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The ‘health paradox’ is a phenomenon in which immigrants report better health than their native-born counterparts despite experiencing numerous adversities. This study examines the ‘health paradox’ among adolescent girls in the U.S. and evaluates the understudied pathways and conditions in the immigration status-health link, including the role of emotional (i.e. depressive symptoms) and cognitive (i.e. decision-making) domains. Drawing on Wave I (1994–1995) and Wave II (1996) of a nationally representative longitudinal study of adolescents (Add Health), a series of regression models was conducted to explore the relationship between girls’ immigration status and health ( N  = 6,543). Further, mean centered multiplicative terms and the KHB decomposition procedure were used to assess the moderating and mediating effects of depressive symptoms and decision-making. Results reveal that, in general, foreign-born girls enjoy better health as compared to their native-born counterparts, which is partially explained by their fewer depressive symptoms. Importantly, however, the experience of higher levels of depressive symptoms appears to decrease immigrant girls’ resilience. The ability to be thoughtful and reflective when making choices serves as a health protective factor among girls overall, suggesting the need to foster adolescent girls’ decision-making skills to improve their health. Policy recommendation based on our findings are discussed.

Untangling the ‘health paradox’ among adolescent girls: the role of immigration status, depression, and decision-making