STUDENT CASE STUDY—WILSON
TRENDS IN IMMIGRANT ADOLESCENT HEALTH IN NEW YORK CITY:
“BECOMING AN AMERICAN CAN BE BAD FOR YOUR HEALTH”
CASE STUDY FOR AAC&U STIRS PROJECT
Katie B. Wilson, Instructor of Interdisciplinary Studies, Stella and Charles Guttman
Community College, New York, NY
Imagine . . . .
. . . that you have just finished college with a degree in Public Health and that you land a
Program Analyst job in the New York City Department of Health and Mental Hygiene
(NYCDOHMH) in the division of Health Promotion and Disease Prevention. You took this job
because of its strong focus on immigrant health issues, which was your concentration in
college. The NYCDOHMH has reported that soon after arriving in New York City, the health of
many immigrant groups declines. The approach of the NYCDOHMH has been to analyze
trends across neighborhoods, identify the contributing forces, and design interventions to
improve health. Your first task at your new job is to read through this case study, analyze the
issues, and make recommendations using the evidence-based public health approach
adapted by the Centers for Disease Control (CDC).
Introduction
This case study explores health issues experienced by immigrant teens adapting to life in urban
America, particularly adolescent girls from Mexico who have immigrated to New York City. You
will examine perspectives in public health, anthropology, and even history. Ultimately, by the
end of the case study, you should understand, connect, frame, and analyze the story of a
young, Mexican woman named Maria who moved to New York City then generate innovative
and concrete suggestions for multi-level interventions, using scientific thinking and evidencebased reasoning. Though Maria’s story is fictional, it is representative of thousands of
immigrant teens whose stories are similar.
The case study is presented in five parts and will be discussed over several class sessions. In Part
One (A), you will be asked to prepare for the first class session by reading a New York Times
article and answering some questions about your relevant prior knowledge. In Part One (B), you
will read Maria’s story and will be asked to reflect on her experiences. In Parts Two through
Five you will analyze various dimensions of adolescent health and immigration, as well as
potential approaches to preventing health issues as adolescents assimilate into US urban
culture.
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STUDENT CASE STUDY—WILSON
Case Study Instructions
This case study will take approximately five class sessions to complete. Your instructor will
indicate exactly how the five parts will be tackled and when assignments will be due. If you
have access to an electronic device (laptop, tablet, etc.) it will be very helpful for both collecting
data and completing online research. All work must be typed, unless otherwise indicated by
your instructor. Throughout the case study, you will see boxes labeled, “Key Questions.” You
are required to answer these questions. Other boxes are labeled, “Reflect,” which, though
written answers are not required, you should have thought through these questions in
preparation for class discussions. There are also “Readings” and “Videos” that you can access
via the hyperlink within each part of the case study. Just click on the title of the reading or video
and you will be sent to the appropriate site or document. Supplementary handouts might be
supplied by your instructor. The final outcome is a two-page (minimum) public health report
and additional assignments (i.e., paper, presentation, etc.) that might be assigned by your
instructor.
Learning Objectives
By exploring this case study, you will be able to:
Part One—UNDERSTAND: Preparation and Meet Maria
 Reflect on your knowledge about adolescent health issues in the United States
 Examine your prior knowledge about the history of immigration in the United States

Begin to critique the systems within which Maria exists and how she might be helped
Part Two—CONNECT: Adolescent Health
 List the most prevalent adolescent health issues in the United States
 Discuss issues in adolescent development
 Define: public health, epidemiology, health disparity, overweight, obesity, diabetes,
depression, risk factors
Part Three—FRAME: History of Immigration in the United States and New York City
 Describe, briefly, the history of immigration in the United States and relate it to
immigration trends shown graphically
 Define: assimilation, acculturation, social capital
 Analyze and interpret data relating to immigrant adolescent health
 Demonstrate parallels between Maria’s experiences and research-based evidence on
immigrant health
Part Four—ANALYZE: Maria’s Story
 Analyze the contributing forces in Maria’s life
 Illustrate the social ecological framework using Maria’s story
 Relate elements of Maria’s story to data in the New York City (NYC) Department of
Health Report
Part Five—SOLVE: Evidence Based Solutions
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STUDENT CASE STUDY—WILSON


Evaluate the nature of adolescent immigrant health issues using the evidence-based
public health framework
Synthesize findings into a multi-dimensional recommendation for solutions
Part One―UNDERSTAND: Preparation and Meet Maria
Day One Directions
In preparation for the first class session, please do the following:
1. Answer the six questions, labeled “KEY QUESTIONS, Part One (A)—Prior Knowledge,” listed
below.
2. Read the Background section on pages 3–4.
3. Complete the reading, “Health Toll of Immigration,” listed on page 4.
4. Watch the video, “Becoming American,” listed on page 5. This short clip is from a California
Newsreel series called Unnatural Causes. You will watch a more comprehensive version
of the film in Part Three of the case study.
