Social Work Immigration and Health Disparities
Kofi Danso
  • LAST MODIFIED: 12 January 2022
  • DOI: 10.1093/obo/9780195389678-0311


Migration continues to be an important component of globalization. With global movement comes migrants’ vulnerability, and the consequent intersection with health and health disparities. The immigrant population in the United States is expected to increase to about eighty-one million by 2050. This ongoing demographic transformation suggests that the health status, health risk behaviors, and health disparities of immigrants and their offspring may play a significant role in shaping the health outcomes of the American population. Immigrants are particularly considered a vulnerable population because of insufficient access to and utilization of health care, limited English proficiency, low socioeconomic status, immigrant status, stigmatization, marginalization, and increased risk for poor physical, psychological, and social health outcomes, especially among the working poor. These factors undoubtedly have detrimental effects on the health and health disparities of immigrants and their children. These social, environmental, and behavioral occurrences or life experiences accumulate over time to improve or jeopardize an individual’s health. Similarly, immigration policies have a tremendous impact on immigrant health disparities, especially during periods of strict and intense enforcement in the United States. Nativity has become a prominent domain in health disparities research. Given that nativity, racial, and ethnic health disparities continue to be a major public health concern, social work scholars and practitioners continue to work toward eliminating health disparities among population subgroups, including immigrants. Included in these discussions are immigrant health service use, immigrant health effects, salmon bias, and determinants of immigrant health. Also important in working with immigrants are problems with accessibility to health services.

General Overviews

This section of the article discusses literature on a broad spectrum of topics, ranging from immigration to immigrant health disparities to healthy-immigrant advantage, including predictors of immigrant health and health disparities. In this section, several books are identified as useful in providing discussions about immigration, immigrant health, and immigrant well-being. These books or references generally reflect on immigrant experiences and the extent to which certain characteristics influence their health and well-being. Findley and Matos 2015 discusses the role of community health workers in promoting better health among immigrants. Fernández-Kelly and Portes 2013 explore the factors that improve or diminish immigrant health. Deeper discussions on health and mental health of immigrants are provided in Hall 2020 and Walker and Barnett 2007. Illingworth and Parmet 2017 and Hilado and Lundy 2018 provide some details about work with immigrant and refugee mental health through collaborative efforts. A detailed understanding of the struggles of immigrants and their health, using case studies from several countries, is found in Park 2011. Other authors have examined the challenges of undocumented immigrants, including immigrants and refugee health (Kemp and Rasbridge 2004). Kolker 2011 also provides a detailed examination of the immigrant health advantage. Furthermore, Raphael 2016 investigates the intersection of public policy, immigrant experience, and health in seven immigrant-receiving nations.

  • Fernández-Kelly, P., and A. Portes. 2013. Health care and immigration: Understanding the connections. New York: Routledge.

    DOI: 10.4324/9781315868622Save Citation »Export Citation » Share Citation »

    This edited book investigates the relationship between health care and immigration in the United States. It demonstrates the extent to which medical institutions provide for the needs of the poor and most vulnerable in society. The authors portray how differences in federal, state, and local governance influence the health-care system and consequently the health and well-being of individuals living in those communities. It also explores health-care provisions, immigration policy, and other factors that contribute to the health of immigrants.

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  • Findley, S. E., and S. Matos. 2015. Bridging the gap: How community health workers promote the health of immigrants. Oxford: Oxford Univ. Press.

    DOI: 10.1093/med/9780199364329.001.0001Save Citation »Export Citation » Share Citation »

    Discusses the inequitable access to health care that contributes to the risk of chronic disease, stress, and lifestyle change of immigrants. It highlights that for community health programs to be effective, programs must be community driven and community oriented. Immigrants’ experiences are captured as case studies. Community health workers’ assistance in navigating the health system helps in making health care accessible for immigrant population and to overcome obstacles in the US health-care system through education, advocacy, and culturally competent practice.

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  • Hall, N. G., ed. 2020. Mental and behavioral health of immigrants in the United States: Cultural, environmental, and structural factors. London: Academic Press.

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    This edited volume reviews research on immigrant health and mental health, acculturation, and multicultural psychology. It has three sections; the first discusses the complex intersection between geography and social context of immigration, including acculturation and cultural orientations. Section 2 discusses mental health issues, and issues of LGBTQ+ individuals and their relationship with Latinx, Asian, and Middle East immigrant populations. Also, the book explores other topics such as alcohol abuse, sleep, and other disorders across various immigrant groups.

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  • Hilado, A., and M. Lundy. 2018. Models for practice with immigrants and refugees collaboration, cultural awareness and integrative theory. Thousand Oaks, CA: SAGE.

    DOI: 10.4135/9781506300214Save Citation »Export Citation » Share Citation »

    This book provides best practices specifically for working with trauma-exposed immigrants and refugees, and how to promote their mental health. It discusses best practices, and how to support the adjustment, acculturation, and empowerment of immigrants and refugees. It highlights ethical considerations across global settings and employs an ecological framework, Western theories, and integrative strategies to inform immigrants and refugees. The book discusses the role of social work in transnational work, and the need for a collaborative approach in working with immigrants and refugees.

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  • Illingworth, P. M., and W. E. Parmet. 2017. The health of newcomers: Immigration, health policy, and the case for global solidarity. New York: New York Univ. Press.

    DOI: 10.18574/nyu/9780814789216.001.0001Save Citation »Export Citation » Share Citation »

    Discusses immigrant health and access to health care. The authors explain the dangers of developing health policy based on ethnocentrism and xenophobia on immigrant and native populations. Challenges associated with extending health care to immigrants have consequently led to chronic diseases and premature death. The authors draw on rigorous legal and ethical arguments as well as empirical studies, including case studies. They highlight the need for global challenges such as poverty and climate change, among others, to inform health policy both for immigrants and natives.

