current study was unable to test whether the association between premigration trauma and post-migration stressors might be mediated or moderated by the legal status of the immigrants, since such information was not collected in the data. There are important differences between documented immigrants, undocumented immigrants, and asylum seekers in terms of trauma exposure, migration experiences, transnational ties, and post-migration circumstances. It is possible that the association between pre-migration trauma and post-migration acculturative stresses might be partly explained by the legal statuses. For instance, asylum seekers and undocumented immigrants are often victims of various pre-migration traumas who are also more likely to experience post-migration social isolation and guilt, due to their very restricted transnational ties and chances of returning. Asylum seekers and undocumented immigrants are more likely to suffer from post- 123 Pre-migration Trauma and Post-migration Stressors for Asian… 57 migration legal status stresses. It is also possible that pre-migration traumas are more likely to evoke acculturative stresses for undocumented immigrants and asylum seekers. Compliance with Ethical Standards Conflict of interest No conflicts of interest were involved in the design and analysis of this study. References Alegria, M., Takeuchi, D., Canino, G., Duan, N., Shrout, P., Meng, X.-L., & Gong, F. (2004). 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Copyright © eContent Management Pty Ltd. Journal of Family Studies (2013) 19(3): 297–305. Burmese refugee young women navigating parental expectations and resettlement LEE CHENG KOH BA DIPED DIPHRM1, PRANEE LIAMPUTTONG PHD AND RAE WALKER PHD BED BSOCSCI School of Public Health and Human Biosciences, La Trobe University, Bundoora, VIC, Australia Abstract: Young refugee women have to navigate life in a new country, learn a new language and adapt to a new culture while juggling parental role, behavioural and academic expectations. This qualitative study explored how 10 Burmese refugee young women experience parental expectations pre- and post-migration, and the effect of resettlement on the parent–child relationship. The data was gathered using the semi-structured in-depth interview technique and thematically analysed. The findings revealed changes in parental expectations as a result of resettlement leading to both role reduction and expansion. While playing the linguistic brokering role post-migration has tilted the power dynamics in favour of the young women, this was undermined by increased social restrictions imposed by parents, resulting in intergenerational acculturation conflict among some participants and their parents. Other implicit factors in causing intergenerational rifts are exposure to an egalitarian style of education and increased access to technology. Keywords: acculturation, gender roles, intergenerational conflict, linguistic brokering, family R efugee young women can be said to be ‘living in the “borderlands” between origin and “host” societies, and childhood and adulthood’ (Sirriyeh, 2010, p. 214). According to Kumsa (2002, p. 472), ‘international migration brings people together from all corners of the world and all walks of life, but localising processes of gender, race, class, sexuality, ethnicity, and nationality vie to set them apart’. This ‘paradox of integration and segregation’ (Kumsa, 2002, p. 472) sums up the acculturation problem that young female refugees face. At the same time that they have to adjust to life in a new country, learn a new language and adapt to a new culture, they face parental pressure to conform to the behaviour prescribed by their traditional culture. Underlying the challenges of establishing equilibrium between the new and old cultural forces is the need to fulfil ongoing roles and responsibilities such as domestic and childcare duties. Post-migration, they have added linguistic brokering roles (Candappa & Igbinigie, 2003; Robbins, 2007). The qualitative research on which this paper is based gave young women a voice and an opportunity to talk about their lived experiences in adapting to a new country whilst navigating parental expectations. It focussed on a segment of the 1 Correspondence to: Burmese refugee population, specifically women aged between 18 and 25, on which no research has yet been done. The data generated from the research provided insights into the Burmese community, which at 1,443, formed the second largest group of refugees who has settled in Australia under the humanitarian programme in 2010–2011 (DIAC, 2011). This paper will discuss how young Burmese refugee women living in Melbourne experience parental expectations, the changes in parental expectations after resettlement and the resulting impact on their relationship with their parents. Challenges faced by refugee youth Refugees experience parental role expectations to a higher degree compared to their nonrefugee counterparts. Being from a marginalised group characterised by lack of resources, refugee young people are expected to take on more roles compared to their peers from nonrefugee backgrounds (Candappa & Igbinigie, 2003; Perry, 2009). Conflict resulting from discrepancy in the rates of acculturation between parents and children is well documented in migrant literature (Kibria, 1990; McMichael, Gifford, & CorreaVelez, 2010; van Leeuwen, Rodgers, Régner, & Chabrol, 2010; Ying & Han, 2008; Zhou & Bankston, 2001). According to Dow (2011, Volume 19, Issue 3, December 2013 JOURNAL OF FAMILY STUDIES 297 Lee Koh, Pranee Liamputtong and Rae Walker p. 210) ‘many migrants come from cultures with a strong emphasis on the family and find it very challenging to adapt to a country with a culture that emphasises individuality and independence’. Their parents, however, expect them to conform to behaviour prescribed by their traditional values and belief system (DuongTran, Lee, & Khoi, 1996; Robbins, 2007; Ying & Han, 2008). This creates an intergeneration acculturation gap, which could lead to conflict between refugees and their parents, resulting in adverse effects such as slowing down of acculturation to the new country, lack of efficacy and low self-esteem (McMichael et al., 2010; Robbins, 2007). The intergenerational acculturation gap is often accentuated by shifts in power dynamics as a result of young people learning the language of the adopted country, and thus having a communication link to the culture of the new country, before their parents (DuongTran et al., 1996; Robbins, 2007; Ying & Han, 2008). Consequently, they are expected to play the role of linguistic brokers, and be the source of settlement information (McMichael et al., 2010; Robbins, 2007; Ying & Han, 2008). This has led to daughters gaining greater power from being the bridge between their parents and the new country, yet being expected to fulfil parental behavioural expectation in accordance with traditional culture which can often be in conflict with the new culture (Robbins, 2007; Rousseau, Drapeau, Chan, & Platt, 2004). Within the refugee population, empirical evidence has reflected that refugee women fare worse on psychological health ratings compared to male refugees (DuongTran et al., 1996; Rousseau et al., 2004; Tousignant et al., 1999). Women are associated with higher risks of emotional problems (Tousignant et al., 1999) and adverse psychological health and wellbeing (Kreitzer, 2002). Although experienced traumas such as extreme depravity, death and loss are common to all refugees, female refugees were common victims of sexual atrocities and violence (Kirk & Taylor, 2006) in their home countries. In DuongTran et al.’s (1996) study of 70 Southeast Asian migrant/refugee adolescents, results show that female adolescents reported higher stress than their male peers in 8 out of 10 life events. Among 292 migrant adolescents aged 298 JOURNAL OF FAMILY STUDIES 15–21 years in van Leeuwen et al.’s (2010) study in France, suicide ideation was found to be higher for girls than boys. Tousignant et al.’s (1999) study of 203 refugees in Canada also found that girls are more at risk of emotional problems. Other contributory causes to poorer psychological health and wellbeing include greater gender role expectations, tighter parental discipline and greater social restrictions (McMichael et al., 2010). Burmese refugees The existing research on Burmese refugees, which is mainly related to life in border refugee camps, have commonly highlighted poor health and wellbeing (Allden et al., 1996; Benner et al., 2010; Cardozo, Talley, Burton, & Crawford, 2004). In Australia, Schweitzer, Brough, Vromans, and Asic-Kobe’s (2011) study found that although pre-migration trauma and post-migration difficulties are predictors of distress and somatisation, post-migration living difficulties had a more significant impact on participants’ mental wellbeing compared to pre-migration trauma. Crouch and Collopy (2011) provided the following perspective of the Burmese community in Melbourne, from interviews with 28 Burmese, including community leaders. Burmese people live in a close knit community, with family relations being the main focus. There are strict expectations of children to respect their elders, obey their parents and seek parental permission before doing anything. Post-migration, children learn English faster than their parents and this was highlighted to be an issue on two fronts; linguistic brokering both caused the young people stress, as well as lead to a change in family power dynamics, causing the parent–child relationship to degenerate. METHODS Researching female refugees involves ‘working with marginalised individuals within [an] already marginalised group’ (Goodkind & Deacon, 2004, p. 723). As such, the qualitative approach was deemed particularly suitable as it gives research participants a voice to share their stories and lived experiences (Liamputtong, 2007, 2013). Semistructured in-depth interviews were conducted to examine the participants’ experiences of parental Volume 19, Issue 3, December 2013 © eContent Management Pty Ltd Burmese refugee young women navigating parental expectations and resettlement expectations in the pre- and post-migration con- many of their parents, who acted as gatekeepers, text, the effects of parental expectations, and their did not want their daughters to participate in coping strategies. Data collection was completed the research for the same reason. This dilemma once data saturation was achieved; that is when has been documented in research concerning little new data could be generated (Liamputtong, cross-cultural groups (Liamputtong, 2010). We acknowledge that this was part of the limitation 2013). The interviews, which were conducted in of this research. Of the 10 participants, 3 were Karen in ethnicEnglish, lasted between 50 and 80 minutes. Among the questions asked were: ‘Can you tell ity while the rest were Burmese. Six participants me about your life before you came to Australia?’, were Muslims, two Buddhists and two Christians. ‘What is good/difficult about your parents’ expec- Except for two participants who did not specify, tations of you?’ and ‘Do you think you fulfil your all participants had lived in refugee camps for parents’ expectations of you, and how do you feel periods ranging from 5 to 11 years, and have been about it?’ The participants were also asked specific settled in Australia for periods ranging from 1 to questions relating to academic, role and behav- 4.5 years. All the participants were unmarried and ioural expectations, including ‘What do your par- engaged in full-time study (see Table 1). Thematic analysis was used to analyse the data. ents expect you to achieve?’, ‘What are the tasks your parents expect you to do?’ and ‘What are the The interview transcripts were read line-by-line in things that your parents say you can, or cannot the initial coding stage. Once these initial codes do?’ All the interviews took place in the partici- were identified, they were re-organised so that pants’ homes except for one which took place at more comprehensive categories could be formed. a café and another at a language school. With These new categories were eventually formed into the permission of the participants, the interviews themes. Thematic coding was also facilitated by the NVivo 8 software. The initial coding was were audio-recorded for data analysis. The 10 participants in this study were intro- undertaken by the first author, in consultation duced to the first author by their respective with the second and third author, before the codes community leaders. They then arranged a meet- and main themes were finally derived. Ethics approval for this study was granted by ing to provide participants with the Participant Information Sheet, answer participant queries the Faculty Human Ethics Committee, Faculty and discuss the issue of confidentiality before of Health Sciences, La Trobe University. In obtaining their informed consent to participate in the study. According to TABLE 1: PARTICIPANTS’ DEMOGRAPHIC DETAILS Liamputtong (2007, 2013), in researching Characteristics No. Characteristics No. the vulnerable, appropriate recruitment Karen 3 Age 6 <19 methods involved people who already Ethnicity Burmese 7 2 19 have relationships with the participants, 2 >19 and are trusted by them. As such, snow- Religion Muslim 6 Study ESL course 4 ball sampling method would often be Buddhist 2 State school 3 Christian 2 Religious 2 employed. Although snowball sampling college 1 technique was used where participants TAFE were encouraged to recommend friends of 1 Family type Nuclear 5 <5 and relatives who met the selection criteria Number people in 6 Extended 4 5–6 to take part in the study, it did not gener- house 3 Single-parent 1 >6 ate any additional participant. This may Years living in <2 1 Years living 5 2 be due to them not knowing, and there- Australia 1 as a refugee 6 2 2–3 8 10 3 3–5 fore not trusting the researcher, a Chinese 11 1 Singaporean migrant, who might be seen Unspecified 2 as an outsider (Liamputtong, 2010). Also, © eContent Management Pty Ltd Volume 19, Issue 3, December 2013 JOURNAL OF FAMILY STUDIES 299 Lee Koh, Pranee Liamputtong and Rae Walker presenting the participants’ verbatim quotes in the results section, fictitious names are used to protect their confidentiality. FINDINGS Pre-migration parental expectations The lives of all the participants revolved around helping the family. In the refugee camps, where poverty and starvation were rife, the majority of the participants were expected to help with activities that fulfilled survival needs such as searching for food, working alongside their parents on activities like farming and selling food, and employment. At the age of 16, Myint San left the refugee camp for 2 years to work as a domestic servant so that her family could have enough food: I also work outside. I have to work because in camp sometime we don’t have enough food. Yea, and I just stay short time and I go to work, and about two years and I came back. A few participants also narrated experiences pertaining to building their family homes in the refugee camp, including collecting building materials such as bamboo and leaves, and being involved in the construction process. All the participants were also expected to perform ongoing domestic duties like cooking, cleaning and childminding. A few participants, especially the older daughters in the family, had to take charge of their families: we don’t have money, my mother borrow someone to money and they buy rice and oil, yeah and they sell again … I have to stay at home to cook but I don’t know how to cook but I try to cook for my sister and my little brother yeah I looking after her. (Na Khin Win) Although life was hard, all the participants accepted parental role expectations as part of life and saw the performance of these tasks as contributing to the family. In the light of their family struggling