5. Answer the three questions, labeled “KEY QUESTIONS, Part One (B)—Background” on pages
4–5.
6. Read “Meet Maria” on pages 5–6.
7. Read Part Two.
8. Read through the rest of the case study so you know what to expect.
Key Questions
Part One (A)―Prior Knowledge
Before class, answer these questions to the best of your ability, using complete sentences.
1. How would you describe the general health of the average American? Explain.
2. List as many health issues (mental, physical, social, environmental) that you can think of
that might be experienced by teenagers in the United States.
3. What do you know about the history of immigration in the United States? In New York
City?
4. When/how/why did your family or ancestors immigrate to the United States? Or, if you
live somewhere other than the United States, when/how/why did your family move
there?
5. Find a definition of assimilation and acculturation. Cite your sources.
6. In two to three sentences, based on your understanding prior to reading this case study,
what is your response to the subtitle of this case: “Becoming American is Bad for Your
Health.”
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STUDENT CASE STUDY—WILSON
Background
According to researchers at the Migration Policy Institute (Nwosu 2014), in 2012:
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41 million immigrants lived in the United States
31.1 million children under 18 living were living in poor families (i.e., with family
incomes below 200 percent of the federal poverty threshold) in the United States and
almost 9.6 million (or 31 percent) were children of immigrants.
17.4 million children under age 18 lived at home with at least one immigrant parent
o Of this total, 2.2 million were children who were born outside the United States
to foreign-born parents.
Given these statistics, immigrant children and teens are assimilating into American culture in
record numbers. As young immigrants adapt both socially and culturally to living in the United
States, there are tremendous implications for the health behaviors that are adopted and the
resulting health outcomes (Morse 2005). Specifically, rates of illnesses like diabetes, asthma,
and obesity are often disproportionately high in immigrant communities in the United States.
Why would this happen? This is a very complex problem that is being tackled by schools,
scholars, policymakers, and politicians but has yet to be fully understood. This case study asks
that you think critically about the relationship between US culture, society, and health and
what immigrants to this country experience while adapting to the American lifestyle. What
does the data have to say about US society? And, what are some ways in which US culture and
society can better serve immigrant communities?
The family history of all Americans involves movement from one land to another. Immigration
into the United States from all corners of the planet continues to this day, as individuals and
families move from their homeland to the United States to pursue a new life. While they are
met by tremendous opportunities, a beautiful country, and the richness of American culture,
they are also met with its complications and struggles. This case explores some of the health
implications specifically experienced by adolescents who immigrate to urban regions in the
United States. You will analyze data from New York City—the ultimate, urban melting pot in the
United States—and think about how the American lifestyle and/or the process of adapting to
the American lifestyle is associated with health outcomes.
Reading
Health Toll of Immigration (Tavernise 2013) from the New York Times
 Read the article and annotate while you read (underline, highlight, questions, etc).
 Be prepared to discuss the article in class.
Video
“Becoming American” (California Newsreel 2008), excerpt, “Arriving Healthy”
 Reflect on your opinion about the video.
 Be prepared to discuss the video in class.
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STUDENT CASE STUDY—WILSON
Key Questions
Part One (B)
“Health Toll of Immigration”
7. What does this article tell you about the relationship between immigrating to the
United States and health? Include a quote from the article that supports your
explanation.
8. Given the perspectives presented in this article, describe the health issues that might be
faced by a teenager who has recently arrived in the United States.
“Becoming American”
9. This clip references the idea that immigrants to the United States arrive with good
health and then their health declines from “the same social forces that erode the health
of all of us.” Explain what the narrator means and list 2–3 examples of social forces.
Meet Maria
Maria recently moved from a small town outside of Mexico City to Elmhurst, Queens, a
neighborhood in New York City with the region’s most highly concentrated immigrant
population and a thriving Mexican community. She is 15 and has two younger sisters, ages 12
and 10. The three girls and their mother moved to Queens last year to join their father who had
lived there for two years working in a deli. Despite the deep pains of leaving their extended
family behind in Mexico, her parents decided to move to NYC, so they could access work and so
that the girls could acquire an American education. The family lives in a one-bedroom,
government-subsidized apartment on a relatively safe block in Elmhurst, but crime and violence
occur throughout the neighborhood on a regular basis. The building is pretty noisy and it’s
always breaking down, but her neighbors are friendly. Living in such close quarters with her
family doesn’t bother her. In fact, these days, the times that they are all actually in the
apartment together are rare. Both of her parents work 10-hour shifts at minimum wage jobs,
six days/week. Both parents have very low-level English language skills, but are taking classes
on Saturday afternoons at the library. They speak Spanish in the home, but practice English
when they remember. Maria looks forward to Sunday mornings when the entire family attends
a nearby Catholic church, calls their grandmother back in Mexico, and walks through the park
and makes a huge family breakfast. Whenever she talks with her grandmother, Maria is so
happy to reconnect but then feels very depressed about the life that she left behind. She
notices that her mother seems depressed as well. Additionally, in merely 18 months of living in
NYC, Maria’s mother has developed the preliminary symptoms of diabetes, and her father has
developed a chronic cough. Maria is becoming worried about her family’s health.