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  • Kemp, C., and L. A. Rasbridge. 2004. Refugee and immigrant health: A handbook for health professionals. Cambridge, UK: Cambridge Univ. Press.

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    This handbook discusses physical health, including infectious disease risks, mental health, and spiritual issues of immigrants and refugees. The text discusses the characteristic differences between immigrants and refugees and the specific health and mental-health-care needs of each group, including women’s health. It also overviews the cultural traditions of various immigrants and refugees and their countries of origin, and the different health beliefs. The book is intended to build an understanding of cross-cultural health and cultural competence.

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  • Kolker, C. 2011. The immigrant advantage: What we can learn from newcomers to America about health, happiness, and hope. New York: Free Press.

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    There is growing evidence that immigrants tend to have better physical and mental health than most native-born Americans. The author writes about her research of second- and third-generation immigrants’ physical and mental health. The author gets into immigrant communities such as in Mexico, Jamaica, India, and Vietnam and introduces some fascinating details about cultures and customs that may promote health advantage. The rich details also include personal stories as case studies.

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  • Park, L. S. 2011. Entitled to nothing: The struggle for immigrant health care in the age of welfare reform. New York: New York Univ. Press.

    DOI: 10.18574/nyu/9780814768013.001.0001Save Citation »Export Citation » Share Citation »

    Lisa Sun-Hee Park writes about how immigration policies, health care, and welfare intertwine in the immigrant experience. She discusses how women of reproductive age were targeted for deportation as a part of “disciplining” immigrants. She provides a first-person account or case studies of the struggles of immigration, and how policies can better protect immigrant populations.

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  • Raphael, D., ed. 2016. Immigration, public policy, and health: Newcomer experience in developed nations. Toronto: Canadian Scholars.

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    This text observes how public policy affects the health of immigrants. It discusses welfare, along with political systems that shape health-care policy. The authors of this edited book use Canadian and international case studies to demonstrate the differential impact of public policy and the welfare state on the experience and outcomes of immigrant health. This is because these policies influence the quality of the distribution of the social determinants of health and its eventual health outcomes.

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  • Walker, P. F., and E. D. Barnett, eds. 2007. Immigrant medicine. St. Louis, MO: Saunders Elsevier.

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    Given the increasing wave of immigrants, this edited book provides a comprehensive guide about immigrant populations within the US health-care system in understanding the complexity of immigrant experiences for proper diagnoses, prevention, and treatment of diseases and disorders. The book is divided into several sections that tackle health topics ranging from medical screening and immunization to epidemiology of diseases, chronic illness, and mental health and illness as they relate specifically to immigrants and refugees.

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Immigrant Health Service Utilization

Immigrants are considered a vulnerable population. Lack of or limited accessibility to health resources has the potential to reduce their ability to maximize preventative care among immigrants. Other factors including but not limited to poverty, language barriers, and health risk behaviors have worsened the disparities of immigrant health. Understanding the determinants of immigrant health service use can help in the development of prevention and treatment programs to improve immigrant health. By implication, the provision of preventive services and care can reduce health-care costs and at the same time preserve the long-term health of individuals. Yang and Hwang 2016 highlight the importance of having a sound theoretical framework to understand health service utilization among immigrants. A systematic review of the literature is provided in Sarría-Santamera, et al. 2016. Several other studies compare the predictors of immigrant and nonimmigrant health service use, such as emergency department use (Tarraf and Gonzalez 2014), the use of eHealth (Wang, et al. 2018), and before and after the implementation of affordable care (Bustamante, et al. 2019). Other immigrant subgroups studied are first-generation immigrants, Latino day laborers, Latino youth, and female immigrants (Alberto, et al. 2020; Bessaha, et al. 2020; Seo and Strauss 2020) and refugees (Guess, et al. 2019). This section of the article explores some of the available literature on immigrant health service use.

  • Alberto, C. K., J. K. Pintor, A. P. Martínez-Donate, J. Chen, and A. N. Ortega. 2020. Health care access and utilization for Latino youth in the United States: The roles of maternal citizenship and distress. Medical Care 58.6: 541–548.

    DOI: 10.1097/MLR.0000000000001306Save Citation »Export Citation » Share Citation »

    Examines the association between maternal citizenship and health-care access and utilization among US-born Latino youth, and whether maternal distress is a moderator. Using the National Health and Interview Survey, the authors indicate that noncitizen mothers are more likely to be uninsured and to lack transportation for delaying care and are less likely to access and utilize health services for their youth compared to US-born mothers. Also, maternal distress moderates the association between maternal citizenship and youths’ health-care access and use.

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  • Bessaha, M. L., L. Cornelius, and G. J. Unick. 2020. Barriers to behavioral health service utilization among first-generation immigrant emerging adults. Social Work in Mental Health 8.1: 55–74.

    DOI: 10.1080/15332985.2019.1679323Save Citation »Export Citation » Share Citation »

    This study attempts to determine the predictors of health service use among first-generation immigrants and emerging adults (i.e., individuals transitioning to adulthood). The findings suggest that employed first-generation immigrants and black US-born emerging adults are less likely to use health services compared to unemployed and white emerging adults.

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  • Boyas, J. F., N. J. Negi, and P. Valera. 2017. Factors associated to health care service use among Latino day laborers. American Journal of Men’s Health 11.4: 1028–1038.

