, Volume 54, Issue 1, pp 175–200 | Cite as

Explaining the Immigrant Health Advantage: Self-selection and Protection in Health-Related Factors Among Five Major National-Origin Immigrant Groups in the United States

  • Fernando RiosmenaEmail author
  • Randall Kuhn
  • Warren C. Jochem


Despite being newcomers, immigrants often exhibit better health relative to native-born populations in industrialized societies. We extend prior efforts to identify whether self-selection and/or protection explain this advantage. We examine migrant height and smoking levels just prior to immigration to test for self-selection; and we analyze smoking behavior since immigration, controlling for self-selection, to assess protection. We study individuals aged 20–49 from five major national origins: India, China, the Philippines, Mexico, and the Dominican Republic. To assess self-selection, we compare migrants, interviewed in the National Health and Interview Surveys (NHIS), with nonmigrant peers in sending nations, interviewed in the World Health Surveys. To test for protection, we contrast migrants’ changes in smoking since immigration with two counterfactuals: (1) rates that immigrants would have exhibited had they adopted the behavior of U.S.-born non-Hispanic whites in the NHIS (full “assimilation”); and (2) rates that migrants would have had if they had adopted the rates of nonmigrants in sending countries (no-migration scenario). We find statistically significant and substantial self-selection, particularly among men from both higher-skilled (Indians and Filipinos in height, Chinese in smoking) and lower-skilled (Mexican) undocumented pools. We also find significant and substantial protection in smoking among immigrant groups with stronger relative social capital (Mexicans and Dominicans).


Migration Health Selectivity Protection Immigrant adaptation 



This research was supported by grant R03HD066061 from the National Institute for Child Health and Human Development. We are also grateful for additional research, administrative, and computing support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)–funded University of Colorado Population Center (R24HD066613). Finally, we thank Francisca Antman, Tania Barham, Brian Cadena, Dick Jessor, and Trevon Logan, as well as the Demography Editorial team and three anonymous reviewers for comments and suggestions on this research.


