Immigration and Health: Volume 19

Age at migration is commonly utilized as a proxy measure for assimilation in health behavior research. We reconsider this approach by examining the role of continued connection with places of origin on alcohol use, an important marker of health behavior and overall population health. Cross-border connections may buffer the association between earlier age at migration and alcohol use by providing an alternative channel of influence for behavioral norms. Alternatively, a stress and coping perspective on cross-border ties suggests potentially countervailing adverse impacts of these connections on alcohol use. We used data from the 2002/2003 National Latino and Asian American Study (NLAAS) (n = 1,641/1,630 Asian and Latino origin respondents, respectively). We first estimated the association between age at migration (child/adolescent versus adult migrant) and any past-year alcohol use. We subsequently tested the interaction between age at migration and two measures of cross-border connections. All models were stratified by region of origin and gender. For Latin American-origin women, cross-border ties were associated with increased risk of past-year alcohol use among those who migrated early in life. In contrast, Asian-origin men and women who migrated as adults and had contact with family and friends abroad had the lowest predicted probabilities of past-year alcohol use. The results among Asians support the idea that cross-border ties may be alternative influences on health behavior outcomes, particularly for adult migrants. Overall, we find qualified support for both transnational and assimilationist perspectives on alcohol use behaviors among US immigrants – as well as the interaction between these two frameworks. The joint influences of cross-border ties and age at migration were observed primarily for immigrant women, and not always in expected directions. We nevertheless urge future research to consider both US and country of origin influences on a wider range of health and health behavior outcomes for immigrants, as well as the potential intersection between US and cross-border connections.

The Russian Federation is the scene of one of the fastest-growing HIV epidemics in the world. In dialogue with the scholarship on gendered connections between migration and HIV/STIs, this study employs unique survey and qualitative data to examine HIV/STI-related risks and attitudes among working migrant women from three Central Asian countries and their native counterparts in three Russian cities. The analyses focus on involvement in risky sexual relationships, negotiation of trust and safer sexual practices in permanent partnerships, worries about HIV infection, and experience of HIV testing by comparing natives and migrants as well as migrants of different legal statuses. The results suggest that while migrant women are generally less likely to engage in risky behavior, they are also less able to establish trust and to negotiate safer sex within their permanent partnerships, compared to native women. Migrants are less worried about HIV risks than are native women. Finally, migrant women are less likely to get tested for HIV than natives, but the analyses also point to a particular disadvantage of migrants with temporary or irregular legal status. The findings are interpreted within the structural and cultural constraints that shape migrant women’s lives in Russia and similar migrant-receiving contexts.

Social scientists often speculate that both acculturation and socioeconomic status are factors that may explain differences in the body weight between Mexican Americans and whites and between Mexican Americans and Mexican immigrants, yet prior research has not explicitly theorized and tested the pathways that lead both of these upstream factors to contribute to ethnic/nativity disparities in weight. We make this contribution to the literature by developing a conceptual model drawing from Glass and McAtee’s (2006) risk regulation framework. We test this model by analyzing data from the 1999–2012 National Health and Nutrition Examination Survey (NHANES). Our conceptual model treats acculturation and socioeconomic status as risk regulators, or social factors that place individuals in positions where they are at risk for health risk behaviors that negatively influence health outcomes. We specifically argue that acculturation and low socioeconomic status contribute to less healthy diets, lower physical activity, and chronic stress, which then increases the risk of weight gain. We further contend that pathways from ethnicity/nativity and through acculturation and socioeconomic status likely explain disparities in weight gain between Mexican Americans and whites and between Mexican immigrants and whites. Study results largely support our conceptual model and have implications for thinking about solutions for reducing ethnic/nativity disparities in weight.

The fact that Mexican immigrants are healthier than their US-born co-ethnics has been well established. The subsequent observation that this health advantage diminishes over time and with increased acculturation is confirmed by only limited research and is severely compromised by several methodological shortcomings. Our analysis directly tests the acculturation hypothesis by investigating childhood health at an early age; specifically, we explore the relationships between birth-weight, primary language spoken, maternal nativity, and stature for age (SFA) among a sample of respondents to the NHANES III Youth survey data. Results indicate that a substantially large portion of the health advantages transferred from mother to child among the Mexican-born are due to birth-weight advantages. After controlling for health advantages conferred at birth among the foreign-born, language differences fully account for nativity differences between Mexican- and US-born mothers, suggesting an additional protective effect of Spanish-language maintenance and lending evidence to the hypothesis that language-based acculturation erodes health among Mexican Americans.