    DOI: 10.1177/1557988317694297Save Citation »Export Citation » Share Citation »

    Latino day laborers constitute a venerable population due to fear of deportation, workers’-rights abuse, and work and life stress, among other factors. However, the study suggests that a predisposing factor such as lack of documentation is associated with limited health service usage. Lack of health insurance, inability to pay for medical care, and lack of family approval of use of health services all contribute negatively to the limited use of health services.

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  • Bustamante, A. V., J. Chen, R. M. McKenna, and A. N. Ortega. 2019. Health care access and utilization among US immigrants before and after the Affordable Care Act. Journal of Immigrants and Minority Health 21.2: 211–218.

    DOI: 10.1007/s10903-018-0741-6Save Citation »Export Citation » Share Citation »

    This study uses the National Health and Interview Survey data from 2011 to 2016 to determine the impact of the implementation of the Patient Protection and Affordable Care Act (ACA) on immigrants and nonimmigrants. The study demonstrates that the ACA has bridged the health coverage gap between US citizens and noncitizen immigrants. Similarly, immigrants with five or more years of residency report greater access to insurance after ACA implementation.

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  • Guess, M. A., K. O. Tanabe, A. E. Nelson, S. Nguyen, F. R. Hauck, and R. J. Scharf. 2019. Emergency department and primary care use by refugees compared to non-refugee controls. Journal of Immigrant and Minority Health 21.4: 793–800.

    DOI: 10.1007/s10903-018-0795-5Save Citation »Export Citation » Share Citation »

    This study uses data from a medical center’s emergency department and primary care visits by refugees and nonrefugees to determine the extent of service use. The findings from the study indicate that refugees use fewer emergency services compared to nonrefugees. However, there is no difference in the use of primary care services. Non-English-speaking refugee patients are more likely to utilize emergency departments compared to refugee patients who are proficient in the English language.

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  • Sarría-Santamera, A., A. I. Hijas-Gómez, R. Carmona, and L. A. Gimeno-Feliú. 2016. A systematic review of the use of health services by immigrants and native populations. Public Health Reviews 37:28.

    DOI: 10.1186/s40985-016-0042-3Save Citation »Export Citation » Share Citation »

    Through a systematic review of databases, this study explores the evidence that assesses the use of health services between immigrants and native-born populations. The review suggests that immigrants are less likely to access health-care services compared to the native-born population. Differences exist between subgroups of immigrants. Some of the attributes considered include country of origin, legal status, reasons for migration, length of stay, generational status, and socioeconomic factors.

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  • Seo, J. Y., and S. M. Strauss. 2020. Association of cancer history and health care utilization among female immigrants using NHANES 2007–2016 data. Journal of Immigrant and Minority Health 22.6: 1208–1216.

    DOI: 10.1007/s10903-020-01090-7Save Citation »Export Citation » Share Citation »

    This study explores how a person’s cancer history influences the utilization of health services among adult female immigrants, using data from the National Health and Nutrition Examination Survey. Ronald M. Andersen’s behavioral model is applied in this study. The results from the multivariate logistics regression models indicate that an individual’s history of cancer is positively associated with past-year inpatient overnight stays but not with outpatient doctor’s visits.

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  • Tarraf, W. W. V., and H. M. Gonzalez. 2014. Emergency department services use among immigrant and non-immigrant groups in the United States. Journal of Immigrant Minority Health 16.4: 595–606.

    DOI: 10.1007/s10903-013-9802-zSave Citation »Export Citation » Share Citation »

    The authors use the Medical Expenditure Panel data (2000–2008) to model and compare differences in emergency departments use by noncitizens and foreign-born and US-born citizens. According to the study, noncitizens are less likely to use emergency department services compared to naturalized immigrants and US citizens. The notable difference in emergency use between the groups is partially attributable to the health-care need and availability of insurance.

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  • Wang, Y., D. P. Do, and F. A. Wilson. 2018. Immigrants’ use of eHealth services in the United States, National Health Interview Survey, 2011–2015. Public Health Reports 133.6: 677–684.

    DOI: 10.1177/0033354918795888Save Citation »Export Citation » Share Citation »

    This study uses the National Health Interview Survey to examine the differential use of eHealth services in the United States by immigration status. The findings suggest limited eHealth service use among naturalized and noncitizens as compared to US citizens. US citizens are more likely to communicate with physicians using the internet than are foreign-born citizens.

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  • Yang, P. Q., and S. H. Hwang. 2016. Explaining immigrant health service utilization: A theoretical framework. SAGE Open 6.2 (April–June).

    DOI: 10.1177/2158244016648137Save Citation »Export Citation » Share Citation »

    This paper proposes a theoretical framework to explain disparities in immigrant health service utilization. Some of the constructs in the framework include health-care need, resources, predisposing factors, and contextual conditions that are both general and immigrant specific, for the broader understanding of health service use of immigrants.

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Immigrants and Salmon Bias

Comparatively speaking, immigrants have lower mortality rates (i.e., mortality advantage) than native-born Americans even though they have lower socioeconomic status. This situation presents an epidemiological paradox. Attempts have been made to explain the paradox by using salmon bias and immigrant health advantage. Salmon bias hypothesis postulates that healthy migrants are less likely to return to their home country of origin compared to those who are unhealthy. The return migration of less healthy individuals is attributable to preference to die in the country of origin rather than stay in a host country. This consequently influences the mortality rates of immigrants in the host country. Immigrant health advantage posits that immigrants arrive as healthy individuals. However, their health declines after years of staying in the host country. In other words, people who are gravely ill or have disease conditions or disabilities are less likely to travel to another country, and therefore, healthy individuals are most likely to be the population that migrates to other countries. Fewer studies have evaluated salmon bias as a potential explanation for immigrant mortality advantage. The studies related to salmon bias clearly demonstrate inconsistencies in the findings. For example, some empirical studies have found salmon bias as an explanation to mortality advantage: for example, among Latinos (Abrafdo-Lanza, et al. 1999; Turra and Elo 2008), internal migrants in Sweden (Andersson and Drefahl 2017), and Western immigrants to China (Minsart, et al. 2017). Other empirical studies do not support the theory of salmon bias (Diaz, et al. 2016; Puschmann, et al. 2017; Wallace and Kulu 2018; Wallace and Kulu 2013).