Ana, who is from Ecuador, lives on Maria’s floor and they have become fast friends. They often
sit in the stairway and gossip about school, the neighborhood, and music.
ANA: What are you up to this weekend—a guy from my school is having a party on Saturday. Do
you want to go?
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STUDENT CASE STUDY—WILSON
MARIA: I dunno. I have to work all day Saturday and then if I don’t study all night, there’s no way
I’m passing my History final on Monday. I love living in New York City, but I’m just
always exhausted. Anyways, I have nothing to wear to a party, I am so fat, and none of
those people like me.
ANA: You’re being crazy! No one knows you, that’s the problem. You are always working and
taking care of your family!
MARIA: Whatever. Anyways, my Mom has been fainting after dinner this week and there’s no
way I am leaving her side.
During the week, Maria wakes up at 5:00 a.m., leaves the house at 6:30 a.m. to drop her sisters
off at a family friend’s house, and commutes for one hour on the subway for a 7:45 a.m. start at
her high school. Maria’s school is ranked as a below-average school, but her teachers are
caring. Most of her classes emphasize testing, and there are no physical education or health
classes. After a full day at school, Maria rushes back to Elmhurst to pick up her sisters at their
grade school, make dinner for the whole family, clean the apartment, and complete her
homework. Maria averages five hours of sleep a night, and her sleep is often disrupted by
noises outside. She is always tired, so she drinks coffee and energy drinks all day. During the
week, Maria eats breakfast and lunch at school through NYC’s School Food Program. Maria has
a home-cooked meal for dinner during the week, but she ends up eating pizza and soda for
lunch and dinner every Saturday and Sunday because of her 8-hour shifts at the Pizza Hut
across the street from her apartment. She makes $8/hr. After taxes, Maria’s monthly check is
about $350. Her parents depend on $250 of her income to contribute to the family’s bills. The
remaining money she uses for her cell phone bill and the occasional outfit.
Despite feeling so stressed and juggling so many family responsibilities, Maria passed her first
year of high school with a C average. She excelled in math and science, but because she was still
learning English, her marks in history, debate, and English were just barely passing grades. Her
reading skills improved dramatically, but her fluency in speaking English and her confidence in
writing were challenged. She struggled to “fit in” at school. The other teens in the school
seemed so much more mature. She heard her classmates talking about parties with lots of
drinking and drugs, and she has heard that pregnancy and STD’s are a big problem at her
school. Maria didn’t develop any solid school friendships in her first year and she often felt
lonely, insecure, and depressed. Like most teenage girls, Maria was consumed with her
appearance. In just one year, she had gained twenty pounds. Her parents said it was probably
just a symptom of puberty, but on her 5’2” frame, twenty pounds made a significant difference.
Her weight gain added to her feelings of insecurity. Her family did not have health insurance
and her parents didn’t trust doctors, so she knew seeking medical help wasn’t an option.
Recently, when Maria and Ana were hanging out in the stairway, they talked about their old
lives in Central America and their futures.
ANA: I bet if my family had stayed in Ecuador I would have a boyfriend by now.
MARIA: I bet you would too! Me, on the other hand, I think I would be living with my
grandmother and cooking for my whole family all week. I’d be even heavier! I am glad I
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STUDENT CASE STUDY—WILSON
am in the United States and making it through school. I know it will all be worth it when
I go to college, become a nurse, and buy my parents a house in the suburbs.
ANA: Ooooo, I am going to do the same! But, I couldn’t handle all of the blood you have to deal
with in nursing. I’m going to become a scientist—I want to get out of New York.
MARIA: I really want to achieve my dreams, but you know what— I am worried about my
family’s health—and my own! We all need to get healthier! I just don’t understand how
things got so bad and where to even begin to improve my family’s health.
ANA: Don’t put so much pressure on yourself. You should get some support!
Reflect
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What are your impressions of Maria? Of Ana?
What are some adjectives you would use to describe the aspects of New York City
culture she experiences?
Maria’s family does not trust doctors. Hypothesize about some of the other obstacles to
access to healthcare for Maria and her family.
What social institutions does she interact with on a daily basis?
What are some of her roadblocks to a healthier life?
What are some of your initial ideas for ways to help Maria?
Part Two—CONNECT: Adolescent Health
Day 2  Directions
 Before coming to class for the second day of this case study, read through Part Two.
 Read the article titled, “Trends in Adolescent Health….” (link is below). Be prepared—it
is a very lengthy, complex, and scholarly article.
 Jot down a few notes and answer the questions listed on page 9.
 Then, watch the video titled, “In Sickness and in Wealth” (link is below).
