Unpacking Acculturation and Migration Health Data Carmela Alcántara, PhD Robert Wood Johnson Foundation Meeting Washington, DC June 28, 2017
RWJF Convening June 28, 2017 2 Outline Immigrant Health Paradox Acculturation Data on Acculturation & Health Concluding Remarks
RWJF Convening June 28, 2017 3 Top Immigrant Populations by U.S. State 2009-2013 http://www.migrationpolicy.org/programs/datahub/charts/top-immigrant-populations-us-state
RWJF Convening June 28, 2017 4 IMMIGRANT HEALTH What happens to their health after they migrate?
RWJF Convening June 28, 2017 5 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
Rate of Any Disorder N(%) RWJF Convening June 28, 2017 6 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 40 30 20 US-Born a p<.001 b p<.05 Immigrant Source: Alegría, Canino, Shrout et al. 2008, American Journal of Psychiatry
RWJF Convening June 28, 2017 7 25 Cardiovascular Health in the Hispanic Community Health Study/Study of Latinos 20 15 10 Foreign-born US-born 5 0 Coronary Heart Disease 3+ Cardiovascular Disease Risk Factors Source: Daviglus, Talavera et al. 2012, JAMA
RWJF Convening June 28, 2017 8 Intense Debate Is the immigrant health paradox real or an artifact?
RWJF Convening June 28, 2017 9 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
RWJF Convening June 28, 2017 10 ACCULTURATION What happens after they migrate?
RWJF Convening June 28, 2017 11 Acculturation changes that take place as a result of contact with culturally dissimilar people, groups, and social influences Source: Schwartz, Unger, Zamboanga, & Szapocznik, 2010
RWJF Convening June 28, 2017 12 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), 237-251. doi:10.1037/a0019330 2010 American Psychological Association
RWJF Convening June 28, 2017 13 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
RWJF Convening June 28, 2017 15 ACCULTURATION & HEALTH
RWJF Convening June 28, 2017 Place, Acculturation, and Depression in Latina/os 17 Source: Kwag et al., 2012, Journal of Immigrant Minority Health
RWJF Convening June 28, 2017 18 BUT, ALSO ACCULTURATION STRESS
RWJF Convening June 28, 2017 19 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
RWJF Convening June 28, 2017 20 Figure. Effect of Acculturation Stress on Insomnia Symptom Severity by Employment Status 20 predicted ISI 15 10 5-1 0 1 2 3 4 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
RWJF Convening June 28, 2017 21 AND TRANSNATIONAL TIES
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
Probability of Current Smoker Status RWJF Convening June 28, 2017 23 0.25 0.21 Figure. 0.20 0.19 Predicted Probability of Current Smoker Status as a Function of Gender and Remittances 0.15 0.10 0.05 0.10 0.05 Men Women 0.00 Did Not Send Money Sent Money Remittances Source: Alcantara, Molina, & Kawachi, 2015, American Journal of Public Health
Prevalence of MDE RWJF Convening June 28, 2017 24 Prevalence of Past-Year MDE by Gender and Number of Visits 0.25 0.2 0.15 0.1 Men Women 0.05 0 0 1 2 3 4 5 6 7 9 9 10 Number of Past-Year Visits to Country of Origin Source: Alcantara, Chen, & Alegria, 2015, Cultural Diversity & Ethnic Minority Psychology
RWJF Convening June 28, 2017 25 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.
RWJF Convening June 28, 2017 26 Thank You Carmela Alcántara, PhD Columbia University ca2543@columbia.edu