  • Abrafdo-Lanza, A. F., B. P. Dohrenwend, D. S. Ng-Mak, and J. Blake Turner. 1999. The Latino mortality paradox: A test of the “salmon bias” and healthy migrant hypotheses. American Journal of Public Health 89.10: 1543–1548.

    DOI: 10.2105/AJPH.89.10.1543Save Citation »Export Citation » Share Citation »

    This paper investigates the mortality rates of Latino and non-Latino white populations and the return migration of Latinos. Also, the study tests the salmon bias hypothesis by using the National Longitudinal Mortality Study data. The results suggest that Cubans and Puerto Ricans have lower mortality compared to US-born non-Latino whites, and that neither the salmon bias nor healthy-migrant effects explains the findings.

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  • Andersson, G., and S. Drefahl. 2017. Long-distance migration and mortality in Sweden: Testing the salmon bias and healthy migrant hypothesis. Population, Space and Place 23.4: e2032.

    DOI: 10.1002/psp.2032Save Citation »Export Citation » Share Citation »

    Immigrants have lower mortality rates than native populations. This study explores salmon bias and healthy-migrant status of long-distance migrants in northern and southern Sweden as an explanation of lower mortality rates. The results demonstrate no differences between the mortality rates of residents from northern and southern Sweden, and further, no evidence of the healthy-migrant effect. There is evidence of salmon bias, since migrants were most likely to return to their place of origin before dying.

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  • Diaz, C. J., S. M. Koning, and A. P. Martinez-Donate. 2016. Moving beyond salmon bias: Mexican return migration and health selection. Demography 53.6: 2005–2030.

    DOI: 10.1007/s13524-016-0526-2Save Citation »Export Citation » Share Citation »

    Using the California Health Interview Survey and the Migrant Study, the authors explore the healthy-migrant effect due to the return of immigrant populations to their countries of origin before passing away. The findings suggest lesser chance of health-related return migration; however, limited access to health care increases the probability of return.

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  • Lu, Y., and L. Qin. 2014. Healthy migrant and salmon bias hypotheses: A study of health and internal migration in China. Social Science & Medicine 102 (February): 41–48.

    DOI: 10.1016/j.socscimed.2013.11.040Save Citation »Export Citation » Share Citation »

    Using a longitudinal survey, this study tests the healthy-migrant effect and salmon bias hypotheses as they relate to internal migration. The results support both hypotheses. Heathier individuals are more likely to emigrate from home, and among the migrants, those who have poor health are more likely to return to home. However, healthier migrants are more likely to stay in the host country.

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  • Minsart, A-F., H. Liu, S. Moffett, C. Chen, and N. Ji. 2017. Salmon bias and preterm birth among Western immigrants in China. Maternal and Child Health Journal 21.10: 1861–1866.

    DOI: 10.1007/s10995-017-2347-3Save Citation »Export Citation » Share Citation »

    The researchers examine immigrant populations from Western countries to determine differences between risk factors and health. The good outcomes of Western immigrants in Eastern countries could be due to selective immigration, along with the salmon bias, which observes the likelihood of individuals returning to their country of origin when a health risk arises. These data support salmon bias.

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  • Puschmann, P., R. Donrovich, and K. Matthijs. 2017. Salmon bias or red herring? Comparing adult mortality risks between natives and internal migrants. Human Nature 28.4: 481–499.

    DOI: 10.1007/s12110-017-9303-1Save Citation »Export Citation » Share Citation »

    This article empirically tests the salmon bias by tracking migrants after they left their cities, and compares mortality risks of those who stayed. In this study, salmon bias is rejected because the lower mortality rate is not caused by selective return migration. However, the study supports the healthy-migrant hypothesis.

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  • Turra, C. M., and I. T. Elo. 2008. The impact of salmon bias on the Hispanic mortality advantage: New evidence from social security data. Population Research and Policy Review 27.5: 515–530.

    DOI: 10.1007/s11113-008-9087-4Save Citation »Export Citation » Share Citation »

    This research focuses on the Hispanic mortality paradox, and the salmon bias, which is the selective return of less healthy Hispanics to their country of birth. The findings suggest a direct evidence of the role of salmon bias on the Hispanic mortality advantage.

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  • Ullmann, S. H., N. Goldman, and D. S. Massey. 2011. Healthier before they migrate, less healthy when they return? The health of returned migrants in Mexico. Social Science & Medicine 73.3: 421–428.

    DOI: 10.1016/j.socscimed.2011.05.037Save Citation »Export Citation » Share Citation »

    This study relies on data from the Mexican Migration Project to explore disparities in pre- and postmigration health. The findings suggest that migrants returned during the early years of their migration experience. However, these migrants have higher rates of chronic illness, including heart disease and obesity and smoking, than nonmigrants. The results also show that no difference exists in self-rated health, diabetes, or hypertension.