 Be prepared to discuss in class.
What is most important in the lives of American teenagers? If you asked the average American,
what might be on their list? Perhaps their Twitter, Facebook, and Instagram profiles? Or, their
friends, relationships, family, school, parties, fashion, sports, music, college, and their future?
What about the food they eat, the health of their surroundings, and the amount of exercise
they get? Are most American teenagers thoughtful about where their food comes from, what
type of nutrition they need, and how the food they eat impacts their bodies and minds? And,
what about fitness? Do most American teens exercise on a regular basis and think about the
ways that fitness impacts the other facets of their lives? Or, how about the health of their social
lives? Ever heard of the saying, “you’re judged by the company you keep?” The friends with
whom we surround ourselves have a significant impact on our self-perceptions and social
behaviors.
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STUDENT CASE STUDY—WILSON
Junk food is pretty central to the American adolescent diet. In New York City, for example,
many teens subsist on soda, pizza, fast food, and deli sandwiches. So, can you imagine how a
poor diet might impact an immigrant teenager like Maria? The NYC Department of Health and
Mental Hygiene suggests that foreign-born New Yorkers who have lived in the United States for
four years or more report worse general health than more recent arrivals and that they are
more likely to be obese (Kim 2006). According to health economists Krista Perreira and India
Ornelas (2011): “for the children of immigrants, poverty, the stresses of migration, and the
challenges of acculturation can substantially increase their risk for developing physical and
mental health problems.”
The news consistently reports that health issues like obesity, diabetes, and depression are on
the rise for young people in this country. Why is this happening? Are these health issues caused
by more than just the choices of the individual? The habits teenagers begin to form
independently from their families create lasting patterns for their future.
14%
28%
Percentage of American high school students
who report on a weekly basis doing absolutely
NO physical activity
Percentage of American high school
students who are overweight or obese
* From the Centers for Disease Control, 2011 national Youth Risk Behavior Survey among US high school students (Frieden
2012)
Maria falls into both columns of the chart above. She doesn’t exercise and her Body Mass Index
(BMI) is just over 30, which is considered obese by national standards. How did this happen?
And, why? We know that she has the desire to improve her health, but is it solely her own
individual health choices that are contributing to declining health? She is being a normal,
American teenager who eats a lot of pizza and soda, but could that be all? Later in this case
study you will focus on potential risk factors for obesity that go beyond Maria’s personal
decisions.
Either you remember being a teenager, or perhaps, you are a teen yourself. Either way, we
know that the adolescent years can be very powerful and sometimes, very tumultuous. There
are physiological and psychological explanations for the complex changes that happen during
adolescent development. So, needless to say, when analyzing adolescent health issues, it is
imperative to interpret both individual (anecdotal) stories and community health patterns in
light of the evidence about how adolescents develop.
Act for Youth Center—a collaboration of Cornell University, University of Rochester, and the
New York State Center for School Safety—created a very helpful, succinct Stages of Adolescent
Development Fact Sheet (Spano 2004). After reading through this fact sheet, reflect on the
questions below.
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STUDENT CASE STUDY—WILSON
Reflect
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After reading the “Stages” fact sheet, can you identify parallel experiences in your
own adolescent development experience?
Where does Maria fit into these stages? Explain.
Is there a prototype of “the American teenager” in the 21st century? If so, how would
you describe him/her? Can you think of a media character who personifies the
quintessential “American teen”?
Reading
“Trends in Adolescent and Young Adult Health in the United States” (Mulye et al. 2009)
Video
In Sickness and in Wealth (California Newsreel 2008) excerpt from, “Health in America”
 Reflect on your opinion about this video and be prepared to discuss it in class.
Key Questions
Part Two—Adolescent Health
1. What are the six primary areas in adolescent health that are covered in the “Trends in
Adolescent Health…..” article?
2. According to Tables 1, 2, and 3 in the “Trends in Adolescent Health…..” article –
describe in your own words the patterns in the data that you find most striking.
3. Prevalence is an essential rate measure in epidemiological studies. Answer the
questions below to exercise your familiarity with this concept.
a.) In the second to last sentence, on page 18 of this article, the authors state that
“the prevalence of overweight among 12 to 19 year olds almost doubled between
1988–94 and 2003–06.” Define prevalence and restate this quote in your own words.
b.) Given the following hypothetical scenario, calculate the prevalence: There is a
problem with teen pregnancy in the 9th grade class at Maria’s school. The total
population of the school is 1,552 and there are 358 students in the 9th grade class,
168 of whom are boys. Of the girls in the 9th grade class, 86 are sexually active. The
school’s wellness office conducted a survey just before Winter recess and there were
14 cases of pregnancy. What was the prevalence of teen pregnancy just before Winter
recess in the 9th grade class (expressed in percentage)?
