1. Introduction
Previous research in Britain shows that newly arrived immigrants tend to have better health than their non-migrant and host society counterparts due to self-selection effects, but their health advantages tend to diminish over time and generations. This is known as the migrant health paradox [
1,
2]. It is argued that an essential reason for the generational deterioration of health could be generational changes in health behaviors and lifestyles, highlighting the importance of understanding ethnic minorities’ generational transition in health behaviors [
3].
In Britain, relatively large immigrant groups (e.g., Indians, Pakistanis, Bangladeshis, Black Caribbeans, and Black Africans) mainly come from South Asian, the Caribbean, and Sub-Saharan African regions [
4]. In these areas, local cultural and religious norms often prohibit or discourage certain detrimental health behaviors such as tobacco and alcohol use, emphasize asceticism and sacredness of the body, and encourage some healthy lifestyles such as vegetarian diets [
2,
5,
6]. In addition, the cultures of these regions tend to emphasize obedience to parents and authority, family honor, and interdependence of family members, which could in turn prevent adolescents from socializing deviant and detrimental health behaviors [
7]. In contrast, the cultures of many migrant-receiving countries such as Britain often emphasize individualism, self-expression, and self-actualization, and are thus more tolerant towards different lifestyles including tobacco smoking, alcohol consumption, and substance use [
8]. As first-generation British immigrants grew up and were socialized in their country of origin, their home country cultures could, to some extent, protect them against the host society’s deviant and unhealthy lifestyles [
9]. For example, many British first-generation immigrants, especially Pakistanis and Bangladeshis, tend to cluster and concentrate in urban ethnic enclaves. The distinctive norms within cohesive ethnic enclaves can facilitate the socialization of norms and exert social control over behavior in ways that accord with those of the home country, therefore preventing them from adopting deviant and unhealthy lifestyles from the host society [
9].
In terms of the second-generation, classical straight-line assimilation theory suggests that the longer immigrants stay in a host country, the more they are integrated or assimilated into a host society, characterized by upward social mobility, reduced ethnic distinctiveness, dispersive residence, mixed marriage, and friendships [
10]. Research shows that British second-generation ethnic minorities who were socialized in Britain not only tend to have a weaker ethnic identity and attach less importance to their home country cultures, but also have higher levels of inter-ethnic friendship and marriage rates, and reside in more ethnically mixed areas than first-generation migrants [
11,
12]. These patterns suggest that, compared to the first-generation, British second-generation ethnic minorities become overall more similar to White British and are likely to accept and adopt host society health behaviors and lifestyles including some unhealthy ones such as tobacco smoking, alcohol consumption, and high-calorie food intake, which could in turn undermine their health [
3].
However, segmented assimilation theory challenges the predictions of classical straight-line assimilation theory by arguing that the different resources of immigrants (e.g., human capital, family structure, mode of incorporations, discrimination, and labor market contexts) may intersect to result in different assimilation outcomes [
13]. The theory has explicitly argued that some ethnic groups may undergo selective assimilation where they achieve upward social mobility in the host country while maintaining the cultural tradition from their home country [
13], suggesting that not all ethnic groups will gradually adopt host society health behaviors and lifestyles over generations. This is especially the case in Britain where a series of multicultural policies (defined as policies promoting cultural diversity and protecting ethnic minorities’ rights) in recent decades (e.g., the Race Relations Act from 1965 to 2000 and the 2010 Equality Act) have been implemented to ensure the rights and entitlements of ethnic minorities, such as the provision of special meals for Muslim students, exemptions from standard British dress code, and funding for minority group organizations [
14,
15]. These policies are thought to encourage ethnic minorities to live ‘parallel lives’ in segregated communities [
16]. According to this view, the high levels of ethnic segregation are likely maintaining ethnic minority healthy lifestyles derived from their home countries and prevent them from adopting some host society unhealthy lifestyles.
Given the different predictions from classical straight-line assimilation theory and segmented assimilation theory, it is crucial to systematically explore British ethnic minorities’ generational changes in health behaviors. To date, most research on ethnic minorities’ generational differences in health behaviors comes from North America and generally supports the argument that second or later-generation ethnic minorities are more likely to smoke, drink alcohol, and eat high-calorie food than their first-generation counterparts [
5,
6,
17]. Given the significant differences in ethnic composition and ethnic policies across countries, the findings from previous research in other countries cannot be easily generalized to Britain. However, in Britain, there have only been a few studies that focused on ethnic minorities’ generational differences in health behaviors, but these studies either solely focused on a small sample [
18,
19], or only used simple descriptive statistics to compare the generational differences in health behaviors [
3].