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  • Wallace, M., and H. Kulu. 2013. Migration and health in England and Scotland: A study of migrant selectivity and salmon bias. Population, Space and Place 20.8: 694–708.

    DOI: 10.1002/psp.1804Save Citation »Export Citation » Share Citation »

    This study investigates the health of migrants on the basis of their migration patterns. The study suggests that migrants have better health than nonmigrants, which includes chronic, long-term illnesses along with mortality rates. However, in this study, no evidence is found to support the salmon bias.

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  • Wallace, M., and M. Kulu. 2018. Can the salmon bias effect explain the migrant mortality advantage in England and Wales? Population, Space and Place 24.8: e2146.

    DOI: 10.1002/psp.2146Save Citation »Export Citation » Share Citation »

    The researchers observe the mortality rates in destination countries, and whether the salmon bias effect can account for the low mortality rates of foreign-born migrants. Using data from the Office for National Statistics Longitudinal Study, the study explores which populations experience migrant mortality advantages or the salmon bias effect. Regarding the healthy-migrant effect and the salmon bias, the researchers did not find strong evidence to support that either of these effects explain the migrant mortality advantage.

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Health Status: Immigrant Health Advantage

The immigrant health advantage or healthy-migrant-effect explains the health advantage of immigrants during the early years of their arrival and stay compared to native-born residents in a host country. Some of the common explanations for healthy-immigrant effect include the self-selective nature of migration, and financial resources to migrate with. However, the immigrant health advantage is not a permanent feature of immigrant life. The studies provided in this section demonstrate various results on the subject matter, as well as issues related to immigrant health advantage. However, immigrant health declines over time and across generations and converges with that of the native-born population. Obviously, individual and postsettlement factors contribute immensely to the decline in the initial immigrant health advantage. Various immigrant groups and health-related issues have been examined in understanding immigrant health advantage. Millett 2016 provides an extensive review of the literature on immigrant health advantage and child maltreatment. There are studies that compare immigrants and native-born populations (see Blue and Fenelon 2011; Hamilton 2015; Lu, et al. 2017; Vanhoutte, et al. 2019), while other studies focus on specific population groups such as refugees and other categories of immigrants (Lu and Ng 2019). Hispanic health advantage is also presented (see Blue and Fenelon 2011 and Diaz and Niño 2019). Taylor and Sarathchandra 2016 present a study related to black immigrant health advantage, especially among black immigrant women. Markides and Rote 2019 also examine immigrant health effects and old age in the United States and other Western countries. Lua, et al. 2017 presents research on the differences in the health of new arrivals.

  • Blue, L., and A. Fenelon. 2011. Explaining low mortality among US immigrants relative to native-born Americans: The role of smoking. International Journal of Epidemiology 40.3: 786–793.

    DOI: 10.1093/ije/dyr011Save Citation »Export Citation » Share Citation »

    This article explores the contribution of smoking-related mortality to differences in all-cause mortality of immigrant populations as compared to native-born populations. According to the authors, smoking explains more than 50 percent of the difference in life expectancy between immigrant men and native-born men, and 70 percent of the difference between immigrant women and native-born women. Similarly, over 75 percent of the life expectancy difference between US Hispanic and non-Hispanic white men and women is explained by smoking.

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  • Diaz, C. J., and M. Niño. 2019. Familism and the Hispanic health advantage: The role of immigrant status. Journal of Health and Social Behavior 60.3: 274–290.

    DOI: 10.1177/0022146519869027Save Citation »Export Citation » Share Citation »

    Discusses the effect that familism has on Hispanic immigrants’ health, using the Hispanic Community Health Study. The findings suggest that the relationship between familism and health varies and depends on the outcome under consideration. For example, Hispanics with strong attitudes toward family have fewer anxiety or depressive symptoms, and those who report the highest mental health outcomes also report high familism.

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  • Hamilton, T. G. 2015. The healthy immigrant (migrant) effect: In search of a better native-born comparison group. Social Science Research 54 (November): 353–365.

    DOI: 10.1016/j.ssresearch.2015.08.008Save Citation »Export Citation » Share Citation »

    Tod Hamilton considers factors that influence the healthy-migrant effect, such as immigrant culture and selective immigration, using March Population Survey. The results demonstrate that immigrants report 6.1 percent lower probabilities of reporting fair to poor health outcomes. They also found that when comparing US-born movers with immigrants, the difference was lessened, which indicates the possibility that higher physical-health outcomes may be due to selective migration and the unobservable characteristics.

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  • Lu, Y., N. Denier, J. S. Wang, and N. Kaushal. 2017. Unhealthy assimilation or persistent health advantage? A longitudinal analysis of immigrant health in the United States. Social Science & Medicine 195 (December): 105–114.

    DOI: 10.1016/j.socscimed.2017.11.019Save Citation »Export Citation » Share Citation »

    This study observes self-rated health trajectories of immigrants and native-born people. Results demonstrate that immigrants’ self-rated health remains stable during the period of the study, but there is a decline in health for the native-born population. Also, the results indicate that immigrants have an advantage in physical-health outcomes.

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  • Lu, C., and E. Ng. 2019. Healthy immigrant effect by immigrant category in Canada. Health Reports 30.4: 3–11.

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    Researchers observe the health immigrant effect among immigrants under the 2002 Immigrant and Refugee Protection Act (IRPA) in Canada. The results indicate that there are higher health outcomes for immigrants. The impact of IRPA was also observed in then-recent family-class immigrants. For refugees, those with less chronic conditions experienced healthy-migrant advantage, especially females. Even after adjusting for socioeconomic and health risk factors, the healthy-migrant advantage can be observed.