to eke out a living and staving off starvation, most of the participants were motivated to help make life better for the family. Behaviourally, all the participants were guided by the understanding that they had to respect and obey their parents, and abide by their parents’ decisions in many areas of their lives, ranging from 300 JOURNAL OF FAMILY STUDIES choice of clothes to the choice of careers and marriage partners. Na Khin Win, engaged to be married to a man living in Thailand, recounted how her parents chose her prospective husband for her: When I find a boyfriend, they say don’t want that same age, because when Burmese people we marry the same age fighting every day. That why they say I have to find boyfriend they find for me. I think they find for me because he got a job, yeah he, how to say, he bigger than me, five years. Although the codes of behaviour varied from family to family, most of the participants were cognizant that these codes were mainly guided by aspects of their culture such as religion. The majority of the participants were also conscious that not observing the appropriate behaviour on their part did not merely affect them personally, but reflected negatively on their parents’ moral stance and/or parenting style: Always go back to them (the parents) … like maybe their parents are before like that, that’s why she become like this … Maybe their parents not train very well. (Khin San) Some behaviour, such as cohabitation, was perceived to bring misfortune to the whole community and required special appeasement rites, as evident in Myint San’s narrative: If you go (out with a male companion), some people in the village don’t believe you. And you must be married immediately … Have to do praying before that because if you are already living together you can’t go to another house … when they (the cohabitating couple) go to the other person’s house, they (the host family) will get bad luck. They will become sick or something wrong in the house. Effect of resettlement on parental expectations Resettlement in Australia led to changes in the participants’ family circumstances, and this resulted in changes in parental role expectations. As a result of access to welfare payments, the girls experienced role reduction as they no longer had to engage in economic activities. Although the ongoing domestic duties and caring roles remain largely unchanged, some of the tasks had been alleviated by modern electrical appliances such as the rice cooker and washing machine. Volume 19, Issue 3, December 2013 © eContent Management Pty Ltd Burmese refugee young women navigating parental expectations and resettlement The most significant post-migration change was the expansion of roles to include linguistic brokering. As all the participants in the study had acquired varying degrees of competence in English, they needed to interpret for their parents in both formal and casual situations. Besides having to deal with tele-promoters and door-to-door salespeople, the young women had to set up and accompany their parents to appointments with service providers where they played the role of interpreters in issues relating to housing, banking and Centrelink payments: Sometimes I do appointment for her like school if they want to see parents. So I make time for her and I ring them that mom coming there, and you have to find interpreter for her, and then tell them those things like that. (Khin San). In Australia, the majority of the participants experienced greater social restrictions. While they had complete freedom within their own homes, the majority of the participants were not allowed to go out with friends, or were only allowed to invite friends to their homes. Of the few who could go out with, or invite friends home, these interactions were restricted to friends who were known to, and trusted by their parents. Going out with a male friend unchaperoned by a male or adult family member was strictly not allowed. Most of the participants were aware that their parents had anxiety about the perceived threats of the Australian society, which included drugs, the acceptance of cohabitation as an alternative way of life, and a social climate of drinking and smoking: because here in Australia they people go out with their friend, yeah they scared … They say when I go outside to meet a boy they scared that’s why they afraid. (Na Khin Win) The increased social restriction also extended to the use of technologically-mediated communication tools. Resettlement in Australia had brought technology into the lives of all the participants. However, a few participants faced restrictions in their use of technologically-mediated communication tools. These participants experienced feelings of disempowerment about their inability to engage in what they perceived to be innocuous © eContent Management Pty Ltd activities such as short text (Short Message Service, SMS) and online instant messaging. At the same time, they felt sad and indignant at their parents’ lack of trust in them: Sometimes I chatting with my friend but they don’t believe that. Yeah one time they look at … I angry, I chatting with my friend but they didn’t believe me. (Na Khin Win) Although some participants expressed unhappiness with their parents with regard to social restrictions, only two girls reported overt clashes