  1. Abraído-Lanza, A. F., Armbrister, A. N., Flórez, K. R., & Aguirre, A. N. (2006). Toward a theory-driven model of acculturation in public health research. American Journal of Public Health, 96, 1342–1346.CrossRefGoogle Scholar
  2. Akresh, I. R. (2007). Dietary assimilation and health among Hispanic immigrants to the United States. Journal of Health and Social Behavior, 48, 404–417.CrossRefGoogle Scholar
  3. Akresh, I. R., & Frank, R. (2008). Health selection among new immigrants. American Journal of Public Health, 98, 2058–2064.CrossRefGoogle Scholar
  4. Alba, R., & Nee, V. (2004). Remaking the American mainstream: Assimilation and contemporary immigration. Cambridge, MA: Harvard University Press.Google Scholar
  5. Antecol, H., & Bedard, K. (2006). Unhealthy assimilation: Why do immigrants converge to American health status levels? Demography, 43, 337–360.CrossRefGoogle Scholar
  6. Arenas, E., Goldman, N., Pebley, A. R., & Teruel, G. (2015). Return migration to Mexico: Does health matter? Demography, 52, 1853–1868.CrossRefGoogle Scholar
  7. Baser, O. (2007). Choosing propensity score matching over regression adjustment for causal inference: When, why and how it makes sense. Journal of Medical Economics, 10, 379–391.CrossRefGoogle Scholar
  8. Bergeron, C. (2013). Going to the back of the line: A primer on lines, visa categories, and wait times (Issue brief). Washington, DC: Migration Policy Institute. Retrieved from
  9. Blue, L., & Fenelon, A. (2011). Explaining low mortality among US immigrants relative to native-born Americans: The role of smoking. International Journal of Epidemiology, 40, 786–793.CrossRefGoogle Scholar
  10. Boardman, J. D. (2009). State-level moderation of genetic tendencies to smoke. American Journal of Public Health, 99, 480–486.CrossRefGoogle Scholar
  11. Bosdriesz, J. R., Lichthart, N., Witvliet, M. I., Busschers, W. B., Stronks, K., & Kunst, A. E. (2013). Smoking prevalence among migrants in the US compared to the US-born and the population in countries of origin. PloS One, 8(3), 1–9. doi: 10.1371/journal.pone.0058654 CrossRefGoogle Scholar
  12. Botman, S. L., Moore, T. F., Moriarity, C. L., & Parsons, V. L. (2000). Design and estimation for the National Health Interview Survey, 1995–2004. Vital and Health Statistics, 2(130), 1–31.Google Scholar
  13. Bzostek, S., Goldman, N., & Pebley, A. (2007). Why do Hispanics in the USA report poor health? Social Science & Medicine, 65, 990–1003.CrossRefGoogle Scholar
  14. Cagney, K. A., Browning, C. R., & Wallace, D. M. (2007). The Latino paradox in neighborhood context: The case of asthma and other respiratory conditions. American Journal of Public Health, 97, 919–925.Google Scholar
  15. Christakis, N. A., & Fowler, J. H. (2008). The collective dynamics of smoking in a large social network. New England Journal of Medicine, 358, 2249–2258.CrossRefGoogle Scholar
  16. Christopoulou, R., Han, J., Jaber, A., & Lillard, D. R. (2011). Dying for a smoke: How much does differential mortality of smokers affect estimated life-course smoking prevalence? Preventive Medicine, 52, 66–70.CrossRefGoogle Scholar
  17. Colón-López, V., Haan, M. N., Aiello, A. E., & Ghosh, D. (2009). The effect of age at migration on cardiovascular mortality among elderly Mexican immigrants. Annals of Epidemiology, 19, 8–14.CrossRefGoogle Scholar
  18. Crimmins, E. M., Kim, J. K., Alley, D. E., Karlamangla, A., & Seeman, T. (2007). Hispanic paradox in biological risk profiles. American Journal of Public Health, 97, 1305–1310.CrossRefGoogle Scholar
  19. Crimmins, E. M., Soldo, B. J., Kim, J. K., & Alley, D. E. (2005). Using anthropometric indicators for Mexicans in the United States and Mexico to understand the selection of migrants and the “Hispanic paradox.” Social Biology, 52, 164–177.Google Scholar
  20. Cunningham, S. A., Ruben, J. D., & Venkat Narayan, K. M. (2008). Health of foreign-born people in the United States: A review. Health & Place, 14, 623–635.CrossRefGoogle Scholar
  21. Deaton, A. (2007). Height, health and development. Proceedings of the National Academy of Sciences, 104, 13232–13237.Google Scholar
  22. De Castro, A. B., Gee, G., Fujishiro, K., & Rue, T. (2015). Examining pre-migration health among Filipino nurses. Journal of Immigrant and Minority Health, 17, 1670–1678.Google Scholar