Latinos in the United States have poor outcomes for periodontal and dental health. However, a detailed description of the mechanisms driving these patterns has only recently started to be addressed in the literature. In the current study, we explore relationships between individual-level characteristics of Mexican immigrants, properties of their networks, and experiences of dental problems. Specifically, using data from an urban community of Mexican immigrants to the American Midwest (n = 332), this study examines how characteristics of oral health matters (OHM) discussion networks and individual-level sociodemographic characteristics are associated with four adverse oral health outcomes. The results provide strong support for relationships between immigrants’ network characteristics and dental problems. We find that people with more dental problems talk about these issues more frequently with network ties. Conversely, stronger relationships with OHM discussion networks, as measured by mean closeness, are predictive of fewer dental problems. In addition, we identify a link between perceptions of alters’ knowledge about teeth, mouth, and gums and egos reporting better oral health outcomes. The observed patterns are suggestive of mechanisms of social influence that are well replicated in the social, medical, and public health literatures, but that have seldom been empirically tested in the domain of oral health. Though preliminary, our findings suggest a potential explanatory role for social networks in some of the most important questions and problems in oral health disparities research. In all, our findings suggest that social network members are active participants in the management and response to oral health problems in this immigrant group and should be considered an important factor in the development and course of diseases.

Past studies have shown wide variation in the obesity rates of Asian American ethnic subgroups. However, whether weight-related behaviors that occur during acculturation are associated with obesity disparities among Asian American ethnic subgroups is unknown. This study examines the differences in body mass index (BMI) across Asian American ethnic subgroups and assesses how acculturation and weight-related behaviors influence these differences. The linear regression models employed in this study use data pools from 2011 to 2014 released by the California Health Interview Survey (CHIS). The sample comprises 3,248 foreign-born Asian Americans aged 18–59 years. Asian Americans who spoke fluent English had significantly lower BMIs than those who spoke poor English, but English fluency did not explain body size disparities among Asian American ethnic subgroups. Filipino Americans had the highest average BMI (25.89 kg/m²) and obesity rate (53.12%), and they were particularly prone to engage in unhealthy weight-related behaviors, such as consuming fast food, drinking soda, and engaging in sedentary lifestyles. However, weight-related behaviors did not explain their high risk of obesity compared to other Asian American ethnic subgroups. The results underscore the potential for misinterpretation when pan-ethnic labels, such as Asian American, collapse the unique experiences of different immigrant origin groups. Future research may investigate whether other factors that affect the acculturation process, such as attitudes, self-identity, beliefs, or experiences with racism and discrimination, explain obesity disparities among Asian American ethnic subgroups.

Social and economic disparities between racial/ethnic groups are a feature of the American context into which immigrants are incorporated and a key determinant of population health. We ask whether racial/ethnic disparities in diabetes vary by nativity and whether native-immigrant disparities in diabetes vary by race and over time in the United States. Using the 2000–2015 National Health Interview Survey, we estimate logistic regressions to examine the interaction of race/ethnicity, nativity, and duration in the US in shaping diabetes patterns. Relative to their native-born co-ethnics, foreign-born Asian adults experience a significant diabetes disadvantage, while foreign-born Hispanic, Black, and White adults experience a significant advantage. Adjusting for obesity, education, and other covariates eliminates the foreign-born advantage for Black and White adults, but it persists for Hispanic adults. The same adjustment accentuates the disadvantage for foreign-born Asian adults. For Black and Hispanic adults, the protective foreign-born effect erodes as duration in the US increases. For foreign-born Asian adults, the immigrant disadvantage appears to grow with duration in the US. Relative to native-born White adults, all non-white groups regardless of nativity see a diabetes disadvantage because the racial/ethnic disadvantage either countervails a foreign-born advantage or amplifies a foreign-born disadvantage. Racial/ethnic differentials in diabetes are considerable and are influenced by each group’s nativity composition. Obesity and (for the foreign-born) time in the US influence these disparities, but do not explain them. These findings underscore the importance of unmeasured, systemic determinants of health in America’s race-conscious society.

Discrimination has been identified as a major stressor and influence on immigrant health. This study examined the role of perceived discrimination in relation to other factors, in particular, acculturation, in physical and mental health of immigrants and refugees. Data for US adults (18 +  years) were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Mental and physical health was assessed with SF-12. Acculturation and perceived discrimination were assessed with multidimensional measures. Structural equation models were used to estimate the effects of acculturation, stressful life effects, perceived discrimination, and social support on health among immigrants and refugees. Among first-generation immigrants, discrimination in health care had a negative association with physical health while discrimination in general had a negative association with mental health. Social support had positive associations with physical and mental health and mediated the association of discrimination to health. There were no significant associations between discrimination and health among refugees, but the direction and magnitude of associations were similar to those for first-generation immigrants. Efforts aiming at reducing discrimination and enhancing integration/social support for immigrants are likely to help with maintaining and protecting immigrants’ health and well-being. Further research using larger samples of refugees and testing moderating effects of key social/psychosocial variables on immigrant health outcomes is warranted. This study used multidimensional measures of health, perceived discrimination, and acculturation to examine the pathways between key social/psychosocial factors in health of immigrants and refugees at the national level. This study included possibly the largest national sample of refugees.