with their parents. Significantly, both girls are among the three girls who were studying in a mainstream school. Post-migration, all the participants were enrolled in full-time educational institutions including mainstream high schools and vocational and religious institutions. Participants’ parents expected them to attend school, learn English, complete their homework and get good grades. The interviews reflected the understanding, by the majority of the participants, that their parents’ academic expectations were motivated by various reasons related to their integration in Australia and future prospects: My parents they are always tell me to go study, study, study because we are coming to other country, we don’t know how to do English. We don’t know how to write English. They [say] study hard, that’s why I’m study hard. (Baw Na Bi) Although all the participants indicated that their parents wanted them to get good reports, the majority only had vague notions of what these expectations entailed. One participant reported that her mother wanted her to be ‘top in the school ’ while another had parental encouragement to go to university. The participants had different responses to their parents’ academic expectations of them. For Na Khin Win, parental academic expectation was a source of stress, to the extent that she hid bad reports from her parents. Baw Na Bi, on the other hand, chose hairdressing despite parental encouragement to go to the university: I say I’m not going to uni, because so hard for me. I don’t know, in my country, we are not studying to English, that’s why we are so hard. I say I’m not going to uni. (Baw Na Bi) Volume 19, Issue 3, December 2013 JOURNAL OF FAMILY STUDIES 301 Lee Koh, Pranee Liamputtong and Rae Walker DISCUSSION In the pre-migration days, characterised by poverty and starvations, most of the participants had to help in activities revolving around food, shelter and making money as well as fulfil ongoing domestic duties and caring roles. In the literature, children from low-socio economic status families, such as those from refugee families that lack financial resources and support structure, were often required to help with household chores and take on caring roles (Candappa & Igbinigie, 2003; Robbins, 2007) and/or engage in income-generating activities (Candappa & Igbinigie, 2003). The cognition of the participants, even at a young age, that the roles they play have a great impact on the wellbeing of their family, made them resilient to the heavy responsibilities they have to shoulder. Although the findings of this study are in line with the findings in the literature about parental role expectations, this study has generated new knowledge about the responsibilities of the participants within the context of the refugee camp and how they coped with the demands of a life fraught with adversities as well as their experiences navigating parental expectations post-migration. In this study, most of the participants had been socialised to fulfil parental role and behavioural expectations without question; the reasons given by the participants reflected that in the Burmese culture, children are expected to obey their parents and respect their elders (Crouch & Collopy, 2011). As well, a daughter’s deviation from social norm is a negative reflection on the parents (Park, 2009) and would bring shame to the family (Crouch & Collopy, 2011). As such, parents employed an authoritarian style of parenting (DuongTran et al., 1996; Park, 2009) which included physical punishment to ensure compliance (Crouch & Collopy, 2011). The participants’ understanding of the impact of their behaviour on the community’s image of them and their parents motivated them to live in accordance with the social norms dictated by the Burmese culture. As a result, they were able to behave appropriately and refrain from behaviours that were considered taboo, which aligns with the literature in which adolescents whose parents 302 JOURNAL OF FAMILY STUDIES had expectations of them not to engage in negative behaviour showed lower tendency to engage in them, even in the face of peer pressure (Nash, McQueen, & Bray, 2005; Simons-Morton, 2004). Crouch and Collopy (2011, p. 53) observed that ‘while school exists in these [refugee] camps, facilities are basic and there is no obligation to attend school’. This observation is mirrored in the participants’ accounts of disrupted education. That there is no mention of parental academic expectations pre-migration concurs with there being no study in the literature on parental academic expectations in the refugee camp context. In the refugee camp, where parents’ energies were channelled to issues related to survival, the children did not experience any expectations to attend school, much less perform well in examinations. Resettlement in Australia had led to many changes resulting in corresponding changes in many aspects of parental expectations. For example, all the participants experienced both role reduction and expansion. As survival concerns were taken care of by Australian government allowances, most of the participants no longer needed to engage in income-generating activities. As well, even though the participants had to fulfil domestic duties and caring roles as they did premigration, electrical appliances resulted in