  23. Department of Homeland Security (DHS). (2013). Yearbook of immigration statistics: 2012. Washington, DC: U.S. Department of Homeland Security, Office of Immigration Statistics. Retrieved from
  24. Derose, K. P., Bahney, B. W., Lurie, N., & Escarce, J. J. (2009). Review: Immigrants and health care access, quality, and cost. Medical Care Research and Review, 66, 355–408.Google Scholar
  25. Diaz, C. J., Koning, S. M., & Martinez-Donate, A. P. (2016). Moving beyond salmon bias: Mexican return migration and health selection. Demography, 53, 2005–2030.CrossRefGoogle Scholar
  26. Docquier, F., & Rapoport, H. (2008). Skilled migration: The perspective of developing countries (IZA Discussion Paper No. 2873). Bonn, Germany: Institute for the Study of Labor. Retrieved from
  27. Elo, I. T., Turra, C. M., Kestenbaum, B., & Ferguson, B. R. (2004). Mortality among elderly Hispanics in the United States: Past evidence and new results. Demography, 41, 109–128.CrossRefGoogle Scholar
  28. Eschbach, K., Ostir, G. V., Patel, K. V., Markides, K. S., & Goodwin, J. S. (2004). Neighborhood context and mortality among older Mexican Americans: Is there a barrio advantage? American Journal of Public Health, 94, 1807–1812.CrossRefGoogle Scholar
  29. Feliciano, C. (2005). Educational selectivity in U.S. immigration: How do immigrants compare to those left behind? Demography, 42, 131–152.CrossRefGoogle Scholar
  30. Feliciano, C. (2008). Gendered selectivity: U.S. Mexican immigrants and Mexican nonmigrants, 1960–2000. Latin American Research Review, 43, 139–160.CrossRefGoogle Scholar
  31. Fenelon, A. (2013). Revisiting the Hispanic mortality advantage in the United States: The role of smoking. Social Science & Medicine, 82, 1–9.CrossRefGoogle Scholar
  32. Goldman, N., Pebley, A. R., Creighton, M. J., Teruel, G. M., Rubalcava, L. N., & Chung, C. (2014). The consequences of migration to the United States for short-term changes in the health of Mexican immigrants. Demography, 51, 1159–1173.CrossRefGoogle Scholar
  33. Grasmuck, S., & Pessar, P. R. (1991). Between two islands: Dominican international migration. Berkeley: University of California Press.Google Scholar
  34. Hoefer, M., Rytina, N., & Baker, B. (2012) Estimates of the unauthorized immigrant population residing in the United States: January 2011. Washington, DC: Department of Homeland Security, Office of Immigration Statistics, Policy Directorate. Retrieved from
  35. Hondagneu-Sotelo, P. (1994). Gendered transitions: Mexican experiences of immigration. Berkeley: University of California Press.Google Scholar
  36. Hooper, K., & Batalova, J. (2015, January 28). Chinese immigrants in the United States. Migration Information Source. Retrieved from
  37. Hummer, R. A., & Hayward, M. D. (2015). Hispanic older adult health & longevity in the United States: Current patterns & concerns for the future. Daedalus, 144, 20–30.CrossRefGoogle Scholar
  38. Hummer, R. A., Powers, D. A., Pullum, S. G., Gossman, G. L., & Frisbie, W. P. (2007). Paradox found (again): Infant mortality among the Mexican-origin population in the United States. Demography, 44, 441–457.CrossRefGoogle Scholar
  39. Hunt, L. M., Schneider, S., & Comer, B. (2004). Should “acculturation” be a variable in health research? A critical review of research on US Hispanics. Social Science & Medicine, 59, 973–986.CrossRefGoogle Scholar
  40. Jiménez, T. R., & Fitzgerald, D. (2007). Mexican assimilation. Du Bois Review: Social Science and Research on Race, 4, 337–354.CrossRefGoogle Scholar
  41. Jurkowski, J. M., & Johnson, T. P. (2005). Acculturation and cardiovascular disease screening practices among Mexican Americans living in Chicago. Ethnicity & Disease, 15, 411–417.Google Scholar
  42. Kenkel, D., Lillard, D. R., & Mathios, A. (2003). Smoke or fog? The usefulness of retrospectively reported information about smoking. Addiction, 98, 1307–1313.CrossRefGoogle Scholar
  43. Kennedy, S., Kidd, M. P., McDonald, J. T., & Biddle, N. (2014). The healthy immigrant effect: Patterns and evidence from four countries. Journal of International Migration and Integration, 16, 317–332.CrossRefGoogle Scholar