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  • Lua, Y., N. Kaushalb, N. Denier, and J. S.-H. Wang. 2017. Health of newly arrived immigrants in Canada and the United States: Differential selection on health. Health & Place 48 (November): 1–10.

    DOI: 10.1016/j.healthplace.2017.08.011Save Citation »Export Citation » Share Citation »

    This study examines the risk of overweight and chronic illness among new immigrants in the United States and Canada. The results indicate that new immigrants to the United States are more likely to be obese or overweight and have chronic diseases than their Canadian counterparts.

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  • Markides, K. S., and S. Rote. 2019. The healthy immigrant effect and aging in the United States and other Western countries. Gerontologist 59.2: 205–214.

    DOI: 10.1093/geront/gny136Save Citation »Export Citation » Share Citation »

    Considers healthy-migrant effects in the United States, Canada, Europe, and Australia in the early years of settlement, ten to twenty years, which is explainable by immigrant health selection, but observes that once immigrants reach old age, they are more likely than any other population to experience comorbidity and disability compared to nonimmigrants. Immigrants to Europe are health selected, but this is not as consistent in countries. Immigrant neighborhoods have positive health effects among older Hispanics in the United States but negative health effects in Europe.

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  • Millett, L. S. 2016. The healthy immigrant paradox and child maltreatment: A systematic review. Journal of Immigrant Minority Health 18.5: 1199–1215.

    DOI: 10.1007/s10903-016-0373-7Save Citation »Export Citation » Share Citation »

    This study examines the relationship between immigrant health advantage and child maltreatment, through an extensive review of the literature. The review suggests strong evidence for healthy-migrant paradox, maltreatment, and physical abuse. Regarding child neglect, immigrant families are less likely to abuse or mistreat their children but are also less likely to call child protective services, but they have higher rates of physical neglect and lack of supervision. Emotional and sexual abuse is associated with healthy-migrant advantage, but with inconclusive findings.

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  • Taylor, C. A. L., and D. Sarathchandra. 2016. Migrant selectivity or cultural buffering? Investigating the black immigrant health advantage in low birth weight. Journal of Immigrant Minority Health 18.2: 390–396.

    DOI: 10.1007/s10903-015-0194-0Save Citation »Export Citation » Share Citation »

    This paper studies migrant selectivity and cultural buffering as reasons for the healthy-migrant effect. The authors observed birth weights in children in the United States, comparing immigrant populations to nonimmigrant populations. The findings suggest that immigrant black mothers do have better health outcomes, which may be because of cultural buffering. This cultural support also reduces risky health behaviors among them.

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  • Vanhoutte, B., V. Loh, J. Nazroo, H. Kendig, K. O’Loughlin, and J. Byles. 2019. Selection, adaptation and advantage: Later life health and wellbeing of English migrants to Australia. Journal of Ethnic and Migration Studies 45.13: 2489–2507.

    DOI: 10.1080/1369183X.2018.1446823Save Citation »Export Citation » Share Citation »

    This study focuses on English adult migrants to Australia and compares their self-rated well-being later in their life. The authors observed selection, adaptation, and advantage as influences of the healthy-migrant effect. Social characteristics were considered to play a role in the overall health outcomes of migrants. Migrants reported a higher subjective quality of life than nonimmigrants, and better physical health.

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Determinants of Immigrant Health Disparities

Broadly speaking, immigrants’ health is influenced by several factors. Scholars have done some studies related to the determinants of immigrant health disparities. Although most scholars investigate sociodemographic and economic determinants of health, others concentrate on biomarkers, for instance. These studies are mostly about nonmedical factors that contribute to health inequalities between immigrants and nonimmigrants and among various immigrant groups. This section is divided into socioeconomic factors and neighborhood characteristics that promote disparities in immigrant health. These factors can ultimately contribute significantly to diseases and premature death.

Socioeconomic Factors and Immigrant Health

Access to both social and economic resources is central to the protection and determination of health outcomes of individuals. Available empirical studies on heath disparities argue that race, ethnicity, class (socioeconomic status), and nativity influence health and health disparities of immigrants. The role of socioeconomic characteristics and stigma on the health of various immigrant groups is addressed in Wang 2014 and Morey 2018. Alcántara, et al. 2014 examines the perception of social mobility on Latino immigrant health. Chang 2019 demonstrates the extent to which social determinants influence the health of immigrant families. Similarly, Haas, et al. 2012 also offers empirical evidence of health and socioeconomic status over the later life course on physical performance. Allen, et al. 2016 looks at the health of adolescent and young adults of various racial and ethnic groups, including immigrants. Khuu, et al. 2017 examines health literacy and other factors contributing to health disparities among Hmong. Rodríguez, et al. 2009 underscores perceived quality of care among undocumented and Latino immigrants and how it perpetuates health disparities. The authors of Omenka, et al. 2020 conducted a review of the literature on health-care experiences and needs of African immigrants. Vargas, et al. 2017 provides a conceptual view on the detrimental effects of socioeconomic and anti-immigrant policies on immigrant health.

  • Alcántara, C., C. N. Chen, and M. Alegría. 2014. Do post-migration perceptions of social mobility matter for Latino immigrant health? Social Science & Medicine 101 (January): 94–106.

    DOI: 10.1016/j.socscimed.2013.11.024Save Citation »Export Citation » Share Citation »

    Investigates the relationships among perceived social mobility, past-year major depression, and self-rated health of Latino immigrants. The study findings suggest that Cuban and Mexican immigrants are more likely than Puerto Rican migrants to perceive upward social mobility postmigration, while Puerto Rican migrants relative to Cuban and Mexican immigrants are more likely to perceive downward social mobility. Perceived downward social mobility is associated with poor health and past-year depression, compared to those who perceived no difference in social status.

