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

Abstract

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).

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Fig. 1
Fig. 2

Notes

  1. 1.

    The HHP is expressed by the favorable health profile of Hispanics as a whole relative to other ethnoracial groups in the United States (see Hummer and Hayward 2015). Because the HHP is especially present among the foreign-born, it is intimately related to the IHA. Thus, we use the HHP literature to inform our study.

  2. 2.

    In 2011, the estimated number of undocumented Indian, Chinese, and Filipino migrants stood, respectively, at 240,000; 280,000; and 270,000 (Hoefer et al. 2012: table 3). Dominican stocks are lower than 170,000 (Hoefer et al. did not report country-specific estimates lower than this number). Assuming a figure of approximately 150,000 and using the 2010 census total foreign-born stock figures for each country (see Hooper and Batalova 2015; McNamara and Batalova 2015; Nwosu and Batalova 2014; Zong and Batalova 2015), the percentage of immigrants from each of these nations who were undocumented circa 2011 ranged between 13 % and 17 %. In contrast, using similar calculations, the share for Mexico was approximately 57 %. Further, a majority of contemporary Mexican legal permanent residents had an undocumented spell prior to legalization (Riosmena 2010).

  3. 3.

    We begin with a simple setup in which X is a random variable representing the real value of height or premigration smoking for the Mexican-born population that one would obtain with perfect survey coverage. In practice, however, we observe only a certain proportion of individuals (for Mexican-born men and women, coverage errors are approximately 28 % and 15 %; Van Hook et al. 2014). As such, the real expected value is a weighted average of X o , the observed expected value; the probability of undercoverage, p(u); and X u , the expected value of for those who are not observed: E(X) = E(X o ) ∙ [1 – p(u)] + E(X u ) ∙ p(u). Using our NHIS estimates for X o and Van Hook et al.’s (2014) estimates for p(u), we calculate the value E(X u ) would need to be to close the height-smoking gap between immigrants in the NHIS and nonmigrants in the WHS. Immigrant men unobserved in the NHIS would need to be 12 cm (4.7 in.) shorter than individuals sampled in the NHIS to close the Mexican immigrant versus nonmigrant gap, which is a relatively large amount (e.g., three times higher than the observed migrant-nonmigrant height differences in our analyses). For women, this amount would need to be a whopping 20 cm (7.9 in), a highly implausible amount. Likewise, the raw prevalence of smoking for both men and women not observed in the NHIS would need to average above 80 % for migrant-nonmigrant differences to be an artifact of undercoverage—highly unrealistic values.

  4. 4.

    Migrant-nonmigrant differences are large and remarkably consistent across the educational groups most common in each immigrant subsample (not shown).

  5. 5.

    To minimize attrition-related biases, we also performed these tests among immigrants reporting less than one year since arrival in the United States, using only Indians and Mexicans, the two largest national-origin groups in the data. The degree of self-selection in height among Indian men as well as Mexican men and women with less than one year of U.S. experience is overall similar to that of more experienced migrants, with the most recently arrived Indian immigrant women indeed having a lower (and nonsignificant) height advantage. Likewise, although the premigration smoking advantage of immigrants appears to be reduced in the case of, for example, Indian men and Mexican women when only examining migrants with less than five or less than one year in the United States, these differences are not statistically significant. Thus, to the extent to which there is some self-selection in smoking, this does not appear to be explained away by the combination of attrition-related biases and cohort differences.

  6. 6.

    That is, we divide the difference between scenarios by the estimated smoking prevalence of immigrants upon arrival, and further subtract this figure by 100 to express it in percentage deviations.

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Acknowledgments

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.

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Riosmena, F., Kuhn, R. & Jochem, W.C. Explaining the Immigrant Health Advantage: Self-selection and Protection in Health-Related Factors Among Five Major National-Origin Immigrant Groups in the United States. Demography 54, 175–200 (2017). https://doi.org/10.1007/s13524-016-0542-2

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Keywords

  • Migration
  • Health
  • Selectivity
  • Protection
  • Immigrant adaptation