4. Can you identify data in these tables that reflect some of Maria’s profile? Explain.
5. Search the Internet to find definitions for the following public health terms listed in
the article: public health, epidemiology, health disparity, risk factors, obesity,
overweight, diabetes, and depression. Cite your sources.
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STUDENT CASE STUDY—WILSON

Optional: Meet Jessica (Hernandez 2013). You might want to read another story about
Jessica, who writes about adapting to the United States from Mexico. She wrote an
article in the Huffington Post and tells a captivating story.
Part Three—FRAME: History of Immigration in the US and NYC
Day 3  Directions
 Before coming to class for the third day of this case study, read through Part Three.
 Read the article titled, “Opportunity and Exclusion” and answer the Key Questions on
page 11.
 Read the two reports listed on page 14, and watch the short video clip.
 Answer all Key Questions on page 14.
Immigration in the United States
Immigration to the United States is a complex phenomenon that has been a major source of
population growth and cultural change throughout most of the history of the United States.
Immigration is defined as “the action of coming to live permanently in a foreign country (Oxford
2014).” Large-scale immigration in the United States can be understood as having occurred
during four primary peak periods: 1) the peopling of the original colonies; 2) westward
expansion during the middle of the 19th century; 3) the rise of cities at the turn of the 20th
century; and 4) beginning in the 1970s and continuing today (Hipsman 2013). So, Maria and her
family arrived during the 4th peak period and were met with the unique aspects of American
life in the 21st century.
The table below lists some important statistics about immigrants in the United States,
according to 2011 American Community Survey estimates:
311.6 million  the total US population
40.4 million  the number of foreign-born in the United States (13 percent of the total)
54%  of the foreign-born come from Latin America
11.7 million  originates from Mexico (29 percent of the total immigrant population)
[*SOURCE: (Hipsman 2013)]
The graph below provides a visual depiction of the trends in immigration to the United States
over a 150-year period. Think about why these fluctuations occurred and how they impacted
the immigrant experience and what US policies may have played a role in producing the
patterns.
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[* SOURCE: (Elemendorf 2013)]
Browse the Migration Policy website (http://www.migrationpolicy.org) for a wealth of
information about immigration in the United States. Can you find data about immigration from
Mexico that might help you understand and frame Maria’s case? The reading below,
“Opportunity and Exclusion,” does a good job of explaining US immigration from a critical and
historical perspective.
As you read, think about Maria’s experience in the context of history. How might the history of
immigration in the United States impact her and her family?
Reading
Opportunity and Exclusion (Ewing 2012)
 Read this report about the History of Immigration in the United States very thoroughly.
 Take notes and answer the Key Questions below.
 Be prepared to discuss the report in class.
Key Questions
Part Three (A)—History of Immigration in the United States
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STUDENT CASE STUDY—WILSON
1. Now that you have thoroughly read the “Opportunity and Exclusion” article, explain
the patterns shown in the graph above.
2. The author states that “everyone in the United States is ultimately descended from an
‘immigrant,’ even Native Americans whose ancestors arrived here thousands of years
ago”. Explain the significance of this idea.
3. The reading ends with the following statement: “. . . the United States is as conflicted
as ever about its historical identity as a nation of immigrants.” What do you think the
author means by this statement?
4. Surf the web for online newspapers that discuss immigration in the United States.
What are the trends? Is there a particular example that might support and/or refute
either of the quotes listed in question 2 or 3?
Immigration to NYC
“PASSAGES : Immigrants at Ellis Island awaiting a ferry to the city.”
[* SOURCE: (Roberts 2009)]
Why would we study New York City when analyzing immigrant health? First of all, it’s one of the
country’s largest and most diverse city—it’s the ultimate melting pot of cultures! Secondly, it
has always been—and continues to be—a destination for immigrants from across the globe.
Lastly, it is a crowded, demanding, and often stressful city with prototypical urban health
problems. Like Maria said to her friend, “I love living in New York City, but I’m just always
exhausted.”
Video
Watch a short clip from the History channel about Ellis Island to refresh your memory about
this icon of NYC’s immigrant history (History.com Staff 2014).
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The table below lists some important statistics about immigrants—specifically, Mexicans—and
the foreign-born in New York City.
37%  3.1 million of the city's 8.2 million population are foreign-born
52%  In the past decade, the Mexican population in New York City has surged by 52
percent, the largest growth surge of any group among the 10 largest immigrant groups in
the city
80% 
1/3
Mexican New Yorkers who were born outside of the United States
 Mexicans are now New York's third largest Hispanic group
[* SOURCE: (Lobo 2013)]
NYC is rife with opportunities, possibilities, and excitement, yet is also a region where great
disparities exist across neighborhoods. These disparities are complex and intertwined across
socio-economic status, race, and ethnicity and typically have a strong impact on health
outcomes. According to a 2006 report, titled, “The Health of Immigrants in NYC,” from NYC’s
Department of Health and Mental Hygiene, “foreign-born New Yorkers face a number of unique
health concerns, as well as specific barriers to accessing health care services. Immigration to
the U.S. can mean changes in social and/or socioeconomic status, language, culture, and many
other aspects of life that may affect one’s health.”
