Immigration and Health

Reanne Frank

• Publisher: Emerald Publishing Limited
• Year: 2019
• ISBN:
  9781787432512
• Topic: Ciencias sociales
• Subtopic: Emigración e inmigración

The current politicized climate around immigration includes heated debate over the potential costs of continued immigration for the health and well-being of the nation. Amid the controversy one pattern that has escaped significant notice is that immigrants today are healthier than the native-born. Even more striking is that these positive health profiles are found among those immigrants who tend to have less education and lower income, factors that population health researchers have typically associated with poor health. A final feature of contemporary immigrant health is evidence of a gradual loss of the immigrant health advantage with time in the U.S. and across generations.
These paradoxical patterns lie at the center of Volume 19 of Advances in Medical Sociology. Too often, immigrant health is set apart and treated as a specialty research area rather than as a topic that is central to understanding such core sociological concepts as stratification and inequality. The contributors in this volume all leverage a population health perspective to help unravel the patterns and paradoxes of immigrant health, and in doing so, help to clarify more broadly how health dis-parities emerge and persist in the contemporary U.S.

PART I
CROSS-NATIONAL PERSPECTIVES

RECONSIDERING THE RELATIONSHIP BETWEEN AGE AT MIGRATION AND HEALTH BEHAVIORS AMONG US IMMIGRANTS: THE MODIFYING ROLE OF CONTINUED CROSS-BORDER TIES

Jacqueline M. Torres, Annie Ro and May Sudhinaraset

ABSTRACT

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.

Keywords: Immigrants; alcohol use; cross-border ties; transnationalism; assimilation; age at migration

Scholarship on immigrant health behaviors has been historically dominated by an assimilationist framework, which focuses on how change and adaptation to the US “mainstream” may in turn impact behaviors that are influential for health and well-being. Within an assimilation-focused framework, the age at which immigrants migrate to the United States is a key predictor of norms, preferences, and behaviors that may be relevant for health. Scholars have observed that individuals who migrate as children or adolescents are more likely to engage in poor health behaviors, including smoking, drinking, and substance abuse, compared to their counterparts who migrate as adults (Alegría, Sribney, Woo, Torres, & Guarnaccia, 2007; Kimbro, 2009). These findings are seen as the result of longer exposure to norms and preferences in the US that favor poor health behaviors at critical developmental time points (e.g., childhood, adolescence), as well as greater cumulative exposure to the US over one’s lifetime (Caetano, 1987; Vaeth, Caetano, & Rodriguez, 2012).

More recently, immigrant health scholars have begun to consider a transnational framework (Abraído-Lanza, Echeverría, & Flórez, 2016; Acevedo-Garcia, Sanchez-Vaznaugh, Viruell-Fuentes, & Almeida, 2012; Villa-Torres et al., 2017), drawing on decades of scholarship in the social sciences that has considered the social, cultural, economic, and political engagement that immigrants often maintain even long after arrival in the US (Glick-Schiller, Basch, & Szanton-Blanc, 1995; Znaniecki & Thomas, 1918 [1996]). A transnational framework highlights immigrants’ cross-border ties, or contact with family and friends in their country of origin through long-distance communication, remittance sending, political participation, and return visits (Faist, Bilecen, Barglowski, & Sienkiewicz, 2015; Falicov, 2007; Waldinger, 2015). Scholars have begun to develop theory outlining hypothetical cultural and psychological pathways by which these transnational connections may impact health and health behaviors, as well as test the associations between ongoing cross-border connection and these outcomes (Alcántara, Chen, & Alegría, 2015; Alcántara, Molina, & Kawachi, 2015; Gorman & Novoa, 2016; Samari, 2016; Torres, Alcántara, Rudolph, & Viruell-Fuentes, 2016; Torres, Lee, González, Garcia, & Haan, 2016).

The adoption of a transnational framework represents an important correction to the dominance of a straight-line, assimilationist focus in immigrant health scholarship. Nevertheless, social scientists have suggested that an exclusively transnational lens may not accurately reflect the everyday lives of immigrants in the US and elsewhere. Instead, a combined approach that considers the simultaneous and interwoven processes of both US-oriented assimilation and transnational engagement may be preferable (Portes & Rumbaut, 2014; Safi, 2017; Waldinger, 2015). These processes may not only inform one another, but also work together to inform health behaviors among US immigrants.

In this chapter, we adopt this combined approach by first considering the independent associations between age at migration – a commonly utilized indicator of US assimilation in health research – and ongoing cross-border ties with immigrant health behavior in a national sample of Latino and Asian-origin migrants. We use alcohol consumption as the health behavior of interest in our empirical example; alcohol is a significant public health issue globally and in the US (WHO, 2014). Subsequent to the main effect associations, we test the interaction between age at migration and cross-border ties in their association with US immigrants’ alcohol use. We hypothesize that continued cross-border connection may diminish the adverse impact of earlier age at migration on subsequent health behaviors by providing an alternative channel of influence for immigrants’ behavioral norms and consumption preferences. However, emerging perspectives linking cross-border connections and health from a stress and coping perspective suggest that there may be both positive and negative impacts of these connections on health behaviors. We additionally consider differences by gender and region of origin, given prior research suggesting that the relationship between age at migration and alcohol use differs by gender as well as substantial differences in the prevalence of alcohol consumption across immigrants’ countries of origin.