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  • Allen, C. D., C. A. McNeely, and J. G. Orme. 2016. Self-rated health across race, ethnicity, and immigration status for US adolescents and young adults. Journal of Adolescent Health 58.1: 47–56.

    DOI: 10.1016/j.jadohealth.2015.09.006Save Citation »Export Citation » Share Citation »

    This article studies the self-rated health perceptions of racial, ethnic, and immigrant groups in the United States. The results indicate that there is no difference between both physical and mental health and body mass index, chronic conditions, functional limitations, and depressive symptoms cross-sectionally. However, the results are different in a longitudinal estimate of health and mental health across ethnic groups.

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  • Chang, C. D. 2019. Social determinants of health and health disparities among immigrants and their children. Current Problems in Pediatric and Adolescent Health Care 49.1: 23–30.

    DOI: 10.1016/j.cppeds.2018.11.009Save Citation »Export Citation » Share Citation »

    This researcher observed that immigrants are negatively affected by poverty, lack of food, housing insecurity, lack of educational attainment, and challenges with health-care access. Further, they face stigma, marginalization, difficulties with acculturation, and fear of deportation and immigration policies.

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  • Haas, S. A., P. M. Krueger, and L. Rohlfsen. 2012. Race/ethnic and nativity disparities in later life physical performance: The role of health and socioeconomic status over the life course. Journals of Gerontology Series B: Psychological Sciences and Social Sciences 67.2: 238–248.

    DOI: 10.1093/geronb/gbr155Save Citation »Export Citation » Share Citation »

    This article observes the racial and ethnic disparities within the United States as they relate to socioeconomic status, nativity, adult and childhood health, and physical performance. Overall, it determines that there is a disparity between race and ethnicities, including immigrants within the United States.

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  • Khuu, B. P., H. Y. Lee, and A. Q. Zhou. 2017. Health literacy and associated factors among Hmong American immigrants: Addressing the health disparities. Journal of Community Health 43.1: 11–18.

    DOI: 10.1007/s10900-017-0381-0Save Citation »Export Citation » Share Citation »

    The burdens of health care and subsequent health disparities within Hmong Americans, and the contributing factors, influence health disparity. Ronald M. Andersen’s behavioral model of health service is the framework used. The literacy levels differed by length of stay in the United States, social or religious affiliations, health status, and difficulties in daily living of Hmong immigrants.

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  • Morey, B. N. 2018. Mechanisms by which anti-immigrant stigma exacerbates racial/ethnic health disparities. American Journal of Public Health 108.4: 460–463.

    DOI: 10.2105/AJPH.2017.304266Save Citation »Export Citation » Share Citation »

    This researcher looked at the effect the anti-immigrant narrative plays on the health disparities in immigrant populations. This narrative increases multilevel discrimination and stress, deportation and detention, and policies that limit resources.

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  • Omenka, O. I., D. P. Watson, and H. C. Hendrie. 2020. Understanding the healthcare experiences and needs of African immigrants in the United States: A scoping review. BMC Public Health 20.27: 1–13.

    DOI: 10.1186/s12889-019-8127-9Save Citation »Export Citation » Share Citation »

    African immigrants are the least-studied group of immigrants in the United States, who demonstrate lack of culturally competent health care, distrust, and complexity. Also mentioned are culture, religion, and spirituality, adding to the paucity of literature on this subgroup.

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  • Rodríguez, M. A., A. V. Bustamante, and A. Ang. 2009. Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. Journal of General Internal Medicine 24.S3: 508–513.

    DOI: 10.1007/s11606-009-1098-2Save Citation »Export Citation » Share Citation »

    Latino populations are more likely to experience persistent disparities in access to and quality of health care. The survey results demonstrate that undocumented Latinos have the lowest percentages of insurance coverage, usual care, blood pressure and cholesterol checked, and good care.

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  • Vargas, E. D., G. R. Sanchez, and M. Juárez. 2017. Fear by association: Perceptions of anti-immigrant policy and health outcomes. Journal of Health Politics, Policy, and Law 42.3: 459–483.

    DOI: 10.1215/03616878-3802940Save Citation »Export Citation » Share Citation »

    This study looks at the effect of the perception of living in states with anti-immigrant policies on health disparities, including the mental health of immigrants. This article expands on the research by finding that the health consequences associated with immigration policies affect Latinos, and recommends how policymakers should consider these negative effects during their decision-making.

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  • Wang, L. 2014. Immigrant health, socioeconomic factors, and residential neighbourhood characteristics: A comparison of multiple ethnic groups in Canada. Applied Geography 51 (July): 90–98.

    DOI: 10.1016/j.apgeog.2014.03.010Save Citation »Export Citation » Share Citation »

    This study examines the health and health-care use among multiple immigrant groups and native-born populations of Canada, using the Canadian Community Health Survey. Significant differences are identified among various subgroups in socioeconomic and lifestyle factors and material deprivation and ethnic density as determinants of health and service use.