Maria and her family certainly began to develop myriad health issues soon after moving to the
United States.
Reflect 
 Could there be an association between their health struggles and the process of
adapting to life in Elmhurst, Queens?
 What are the health consequences of the family’s lack of access to healthcare?
 Does Maria’s assimilation into “American” habits of fast food and lack of exercise make
her more or less likely to seek healthcare?
Reading
The Health of Immigrants in New York City (Kim et al. 2006 )
 Familiarize yourself with this report. It is a very lengthy, complex, and scholarly article.
 Jot down a few notes and answer Question 1, below.
 Be prepared to discuss the report in class
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Take Care New York: Community Health Profiles – Northwest Queens (Olson et al. 2006)
 Familiarize yourself with this report. It is a very lengthy, complex, and scholarly article.
 Jot down a few notes and answer Question 2, below.
 Be prepared to discuss the report in class.
Watch
“Becoming American” (California Newsreel 2008)
 View the first two clips (BA_1 and BA 3) from a youtube clip of “Becoming American.”
Key Questions
Part Three (B)
5. In “The Health of Immigrants in NYC” article, identify at least two pieces of
quantitative evidence related to any aspect of Maria’s case. Explain why you selected
these data and how they highlight Maria’s case.
6. In the “Community Health Profiles—NW Queens” article, identify at least two pieces
of quantitative evidence related to any aspect of Maria’s case. Explain why you
selected these data and how they highlight Maria’s case.
7. Find scholarly evidence that supports the ideas of these reports and the video. Search
for an article that discusses health issues experienced by people who immigrate to
the United States. It could be a scholarly article (check out Google Scholar, or your
school’s journal database), or find an article from a popular newspaper (Wall Street
Journal, USA Today) or magazine (Time, The Economist).
Part Four—ANALYZE: Maria’s Story
Day 4  Directions
 Before coming to class for the fourth day of this case study, read through Part Four.
 Complete reading assignment, “Social Ecological Model” on page 17.
 Complete Chart A and Chart B.
So, now you have met Maria, connected her story to adolescent health theories, framed her
story against the history of immigration in the United States, and learned about immigrant
health issues in New York City. Now, your task is to critically analyze her case and connect it to
evidence from the readings, reports, and videos.
In college, you are always asked to “critically” analyze an issue, but what does that even mean?
According to a quote from the Critical Thinking Community website, critical thinking is “the
intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing,
synthesizing, and/or evaluating information gathered from, or generated by, observation,
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STUDENT CASE STUDY—WILSON
experience, reflection, reasoning, or communication, as a guide to belief and action (Scriven,
2014).” One way of approaching the critical analysis of an issue is by using an interdisciplinary
framework.
Clearly, Maria and her family have been struggling with a variety of health issues since their
move to Queens. Your task is to answer the complex question, why? First, start by looking back
through the case and circle, underline, or list anything that you think might be a contributing
factor. You will look for determinants of health that might be genetic, historical, environmental,
economic, psychological, social, or cultural.
Then, look back through all of the reports and data, and ask critical questions about the validity
of the data:



Reflect
It is possible that Maria and her family arrived in Queens undernourished, and if so,
how would the data be affected?
If the information is close to ten years old (for example, the “Trends in Adolescent
Health” article), is it still useful? Could this be a limitation to the strength of an
argument?
Are there inaccuracies or insufficiencies in the data that you have read thus far?
And/or are there any data needed to deepen your analysis of Maria’s case?
Key Questions
Part Four (A)
1. Complete Chart A: Re-create the Interdisciplinary Framework on your own computer.
If you don’t have a computer, you can photocopy the page below, or you can draw it
by hand. Your instructor may ask you to complete this chart in pairs or groups. Reread
Maria’s story and list each contributory cause that is mentioned in her story. The
causes are divided into categories, including: biological/genetic, historical,
environmental, economic, psychological, political, and socio-cultural.
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STUDENT CASE STUDY—WILSON
CHART A—Interdisciplinary Framework
FACTOR
HOW THIS FACTORS IMPACTS MARIA’S
HEALTH
Can you connect any
piece of evidence
from any of the
reports/articles/videos?
List them here.
Biological-Genetic
Historical
Economic
Environmental
Psychological
Political
Socio-Cultural
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STUDENT CASE STUDY—WILSON
Recall from the beginning of this case study that your task is to “solve” the case using the
evidence-based public health approach adapted by the Centers for Disease Control (CDC).
In the reading below, you will be introduced to this approach—called Social-Ecological Theory—
as it was applied to a violence prevention program. The Social-Ecological Model (SEM) places
the individual issues at the center and analyzes the complex interrelationship among highly
interconnected systems embedded within each other that impact that individual.