  44. Kimbro, R. T. (2009). Acculturation in context: Gender, age at migration, neighborhood ethnicity, and health behaviors. Social Science Quarterly, 90, 1145–1166.CrossRefGoogle Scholar
  45. Landale, N. S., Gorman, B. K., & Oropesa, R. S. (2006). Selective migration and infant mortality among Puerto Ricans. Maternal and Child Health Journal, 10, 351–360.CrossRefGoogle Scholar
  46. Landale, N. S., Oropesa, R. S., & Gorman, B. K. (2000). Migration and infant death: Assimilation or selective migration among Puerto Ricans? American Sociological Review, 65, 888–909.CrossRefGoogle Scholar
  47. Lara, M., Gamboa, C., Kahramanian, M. I., Morales, L. S., & Bautista, D. E. H. (2005). Acculturation and Latino health in the United States: A review of the literature and its sociopolitical context. Annual Review of Public Health, 26, 367–397.CrossRefGoogle Scholar
  48. Lariscy, J. T., Hummer, R. A., & Hayward, M. D. (2015). Hispanic older adult mortality in the United States: New estimates and an assessment of factors shaping the Hispanic paradox. Demography, 52, 1–14.CrossRefGoogle Scholar
  49. Le Espiritu, Y. (1995). Filipino American lives. Philadelphia, PA: Temple University Press.Google Scholar
  50. Lillard, D. R., Christopoulou, R., & Lacruz, A. G. (2014). Re: “Validation of a method for reconstructing historical rates of smoking prevalence.” American Journal of Epidemiology, 180, 656–658.Google Scholar
  51. Lindstrom, D. P., & López-Ramírez, A. (2010). Pioneers and followers: Migrant selectivity and the development of U.S. migration streams in Latin America. Annals of the American Academy of Political and Social Science, 630, 53–77.CrossRefGoogle Scholar
  52. Lindstrom, D. P., & Massey, D. S. (1994). Selective emigration, cohort quality, and models of immigrant assimilation. Social Science Research, 23, 315–349.CrossRefGoogle Scholar
  53. Martinez, J. N., Aguayo-Tellez, E., & Rangel-Gonzalez, E. (2015). Explaining the Mexican-American health paradox using selectivity effects. International Migration Review, 49, 878–906.CrossRefGoogle Scholar
  54. Massey, D. S., & Riosmena, F. (2010). Undocumented migration from Latin America in an era of rising US enforcement. Annals of the American Academy of Political and Social Science, 630, 294–321.CrossRefGoogle Scholar
  55. McNamara, K., & Batalova, J. (2015, July 21). Filipino immigrants in the United States. Migration Information Source. Retrieved from
  56. National Center for Health Statistics (NCHS). (2008). 2007 National Health Interview Survey public use data release: NHIS survey description. Hyattsville, MD: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.Google Scholar
  57. Ng, M., Freeman, M. K., Fleming, T. D., Robinson, M., Dwyer-Lindgren, L., Thomson, B., . . . Gakidou, E. (2014). Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. Journal of the American Medical Association, 311, 183–192.Google Scholar
  58. Nwosu, C., & Batalova, J. (2014, July 18). Immigrants from the Dominican Republic in the United States. Migration Information Source. Retrieved from
  59. Orrenius, P. M., & Zavodny, M. (2005). Self-selection among undocumented immigrants from Mexico. Journal of Development Economics, 78, 215–240.CrossRefGoogle Scholar
  60. Osuna-Ramírez, I., Hernández-Prado, B., Campuzano, J. C., & Salmerón, J. (2006). Body mass index and body image perception in a Mexican adult population: The accuracy of self-reporting. Salud Publica De Mexico, 48, 94–103.Google Scholar
  61. Park, J., & Myers, D. (2010). Intergenerational mobility in the post-1965 immigration era: Estimates by an immigrant generation cohort method. Demography, 47, 369–392.CrossRefGoogle Scholar
  62. Patel, K. V., Eschbach, K., Ray, L. A., & Markides, K. S. (2004). Evaluation of mortality data for older Mexican Americans: Implications for the Hispanic paradox. American Journal of Epidemiology, 159, 707–715.CrossRefGoogle Scholar
  63. Portes, A., & Böröcz, J. (1989). Contemporary immigration: Theoretical perspectives on its determinants and modes of incorporation. International Migration Review, 23, 606–630.CrossRefGoogle Scholar
  64. Portes, A., & Zhou, M. (1993). The new second generation: Segmented assimilation and its variants. Annals of the American Academy of Political and Social Science, 530, 74–96.CrossRefGoogle Scholar