Thus, this article’s objective is to explore the generational differences in health behaviors and see whether the differences, if any, can be explained by their socioeconomic status (SES) and degree of ethnic identity. If the second-generation minorities are more likely to adopt unhealthy lifestyles than the first-generation, policy interventions to boost healthy lifestyle and ethnic health equity may need to be more targeted at these population groups. However, if health behaviors do not vary over minority generations, scholars and policymakers may need to focus on other factors that may contribute to ethnic minorities’ poor health, such as discrimination, racial harassment, and economic inequalities.
4. Discussion
As the Race Equality Scheme of the Department of Health in Britain states, ‘the NHS increasingly needs to take into account not only cultural and linguistic diversity but also needs to be able to cater for varying lifestyles and faiths’ (The Department of Health, 2005, p.12). As a result, exploring generational changes in health behaviors could not only help gain a deeper understanding of ethnic health disadvantages but could also shed light on public policy in terms of providing culturally diverse health care services and promoting healthy lifestyles. Thus, this article contributes to previous research by exploring whether British ethnic minorities have undergone a generational transition in health behaviors and whether such transitions, if any, can be explained by their SES and degree of ethnic identity.
In terms of smoking behavior, we find that second-generation Indians, Pakistanis, and Black Caribbeans have a significantly higher probability of smoking than their first-generation counterparts. This result lends some support to classical straight-line assimilation theory and is consistent with previous studies from the U.S. [
5,
6]. The relatively high probability of smoking may imply potential health risks for the second-generation of these groups, which could exacerbate ethnic inequalities in health and may warrant policy intervention. Importantly, we find that the generational differences in smoking behavior are not explained by generational differences in SES and ethnic identity, highlighting that other unobserved characteristics may play a role in explaining the generational transition in smoking behavior. For Bangladeshis and Black Africans, there is little evidence for generational changes in smoking behavior. One possible explanation could be that both groups may be well protected by their ethnic communities from adopting unhealthy behavior or lifestyles in the host society [
9].
In terms of alcohol consumption, we find strong evidence of generational changes for all ethnic groups with the second-generation being significantly more likely to consume alcohol than the first-generation. This result is consistent with previous studies from the U.S. [
5,
6] and suggests that high levels of alcohol consumption among the second-generation may be a potential reason for ethnic minorities’ generational deterioration of health, highlighting the need for policy intervention. Moreover, these generational differences are partly explained by second-generation ethnic minorities’ higher SES and weakened ethnic identity. Although ethnic minorities’ upward social mobility is often associated with the improvement of health, the process of social mobility could also mean that ethnic minorities have more interactions with White British and higher levels of exposure to White British culture and lifestyles and gradually attach less importance to their home country’s traditions regarding alcohol drinking [
4].
In terms of dietary style (i.e., the number of fruits and vegetables eaten per day), we find that both first- and second-generation ethnic minorities are significantly less likely to eat fruits and vegetables than White British to a similar degree, and there are no significant generational differences. One exception is Indians, but the size of the generational difference for Indians is very small. Overall, this pattern is partly because dietary habits are primarily socialized within families, whereas the formation of smoking and drinking behaviors may also depend on socialization in other social settings such as schools, neighborhoods, and workplaces. Nevertheless, the lower levels of fruit and vegetable consumption among both first- and second-generation ethnic minorities compared to White British may be an essential reason for the poor health of ethnic minorities and warrant health policy intervention.
Limitations and Future Research Directions
Despite several contributions to previous literature, there are several limitations in this study that could be the focus of future research. First, due to data limitation, this article primarily used migration generation and ethnic identity to measure acculturation, but such a measure is incomplete and may only capture a single dimension of acculturation. Future research could profitably use more comprehensive measures of ethnic acculturation such as length of time stayed in the host society, the language used at home, inter-ethnic social networks, and neighborhood ethnic composition. Second, there are substantial remaining unexplained generational differences in smoking behavior and alcohol consumption net of demographic characteristics, SES, and ethnic identity, highlighting the complexity of generational transition in health behaviors. Future research could explore whether such generational differences could be explained by other ethnic minorities’ characteristics that were not included in this research. Finally, because all ethnic minorities analyzed in this study came from previous British colonial countries, they might have been influenced by British culture to a varying degree before migration, depending on the duration of colonization. Future research exploring the mechanisms behind the generational transition in health behaviors may need to distinguish between the effects of sending and host societies.