Maria’s case doesn’t involve violence, but the framework is very useful.
Complete Chart A below as an exercise in unpacking all of the factors that are simultaneously
influencing Maria’s case.
Reading
Social-Ecological Theory: A Framework for Violence Prevention (CDC 2014)
 Read the CDC framework that has been used for violence prevention programs—while
Maria’s case is not related to violence, this CDC framework is a public health prevention
model that is relevant to any public health issue.
Key Questions
Part Four (B)
2. Complete Chart B: Re-create the Socio-Ecological Model chart displayed below on your
own computer. If you don’t have a computer, you can photocopy the page below or draw
it by hand. Your instructor may ask you to complete this chart in pairs or groups. Use the
social-ecological model to frame your intervention strategies. In other words, describe
how you would intervene to help Maria at each “level” listed in the chart.
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STUDENT CASE STUDY—WILSON
CHART B: Social-Ecological Model of Health
DIMENSION
DESCRIBE HOW YOU COULD CREATE AN
INTERVENTION AT THIS LEVEL TO
IMPROVE MARIA’S HEALTH
Can you connect any
evidence at this level
from the
reports/articles/videos
from this case? List them
here.
Individual
Relationship
Community
Societal
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STUDENT CASE STUDY—WILSON
Part Five—Evidence-based Solutions
You’ve finally made it to Part Five.
The culmination of this assignment asks that you create an evidence-based solution that
provides recommendations for improved health that can apply not only in Maria’s case, but
could also be applicable as preventative interventions for other adolescents who have recently
immigrated to the United States.
Day 5  Directions
 Before coming to class for the fifth day of this case study, thoroughly read through Part
Five and complete all required assignments.
 Review the entire case, including the readings, reports, videos, as well as all of your
responses to the key questions and reflection questions.
 Choose one or more dimension(s) from the social-ecological model that you plan to use
as your intervention focus in your solution.
 Use the public health approach as a framework for writing up your solution.
Prior to completing the Final Report, consider the reflection questions below:
Reflect




What did you learn?
What were surprised about? Why?
What facets of this case did you agree with? Why?
What facets of this case did you disagree with? Why?
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STUDENT CASE STUDY—WILSON
[ * Source: (CDC 2014)]
THE FINAL ASSIGNMENT:
A Public Health Recommendation Report
The Task
Write a public health recommendation report that outlines your plan to “solve Maria’s
case”—that is, to improve her health opportunities—using the four-step, evidence-based
public health approach (see figure above) as your outline.
What does it mean to solve Maria’s case? Your solutions should help Maria lead a healthier
lifestyle that prevents the development of poor health outcomes. Your recommendations
must be informed by and based on evidence from what you’ve read in this case, from
additional materials provided by your instructor, and from your supplementary research.
Maria’s case is reflective of a more universal experience of adolescent immigrant teens in
New York City. Therefore, your recommendation report for Maria will have implications for
other young people in the future.
This report should convey complex analysis, evidence-based reasoning skills, as well as any
ethical considerations. You must use at least some factors from the interdisciplinary
framework to frame your analysis and some from the social-ecological model of health to
frame your intervention strategies.
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STUDENT CASE STUDY—WILSON
Requirements
Each of the four sections should be approximately one page. The report should be
approximately six pages in length, including a one-page cover page, about four pages of the
report, and a one-page References page. Your writing should be concise, yet thorough.
Unless otherwise specified by your instructor, the report should adhere to the following
technical requirements:
 Typed, 12 font, Times New Roman
 Double-spaced
 Pagination
 One-inch margins
 References in APA Format
Sections of the Report
Section 1  The Problem
 This section should provide a summary of Maria’s case, including references to
pertinent details of her life, the stages of adolescent development, history of
immigration to the United States and the health status of immigrants in New York
City.
 Make sure you have answered the “who, what, where, when, and hows” of the case.
Section 2  The Cause
 Describe the underlying reasons why the problem exists.
 Using the interdisciplinary framework, discuss the factors that have the most
profound impacts on Maria’s life.
 Use evidence from any/all readings and videos to support your ideas.
Section 3  Recommended Intervention Strategies
 Choose one or more dimensions from the social-ecological model and describe an
intervention that you would design to support Maria in achieving better health.
 Explain why you have chosen this dimension as a focus for prevention.
 Use evidence from any/all readings and videos to support your ideas.
Section 4  Implementation
 Describe exactly how you would go about implementing your strategies and ensure
that they are both sustainable and applicable to a more universal audience.
 Use evidence from any/all readings and videos to support your ideas.
References
California Newsreel (producer). 2008. Unnatural Causes [Motion Picture]. Available at:
http://www.unnaturalcauses.org/about_the_series.php.
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Centers for Disease Control and Prevention (CDC). 2014. "Public Health Approach to Violence
Prevention." Last modified August 26, 2014.
http://www.cdc.gov/violenceprevention/overview/publichealthapproach.html.