  65. Riosmena, F. (2010). Policy shocks: On the legal auspices of Latin American migration to the United States. Annals of the American Academy of Political and Social Science, 630, 270–293.CrossRefGoogle Scholar
  66. Riosmena, F., Everett, B., Rogers, R. G., & Dennis, J. A. (2015a). Negative acculturation and nothing more? Cumulative disadvantage and mortality during the immigrant adaptation process among Latinos in the United States. International Migration Review, 49, 443–478.CrossRefGoogle Scholar
  67. Riosmena, F., Palloni, A., & Wong, R. (2013). Migration selection, protection, and acculturation in health: A bi-national perspective on older adults. Demography, 50, 1039–1064.Google Scholar
  68. Riosmena, F., Root, E., Humphrey, J., Steiner, E., & Stubbs, R. (2015b). The waning Hispanic health paradox. Pathways, Spring, 25–29. Retrieved from
  69. Rubalcava, L. N., Teruel, G. M., Thomas, D., & Goldman, N. (2008). The healthy migrant effect: New findings from the Mexican family life survey. American Journal of Public Health, 98, 78–84.CrossRefGoogle Scholar
  70. Rubin, D. B. (2001). Using propensity scores to help design observational studies: Application to the tobacco litigation. Health Services and Outcomes Research Methodology, 2, 169–188.CrossRefGoogle Scholar
  71. Singh, G. K., & Hiatt, R. A. (2006). Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979–2003. International Journal of Epidemiology, 35, 903–919.CrossRefGoogle Scholar
  72. Teitler, J. O., Hutto, N., & Reichman, N. E. (2012). Birthweight of children of immigrants by maternal duration of residence in the United States. Social Science & Medicine, 75, 459–468.CrossRefGoogle Scholar
  73. Teitler, J., Martinson, M., & Reichman, N. E. (2015). Does life in the United States take a toll on health? Duration of residence and birthweight among six decades of immigrants. International Migration Review. Advance online publication. doi: 10.1111/imre.12207
  74. Turra, C. M., & Elo, I. T. (2008). The impact of salmon bias on the Hispanic mortality advantage: New evidence from Social Security data. Population Research and Policy Review, 27, 515–530.CrossRefGoogle Scholar
  75. Van Hook, J., Bean, F. D., Bachmeier, J. D., & Tucker, C. (2014). Recent trends in coverage of the Mexican-born population of the United States: Results from applying multiple methods across time. Demography, 51, 699–726.CrossRefGoogle Scholar
  76. Villarreal, A. (2014). Explaining the decline in Mexico-US migration: The effect of the Great Recession. Demography, 51, 2203–2228.CrossRefGoogle Scholar
  77. Viruell-Fuentes, E. A. (2007). Beyond acculturation: Immigration, discrimination, and health research among Mexicans in the United States. Social Science & Medicine, 65, 1524–1535.CrossRefGoogle Scholar
  78. Viruell-Fuentes, E. A., Morenoff, J. D., Williams, D. R., & House, J. S. (2011). Language of interview, self-rated health, and the other Latino health puzzle. American Journal of Public Health, 101, 1306–1313.CrossRefGoogle Scholar
  79. Weisbrot, M., Lefebvre S., & Sammut, J. (2014). Did NAFTA help Mexico? An assessment after 20 years (CEPR Reports and Issue Briefs 2014–03). Washington, DC: Center for Economic and Policy Research (CEPR). Retrieved from
  80. World Health Organization (WHO). (2008). World Health Survey. Geneva, Switzerland: World Health Organization. Retrieved from
  81. Zong, J., & Batalova, J. (2015, May 6). Indian immigrants in the United States. Migration Information Source. Retrieved from
  82. Zong, J., & Batalova, J. (2016, March 17). Mexican immigrants in the United States. Migration Information Source. Retrieved from

Copyright information

© Population Association of America 2017

Authors and Affiliations

  • Fernando Riosmena
    • 1
    Email author
  • Randall Kuhn
    • 2
  • Warren C. Jochem
    • 3
  1. 1.Population Program and Geography DepartmentUniversity of Colorado at BoulderBoulderUSA
  2. 2.UCLA Fielding School of Public Health, Department of Community Health Sciences and the California Center for Population ResearchUniversity of CaliforniaLos AngelesUSA
  3. 3.Department of Geography and EnvironmentUniversity of SouthamptonSouthamptonUK

Personalised recommendations