Exploring risk-taking and health in immigrant adolescents to Canada: A unique focus on the “healthy immigrant effect”

The Healthy Immigrant Effect (HIE) describes the phenomenon in which immigrants initially experience better health outcomes than the host population, followed by a gradual decline in health across time and generations. While the HIE has been widely documented among adults, less is known about how it operates during adolescence, particularly in relation to risk-taking behaviours. This thesis explored the association between immigrant generational status and substance use behaviours among adolescents in Canada, with a specific focus on the potential erosion of the HIE across generations. The hypothesis was that first-generation immigrant adolescents would report lower engagement in substance use compared to second- and third-generation adolescents, with variation by gender and ethnicity. The thesis consists of a literature review, a national cross-sectional analysis using data from the 2022-2023 Canadian Health Behaviour in School-aged Children (HBSC) study, and a general discussion. For my analysis, the analytic sample included 11,557 adolescents aged 11-15 years from across Canada. Substance use outcomes included cigarette smoking, vaping, alcohol drinking, cannabis use, and illicit drug use. Weighted prevalence estimates and modified Poisson regression models were used to estimate adjusted prevalence ratios while accounting for the complex survey design. Models were adjusted for age, family structure, and family support, while gender and ethnicity were examined as potential effect modifiers. Findings demonstrated an intergenerational gradient in substance use behaviours. First-generation adolescents reported the lowest prevalence of substance use, second-generation adolescents reported intermediate prevalence, and third-generation adolescents reported the highest prevalence. Compared to third-generation adolescents, first-generation adolescents had significantly lower prevalence levels of lifetime vaping, alcohol drinking, and cannabis use. Similar but weaker protective patterns were observed among second-generation adolescents. Variations by gender and ethnicity were also identified, suggesting that broader social and cultural contexts shape the relationship between immigrant generational status and substance use. Overall, the findings support the existence of an adolescent form of the HIE in Canada and suggest that substance use behaviours possibly contribute to the gradual erosion of immigrants’ initial health advantage across generations. These findings highlight the importance of culturally sensitive and targeted public health interventions to preserve protective health behaviours among immigrant adolescents.

Name thesis:degree_name

M.Sc. Applied Health Sciences

Level thesis:degree_level

Master

Discipline thesis:degree_discipline

Faculty of Applied Health Sciences

Department dc:contributor.department

Applied Health Sciences Program

Grantor dc:publisher

Brock University

Year dc:date.issued

2026

Author dc:creator

• Youssef Nassar

Advisor dc:contributor.advisor

• Dr. William Pickett and Dr. Mostafa Shokoohi

• MEDICINE::Social medicine::Public health medicine research areas::Epidemiology
• MEDICINE::Social medicine::Public health medicine research areas::Public health science

Language dc:language.iso

eng

Handle dc:identifier.uri

https://hdl.handle.net/10464/20329

OAI identifier oai:identifier

oai:brocku.scholaris.ca:10464/20329