taskrelated role reduction. This finding gave rise to a new positive perspective on resettlement which contrasted with the literature, which predominantly focussed on young people’s role strains (Candappa & Igbinigie, 2003; DuongTran et al., 1996; Robbins, 2007; Yeh, 2003). Notwithstanding the relief from some household tasks, all the participants experienced role expansion. As they had attained varying degrees of competence in the English language ahead of their parents, the participants were expected to play linguistic brokering roles (DuongTran et al., 1996; Perry, 2009; Robbins, 2007). Having to negotiate with various professionals, on issues that could impact their lives and family, in a language that they were not yet proficient or confident in, put significant strain on the participants; yet they all did it without question, in the light of helping their parents. Helping the family is very important in helping young refugees attain Volume 19, Issue 3, December 2013 © eContent Management Pty Ltd Burmese refugee young women navigating parental expectations and resettlement acculturative success (McMichael et al., 2010), and in this study, the notion of being of help had contributed to the resilience of the young women. Post-migration, the participants experienced increased parental social restrictions, needing permission to go out of their homes, and having to abide by strict rules related to who they could go out with, a phenomenon experienced by many migrant and refugee children, and noted to contribute to tension in parent–child relationships (DuongTran et al., 1996; Robbins, 2007). Another source of disharmony between some of the participants and their parents, which has not been explored in the literature, pertained to technologically-mediated communications. In an age where technology is ubiquitous and considered empowering (Reynolds, 2006), young refugees become technologically acculturated quickly. The SMS and Instant Message (IM) means of social communication use a medium and language that the participants’ parents were not familiar with, leading to feelings of anxiety about the negative influences of these forms of communication on their daughters. The technological restrictions experienced by the participants in this study could be interpreted in the light of the parents’ attempts to reassert control of their daughters. In their responses to increased social restrictions, the findings did not support existing literature where parental social restrictions were correlated with high levels of volatility in parent–child relationships (DuongTran et al., 1996; Robbins, 2007; Ying & Han, 2008). As the participants took advantage of the increased educational opportunities in Australia, they were also subject to academic expectations by their parents. Whilst the main focus of life pre-migration was about personal and family safety and the avoidance of starvation, in Australia, the survival lens was trained on learning the host language and seeking education as a means for securing employment and making money, a phenomenon discussed in Okigbo, Reierson, and Stowman’s (2009) study. Moreover, the parents of the majority of the participants in the study did not concretise their academic expectations of their children, which appeared to contradict studies in the literature about migrant and refugee parents expecting high academic achievements of their © eContent Management Pty Ltd children (DuongTran et al., 1996; Hodes, 2002; Zhou & Bankston, 2001). All the participants had only been in Australia for less than 5 years, and it could be that their parents did not have enough understanding of the educational and career pathways within Australia, and therefore were not able to vocalise any concrete educational expectations nor motivate or support their children’s educational pursuit and aspirations (Atwell, Gifford, & McDonald-Wilmsen, 2009). Parental academic expectations for the participants may change as they gain more understanding of the possible education, professional and career pathways as the period of resettlement in Australia increases. Nevertheless, it arose from the findings that the addition of parental academic expectations had resulted in stress for some of the participants. Participants’ reports about hiding poor results from their parents could be interpreted as a manifestation of the academic stress that has been vastly studied in the literature (Ang & Huan, 2006; Cho & Bae, 2005; DuongTran et al., 1996; Park, 2009; Wang & Heppner, 2002). On the whole, participants’ perception of their inability to fulfil parental expectations, or their reluctance to fulfil them led to feelings of guilt, sadness and inadequacies. The relationship between perceived non-fulfilment of parental expectation and poor wellbeing is a theme that consistently surfaced in studies of Asian youth and parental expectations (Chang, 1998; DuongTran et al., 1996; Oishi & Sullivan, 2005; Robbins, 2007; Wang & Heppner, 2002), and this is also evident in the current study. LIMITATION We did not have resources to employ an interpreter for the interviews, and as such, the interviews had to be conducted in English, a language that the majority of the participants did not have enough confidence or proficiency in. This might have impacted the quality of the data collected, as evidenced