BACKGROUND

The Emergence of a Transnational Framework in Immigrant Health Behavior Research

Immigrant health research has historically been dominated by attention to the ways in which immigrants assimilate, or acquire the social, cultural, economic, and political attributes typically ascribed to the US “mainstream.” There has been a particularly notable emphasis on the relationship between cultural dimensions of assimilation or acculturation (Abraido-Lanza, Armbrister, Florez, & Aguirre, 2006; Abraído-Lanza et al., 2016; Lara, Gamboa, Kahramanian, Morales, & Bautista, 2005). This literature typically adopts a “straight-line” assimilationist orientation, either explicitly or implicitly assuming that with increased time in the US, immigrants will be at greater risk of adopting the norms, preferences, and behaviors that are characteristic of their US-born counterparts (Abraído-Lanza et al., 2016).

This chapter considers age at migration as our marker of assimilation. This commonly adopted indicator of US assimilation incorporates information about both relative years spent in the US as well as the developmental timing of that exposure. In general, those who migrate at earlier ages may have a more accelerated assimilation trajectory than their counterparts who migrate in adulthood, and are often hypothesized to be at greater risk for adopting behaviors that are typical of the US population at large. Age at migration may also contribute to the development of key social influences on health behaviors, such as language, social networks, and environments (Leu et al., 2008). Compared to adults, children and adolescent immigrants are exposed to a greater number of institutions, such as schools, youth organizations, social clubs, and friendship networks that facilitate integration into their new society (Takeuchi, Hong, Gile, & Alegría, 2007). These early social relationships and environments may establish immigrants’ orientation toward alcohol use into adulthood (Zucker, Donovan, Masten, Mattson, & Moss, 2008), which is the focus of our empirical example.

In contrast to the focus on US-oriented assimilation of health behaviors, immigration scholars across the social sciences have long considered and debated the role of ongoing connection to places of origin for immigrants and their family members (Levitt & Jaworsky, 2007; Waldinger, 2015). These connections may be maintained through ongoing communication by mail, phone, text, or social media, through financial transfers or remittances, through return visits back to communities of origin, as well as ongoing engagement with political, economic, and cultural practices, even from a far.

A recent groundswell of literature theorizes and tests the relationships between ongoing transnational engagement – primarily by way of cross-border ties to family and friends and return visits – and the health of immigrants (Acevedo-Garcia et al., 2012; Viruell-Fuentes & Schulz, 2009). Within the transnationalism framework, cross-border ties are defined as the social connections maintained with close kin in countries of origin that not only include physical contact (such as visits) but may also include financial and cultural aspects of transnationalism.¹ Scholars have found evidence that cross-border contact with family and friends living in countries of origin is associated with mental health and overall well-being among immigrant populations in the US (Alcántara, Molina, et al., 2015; Samari, 2016; Torres, Alcántara, et al., 2016). While we are not aware of any empirical work examining the relationship between cross-border ties and alcohol use, some work has found a relationship between cross-border ties and other health outcomes, including self-rated health (Afulani, Torres, Sudhinaraset, & Asunka, 2016; Torres, 2013), health behaviors such as smoking (Alcántara, Molina, et al., 2015), as well as self-reported body mass index (Gorman & Novoa, 2016).

Most of the extant research on transnationalism and health has emphasized a stress and coping perspective, suggesting that maintaining contact with family and friends in communities of origin can serve as both a protective and a risk factor for emotional well-being (Alcántara, Chen, et al., 2015; Torres, Alcántara, et al., 2016). In particular, scholars suggest that ongoing cross-border connection may offer immigrants an “alternative space of belonging” (Viruell-Fuentes & Schulz, 2009) within a broader familial or ethnonational network that might have otherwise been disrupted by migration (Torres, Alcántara, et al., 2016). However, as with other social relationships, cross-border relationships may serve as a source of strain or burden. Conversely, cross-border relationships necessarily entail cross-border separation; cross-border separation may be linked to acute psychological distress for immigrants, particularly in a geopolitical context in which return visits to places of origin and/or family reunification in the US may be impossible.

There may be other pathways by which cross-border ties influence health behaviors among immigrants. Cross-border ties may serve as an important source of norms and social influence. For example, greater contact with the country of origin may contribute to patterns of health behavior that reflect country of origin trends. This viewpoint is informed by social norms theory, in which perceptions of peer behaviors have an effect on the individual’s own behavior (Maxwell, 2002; Rosenquist, Murabito, Fowler, & Christakis, 2010; Unger & Molina). In general, social networks and relationships play an important role in predicting alcohol consumption behavior (Rosenquist et al., 2010). Norms around health-related consumption patterns in countries of origin have been found to have long-term effects on health behaviors among immigrants. For example, Asian immigrants from countries with strong drinking cultures are more likely to have problematic drinking patterns after migrating to the US (Cook, Karriker-Jaffe, Bond, & Lui, 2014).

Continued cross-border ties may thus reinforce behavioral patterns that reflect immigrants’ places of origin, serving as an ongoing channel of influence for immigrants even after migration. Qualitative research has documented the influence of cross-border connections on the everyday dietary behaviors of immigrants in the US (Handley et al., 2013). In an analysis of data from a national sample of foreign-born Latinos living in the US, Alcántara and authors (2015) found that more frequent return visits to countries of origin was associated with greater odds of being a current smoker. However, sending remittances to family and friends abroad was associated with lower odds of being a current smoker, with particularly strong protective effects for women.

A Combined Approach: Considering both Assimilation and Transnationalism Frameworks

Theoretical and empirical contributions on transnational engagement and the health and health behaviors of immigrants represent important steps toward expanding the geographic lens of immigrant health research. Nevertheless, a perspective that incorporates ...