Unpacking Acculturation and Migration Health Data

Transcription

1 Unpacking Acculturation and Migration Health Data Carmela Alcántara, PhD Robert Wood Johnson Foundation Meeting Washington, DC June 28, 2017

2 RWJF Convening June 28, Outline Immigrant Health Paradox Acculturation Data on Acculturation & Health Concluding Remarks

3 RWJF Convening June 28, Top Immigrant Populations by U.S. State

4 RWJF Convening June 28, IMMIGRANT HEALTH What happens to their health after they migrate?

5 RWJF Convening June 28, Immigrant Health Paradox Immigrants have better health profiles than their non-hispanic White and US-born counterparts. Health paradox not consistent across specific immigrant subgroups. Health advantages deteriorate with increased duration in US. Source: Cunningham et al., 2008; Escarce, Morales, & Rumbaut, 2006; Ruiz et al, 2013

6 Rate of Any Disorder N(%) RWJF Convening June 28, Figure 1. Lifetime Prevalence Rates of Any Psychiatric Disorder According to Nativity and Ethnicity 60 Non-Latino White Puerto Rican 50 Cuban Mexican Other Latino US-Born a p<.001 b p<.05 Immigrant Source: Alegría, Canino, Shrout et al. 2008, American Journal of Psychiatry

7 RWJF Convening June 28, Cardiovascular Health in the Hispanic Community Health Study/Study of Latinos Foreign-born US-born 5 0 Coronary Heart Disease 3+ Cardiovascular Disease Risk Factors Source: Daviglus, Talavera et al. 2012, JAMA

8 RWJF Convening June 28, Intense Debate Is the immigrant health paradox real or an artifact?

9 RWJF Convening June 28, Figure. Contemporary Explanations for the Immigrant Paradox Psychosocial and Behavioral Paradox is true Specific cultural, psychosocial, and behavioral factors among immigrant communities lead to increased resiliency to confront disadvantage in relatively healthy ways Result in favorable health outcomes for immigrants (especially new arrivals) versus US natives. Increased stress exposure over time increases likelihood to engage in health risk behaviors (i.e., acculturation hypothesis). Sociological Paradox is true, but largely explained by migrant selectivity theory. Healthy migrant hypothesis: selection for individuals who are healthier than the general population Salmon hypothesis: immigrants return to their country of origin when they become seriously ill and are therefore statistically immortal Methodological Paradox is treated as false and nativity differences attributed to methodological factors. Misclassification of ethnicity on death certificates. Under-representation of ethnic groups in the census counts used to generate health statistics. Data artifacts related to immigrant versus native differences in response styles, stimulus familiarity, or construct bias. Source: Alcantara, Estevez, & Alegria, 2017, Oxford Handbook on Acculturation

10 RWJF Convening June 28, ACCULTURATION What happens after they migrate?

11 RWJF Convening June 28, Acculturation changes that take place as a result of contact with culturally dissimilar people, groups, and social influences Source: Schwartz, Unger, Zamboanga, & Szapocznik, 2010

12 RWJF Convening June 28, Schwartz, S. J., Unger, J. B., Zamboanga, B. L., & Szapocznik, J. (2010). Rethinking the concept of acculturation: Implications for theory and research. American Psychologist, 65(4), doi: /a American Psychological Association

13 RWJF Convening June 28, Factors Involved in Acculturation Process ethnicity discrimination context of reception race age at migration language Place cultural similarity acculturative challenges SES Source: Schwartz, Unger, Zamboanga, & Szapocznik, 2010

14 RWJF Convening June 28, ACCULTURATION & HEALTH

15 RWJF Convening June 28, 2017 Place, Acculturation, and Depression in Latina/os 17 Source: Kwag et al., 2012, Journal of Immigrant Minority Health

16 RWJF Convening June 28, BUT, ALSO ACCULTURATION STRESS

17 RWJF Convening June 28, Acculturation Stress a psychosocial stressor refers to the psychological distress/worry associated with the multidimensional process of acculturation Source: Berry, Chun, Balls Organista, & Marín, 2003

18 RWJF Convening June 28, Figure. Effect of Acculturation Stress on Insomnia Symptom Severity by Employment Status 20 predicted ISI Standardized Acculturation Stress Employment Employed Not Employed Figure Legend: Effect of acculturation stress (continuous) on ISI (continuous) in analyses weighted for sampling weights and adjusted for age, sex, site and ethnicity with an employment term (dichotomous), an acculturation stress term and an acculturation stress X employment term (interaction). Source: Alcantara et al., in preparation

19 RWJF Convening June 28, AND TRANSNATIONAL TIES

20 F&M November 19, 2015 Page 22 Transnational Ties development of frequent and enduring social, economic, political, or cultural ties between two or more countries Portes, 2003; Schiller, Basch, & Blanc, 1995

21 Probability of Current Smoker Status RWJF Convening June 28, Figure Predicted Probability of Current Smoker Status as a Function of Gender and Remittances Men Women 0.00 Did Not Send Money Sent Money Remittances Source: Alcantara, Molina, & Kawachi, 2015, American Journal of Public Health

22 Prevalence of MDE RWJF Convening June 28, Prevalence of Past-Year MDE by Gender and Number of Visits Men Women Number of Past-Year Visits to Country of Origin Source: Alcantara, Chen, & Alegria, 2015, Cultural Diversity & Ethnic Minority Psychology

23 RWJF Convening June 28, Concluding Remarks Acculturation is not assimilation. Limits to the acculturation proxies. Need to use acculturation measures that reflect the current multidimensional conceptualization. Acculturation processes interact with other social and contextual factors to alter health risk. Immigrants actively maintain transnational ties.

24 RWJF Convening June 28, Thank You Carmela Alcántara, PhD Columbia University