There is a conflation of Mexican origin with the category “undocumented immigrant” that targets and stigmatizes undocumented Mexicans – I call this Mexican illegality stigma. I assess whether Mexican illegality stigma negatively affects the psychological well-being of Mexican-origin individuals in the US, distinguishing between undocumented Mexicans and citizen Mexican Americans. I draw from the stress process model and 52 in-depth interviews – 30 with undocumented young adults from Mexico and 22 with US-born young adults of Mexican descent – to evaluate how undocumented Mexicans and citizen Mexican Americans experience Mexican illegality stigma and to determine whether it affects the psychological well-being of undocumented Mexicans in a distinct manner. I found that all respondents experienced social rejection and discrimination when they were assumed or perceived as undocumented Mexicans. While few of the US-born respondents were affected by these incidents, most undocumented young adults found these incidents stressful because they were humiliating, excluded them from valuable resources and opportunities, and forced them to incur financial burden (e.g., unfair fines), which disrupted their transition to adulthood processes such as parenthood and labor market advancement. This study found evidence that Mexican illegality stigma is a stressor and source of distress for undocumented young adults from Mexico. As opposition to undocumented immigration from Mexico intensifies, the hostile context may further strain the psychological well-being of undocumented Mexicans.

While the Affordable Care Act (ACA) promised to reduce inequalities in insurance coverage between Latinos and non-Latinos by expanding coverage, it also excluded a large portion of noncitizen immigrants. Past research has demonstrated that among Latinos, further inequalities have developed between citizens and noncitizens after the ACA took effect, but it is unclear if this pattern is unique to Latinos or is evident among non-Latinos as well. I use data from the 2011 to 2016 waves of the National Health Interview Survey (NHIS) (n = 369,386) to test how the relationship between citizenship status (native citizen, naturalized citizen, or noncitizen) and insurance coverage changed after the ACA, adjusting for health, demographic, and socioeconomic factors. I disaggregate the analysis by ethnicity to test whether this change differs between Latinos and non-Latinos. The analysis finds that after the ACA, naturalized citizens across ethnic groups moved toward parity with native citizens in health insurance coverage while the benefits of the ACA for noncitizens were conditional on ethnicity. For non-Latinos, lacking citizenship became less disadvantageous for predicting insurance coverage while for Latinos, lacking citizenship became even more disadvantageous in predicting insurance coverage. This bifurcation among noncitizens by ethnicity implies that while the ACA has strengthened institutional boundaries between citizens and noncitizens, this distinction is primarily affecting Latinos. The conclusion offers considerations on how legal systems of stratification influence population health processes.

This chapter proposes that efforts to improve our understanding of factors affecting migrant health and longevity in the United States must consider migrants’ labor market incorporation and the structural conditions under which they work. I use public-use death certificate data to examine whether there is a mortality penalty for foreign-born workers in the secondary sector industries of agriculture and construction. I focus on the decade of the 1990s for two contextual and empirical reasons: (1) the decade was characterized by economic restructuring, restrictive immigration policy, increased migration, and dispersion of migrants to new geographic destinations; and (2) the 1990s is an opportunistic decade because 19 states coded the industry and occupation of the decedent during this time. These numerator mortality data and Census denominator data are used to compare all-cause mortality rates between working-age (16–64 years) US-born and foreign-born agricultural and construction workers, the overall foreign-born population, and foreign-born workers in health care – an industry where the foreign-born tend to work in well-paid occupations that are well-regulated by the state. The results show a clear mortality penalty for foreign-born workers in agriculture and construction compared to the overall foreign-born population and foreign-born healthcare workers. The results also show the mortality penalty for foreign-born secondary sector workers varies by industry. These findings support the argument that bringing work into our analyses is critical to understanding the contextual and structural factors affecting migrant health and survival.

Past research on the immigrant health paradox suggests that children with immigrant parents may have a health advantage over those with US-born parents, especially if the parent is a recent immigrant. Other research emphasizes the social and economic challenges children with immigrant parents face, in part due to disadvantaged social class and racial/ethnic positions. Underlying physiological changes due to chronic stress exposures among children in immigrant families is one potential health disadvantage that may not yet be apparent in traditional health measures. To explore these biological disparities during childhood, I use national biomarker and survey data from the National Health and Nutrition Survey (NHANES) (N = 11,866) to evaluate parent nativity and educational status associations with low-grade inflammation, indicated by C-reactive protein (CRP), in children ages 2–15 years. I find that children with an immigrant parent, and particularly a low-educated immigrant parent, have higher CRP, net of birth, body mass index (BMI) and other factors, than children with a US-born parent with either a low or higher education. Comparing children with low-educated parents, those with a foreign-born parent have higher predicted CRP. The findings from this study provide new evidence that children living in immigrant families in the US may be facing higher levels of chronic stress exposure, as indicated by the increased risk of low-grade inflammation, than those with US-born parents. The physiological changes related to increased risk of inflammation, could set children in immigrant families on pathways toward mental and physical health problems later in the life course.