Elemendorf, D. 2013. A Description of the Immigrant Population—2013 Update. Washington,
DC: Congressional Budget Office.
Ewing, W. 2012. "Opportunity and Exclusion: A Brief History of US Immigration Policy."
Retrieved from Immigration Policy Center:
http://www.immigrationpolicy.org/sites/default/files/docs/opportunity_exclusion_011312.pdf.
Frieden, T. R. 2012. Youth Risk Behavior Surveillance—United States 2011. Atlanta, GA: Centers
for Disease Control and Prevention.
Hernandez, J. 2013. "Jessica is an Immigrant." Huffington Post, November 20.
http://www.huffingtonpost.com/2013/11/20/jessica-is-an-immigrant_n_4304636.html.
Hipsman, F., and D. Meissner. 2013 "Immigration in the United States: New Economic, Social,
Political Landscapes with Legislative Reform on the Horizon." Retrieved from Migration Policy
Institute: http://www.migrationpolicy.org/article/immigration-united-states-new-economicsocial-political-landscapes-legislative-reform.
History.com Staff. 2009. "Deconstructing History: Ellis Island [Motion Picture]." Available at:
http://www.history.com/topics/ellis-island.
Kim, M., G. Van Wye, B. Kerker, L. Thorpe, and T. R. Frieden. 2006. The Health of Immigrants in
New York City. New York: New York City Department of Health and Mental Hygiene. Available
at: http://www.nyc.gov/html/doh/downloads/pdf/episrv/episrv-immigrant-report.pdf.
Lobo, A. P., and J. J. Salvo. 2013. The Newest New Yorkers. New York: NYC Department of City
Planning.
Morse, A. 2005. "A Look at Immigrant Youth: Prospects and Promising Practices." National
Conference of State Legislatures. http://www.ncsl.org/research/immigration/a-look-atimmigrant-youth-prospects-and-promisin.aspx.
Mulye, T. P., M. J. Park, C. D. Nelson, S.H. Adams, C. E. Irwin, Jr., and C. D. Brindis. 2009.
"Trends in Adolescent and Young Adult Health in the United States." Journal of Adolescent
Health, 45(1): 8–24.
Olson E. C., G. Van Wye, B. Kerker, L. Thorpe, and T. R. Frieden. 2006. "Take Care Northwest
Queens." NYC Community Health Profiles, 2nd ed., 30(42): 1–16.
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Oxford Dictionaries. 2014. "Immigration." Retrieved from Oxford Dictionaries, Oxford University
Press: http://www.oxforddictionaries.com/definition/english/immigration.
Perez-Escamilla, R., and G. Kac. 2013. "Childhood Obesity Prevention: A Life-Course
Framework." International Journal of Obesity Supplements, 3: S3–S5. doi:
10.1038/ijosup.2013.2.
Perreira, K. M., and I. J. Ornelas. 2011."The Physical and Psychological Well-Being of Immigrant
Children." Immigrant Children, 21(1): 195–218. Retrieved from Future of Children.
http://futureofchildren.org/futureofchildren/publications/docs/21_01_09.pdf.
Roberts, S. 2009. "A Portrait of Ellis Island, and Tabloid Fodder." New York Times, July 4.
http://www.nytimes.com/2009/07/05/nyregion/05bookshelf.html?_r=0.
Schapiro, N. A., S. M. Kools, S. J. Weiss, and C. D. Brindis. 2013. "Separation and Reunification:
The Experiences of Adolescents Living in Transnational Families." Current Problems in Pediatric
and Adolescent Health Care, 43(3): 48–68. doi:10.1016/j.cppeds.2012.12.001
Scriven, M., and R. Paul. 2014. "Defining Critical Thinking." Retrieved from The Critical Thinking
Community: http://www.criticalthinking.org/pages/defining-critical-thinking/766.
Spano, S. 2004. "Stages of Adolescent Development." Research Facts and Findings. Ithaca, NY:
ACT for Youth Upstate Center for Excellence.
Tavernise, S. 2013. "Health Toll of Immigration." New York Times, May 18.
http://www.nytimes.com/2013/05/19/health/the-health-toll-ofimmigration.html?pagewanted=all.
About the Author
Katie B. Wilson, is an instructor of Interdisciplinary Studies at Stella and Charles Guttman
Community College in New York City, where she teaches public health and environmental ethics
classes and is developing the college’s burgeoning study abroad programs. She has taught
biological science and social science classes from grades K–college, both in the traditional
classrooms and in experiential programs in places like Australia, Fiji, the Alps, and Berlin. Her
research interests include undergraduate public health curricular design and global learning and
civic engagement models. Ms. Wilson is involved in the food justice community in Brooklyn and
cares passionately about education and health equity issues—locally, nationally, and globally.
She loves the outdoors especially hiking, canoeing, biking, and cross-country skiing—
particularly in eastern Canada, which is where she is from.
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