in the richer narratives of the participants who had a better command of the interview language. Additionally, the use of community leaders to recruit participants might have given rise to potential selection bias. However, we were very cautious about this when recruiting our participants. Volume 19, Issue 3, December 2013 JOURNAL OF FAMILY STUDIES 303 Lee Koh, Pranee Liamputtong and Rae Walker CONCLUSION Since arriving in Australia the roles of these young women, living between two cultures, have changed substantially. While they retained their pre-migration gender roles including childcare, cooking and cleaning, some tasks are made easier by technology. They experienced higher levels of parental control over their social lives, but they have also become more powerful as a result of helping their parents interact with the host society through linguistic brokering. A similar contrast exists academically, where the young women face the pressure of academic achievement without being given direction on long term educational planning. The findings offered in-depth insight into Burmese young women’s experience of ongoing parental expectations and the impact of resettlement on parental expectations. This study bridged a gap in literature as it focussed on Burmese young women, a vulnerable group on which no research has been done. As well, the data generated from the research added new knowledge to the existing literature on the growing Burmese community in Australia. Thus, our findings can be used as a conceptual understanding for future research regarding refugee young people. The insight gained could be used by health professionals, government departments and funding bodies when considering intervention programmes to improve the wellbeing of young refugee women. For example, parent-directed interventions such as parenting programmes, and English language and computer literacy classes can moderate parental expectations, bridge the intergenerational acculturation gap and thus improve the wellbeing of young refugee women. Additionally, it is important for policy makers to note that cultural sensitivity is the key to the success of any intervention or service directed at the girls or their parents. As a result, the voices of the young Burmese refugee women may become the impetus for culturally appropriate intervention programmes to help other young Burmese refugee women. 304 JOURNAL OF FAMILY STUDIES CONFLICT OF INTEREST The authors declare that there is no conflict of interest. ACKNOWLEDGEMENTS The authors would like to thank the participants of this study for their invaluable contributions of time and knowledge to the research. REFERENCES Allden, K., Poole, C., Chantavanich, S., Ohmar, K., Aung, N. N., & Mollica, R. F. (1996). Burmese political dissidents in Thailand: Trauma and survival among young adults in exile. American Journal of Public Health, 86(11), 1561–1569. Ang, R. P., & Huan, V. S. (2006). Academic expectations stress inventory: Development, factor analysis, reliability, and validity. Educational and Psychological Measurement, 66(3), 522–539. Atwell, R., Gifford, S., & McDonald-Wilmsen, B. (2009). Resettled refugee families and their children’s futures: Coherence, hope and support. Journal of Comparative Family Studies, 40(5), 677–697. Benner, M. T., Townsend, J., Kaloi, W., Htwe, K., Naranichakul, N., Hunnangkul, S., … Sondorp, E. (2010). Reproductive health and quality of life of young Burmese refugees in Thailand. 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Parental contributions to Southeast Asian American adolescents’ well-being. Youth & Society, 40(2), 289–306. Zhou, M., & Bankston, C. L. (2001). Family pressure and the educational experience of the daughters of Vietnamese refugees. International Migration Review, 39(4), 133–151. Received 28 February 2013 Accepted 22 September 2013 Volume 19, Issue 3, December 2013 JOURNAL OF FAMILY STUDIES 305 Copyright of Journal of Family Studies is the property of eContent Management Pty. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

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These articles tend to explain the suffering, problems, and challenges faced by
immigrants. The immigrants are categorized into two; that is domestic immigrants and
international immigrants. Local immigrants are the migrations that occur within a country but
mostly affected by language indifference and other social factors. Foreign immigrants are kind of
movements that happen as a result of countries interfaculty, whereby one changes the residence
or the citizenship from one state to another. Therefore, the fundamental role of this summary
paper is to explain the challenges faced by the immigrants and the way to handle such
predicaments challenges.
Article One
The article, Cultural Shock and Adaptation address the causes, stages and the nature of
cultural shocks to immigrants and how to manage such issues. The articles claim that four phase
factors that affect the life of the immigrants; they include the phase of crises, the phase of tourist
shocks, the face of cultural adaptations and the phase of gradual recovery. This article vividly
urges that immigrants experience some challenges such as stress, cognitive fatigue due to
overloaded information, ...

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