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Neighborhood Effects: Immigrant Health

Alongside the increasing desire to determine and understand the patterns of disease and health on the basis of geographical areas and populations is a recognition that individual health is influenced not only by individual factors. Neighborhood effects on health or neighborhood context has become one of the dominant domains in immigrant health disparities. The neighborhood context encompasses both the social and spatial perspectives that affect individual health in society. Neighborhood effects on health are equally important to public health social workers who are interested in improving immigrant neighborhoods for better health. Using a nationally representative sample, Choi, et al. 2021 presents findings on the neighborhood and the health of immigrant children. A similar study is also discussed in George and Bassani 2013, pertaining to children in immigrant families. Danso 2017 explores the neighborhood, sociodemographic characteristics, and civic engagement and their effects on the health of immigrants. The differences in the health of native Canadians, overall foreign-born immigrants, and Chinese immigrants are discussed in Wang and Hu 2013, a comparative study. Ethnic enclaves and their impact on various immigrants’ health are investigated in other studies (Akresh, et al. 2016; Bjornstrom and Kuhl 2014; Guan, et al. 2021). Also, scholars have examined the effect of neighborhood context on specific diseases such as obesity (see Ishizawa and Jones 2016 and Wen and Maloney 2014) on immigrant oral health (see Mao, et al. 2020).

  • Akresh, I. R., D. P. Do, and R. Frank. 2016. Segmented assimilation, neighborhood disadvantage, and Hispanic immigrant health. Social Science & Medicine 149 (January): 114–121.

    DOI: 10.1016/j.socscimed.2015.12.013Save Citation »Export Citation » Share Citation »

    The purpose of this study was to examine the relationship between assimilation and health and changes resulting from neighborhood disadvantage, using data of Hispanics from the New Immigrant Survey, a nationally representative sample of immigrants. The results demonstrate that assimilation in the least disadvantaged neighborhoods serves as a protective factor against poor health. Lower neighborhood disadvantage is associated with a lower chance of poor health and being overweight among more assimilated men and women, respectively.

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  • Bjornstrom, E. E. S., and D. C. Kuhl. 2014. A different look at the epidemiological paradox: Self-rated health, perceived social cohesion, and neighborhood immigrant context. Social Science & Medicine 120 (November): 118–125.

    DOI: 10.1016/j.socscimed.2014.09.015Save Citation »Export Citation » Share Citation »

    Using the Los Angeles Family and Neighborhood Survey, the study investigates the effects of neighborhood immigrant concentration and perceived social cohesion on self-rated health. The findings indicate that foreign-born Latinos report good health compared to African Americans and whites. This finding is similar to US-born Latinos. Immigrant concentration is not associated with health, but its interaction with nativity has an influence on health. Also, perceived cohesion influences health, but immigrant concentration does not moderate health.

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  • Choi, J.-K., M. Kelley, D. Wang, and H. Kerby. 2021. Neighborhood environment and child health in immigrant families: Using nationally representative individual, family, and community datasets. American Journal of Health Promotion 35.7: 948–956.

    DOI: 10.1177/08901171211012522Save Citation »Export Citation » Share Citation »

    Investigates neighborhood effect on the physical and socioemotional health of children from immigrant families. The findings indicate that factors such as neighborhood trust, area-level poverty rate, and the presence of primary care physicians are significant predictors of children’s health. Foreign populations, green spaces, and food deserts are not significant contributors to children’s health. Parents’ racial and ethnic minority status, as well as nonmarital status, are risk factors for children’s health. Protective factors identified included parents’ financial resources and education.

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  • Danso, Kofi. 2017. Immigrant health disparities: Does neighborliness improve health? Journal of Sociology & Social Welfare 44.3: 75–94.

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    The author uses the California Health and Interview Survey to determine the extent of association between perceived neighborhood characteristics and immigrant and nonimmigrant health. The findings reveal that neighborhood safety, social cohesion, and civic engagement are positively associated with the health of immigrants and nonimmigrants. Age, employment, education, marital status, and poverty levels also contribute negatively to the health of immigrants and nonimmigrants.

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  • George, M. A., and C. Bassani. 2013. Does living in a neighbourhood with others of the same ethnic background contribute to health of Canada’s immigrant children? Canadian Journal of Public Health 104.7: e482–e486.

    DOI: 10.17269/cjph.104.4101Save Citation »Export Citation » Share Citation »

    This study helps in understanding neighborhood characteristics and their effects on the health of immigrants from Hong Kong, Philippines, and mainland China. The results suggest that immigrant girls exhibit excellent health as compared to immigrant boys. A similar result is observed among children living in a neighborhood with a lower mean education. Children from Hong Kong are less likely to report excellent health compared with Filipinos. There is a negative relationship between individual Chinese living in highly concentrated neighborhoods and good health.

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  • Guan, A., J. E. Kim-Mozeleski, P. Vyas, et al. 2021. Neighborhood ethnic composition and self-rated health among Chinese and Vietnamese American immigrants. Journal of Immigrant and Minority Health 23.3: 574–582.

    DOI: 10.1007/s10903-020-01041-2Save Citation »Export Citation » Share Citation »

    This study examines the association between neighborhood ethnic composition and self-rated health among Chinese and Vietnamese immigrants. The results show that the combination of Chinese and Vietnamese immigrants living in neighborhoods densely populated by whites is associated with poor health of the immigrants. In addition, the association of neighborhood household income and the density of participant ethnic groups is not correlated with poor health.

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  • Ishizawa, H., and A. Jones. 2016. Immigrant neighborhood concentration, acculturation, and obesity among young adults. Journal of Urban Affairs 38.2: 298–311.

    DOI: 10.1111/juaf.12208Save Citation »Export Citation » Share Citation »

    Uses data from the National Longitudinal Study of Adult Health to examine the relationships of acculturation, neighborhood characteristics, and obesity among young adults, including the moderating effects of neighborhood socioeconomic conditions. The results suggest that first-generation Asians are not associated with the healthy-immigrant advantage. For Hispanics, second, third, and higher generations are likely to be obese compared to their white counterparts. Areas of high concentrations of immigrants and linguistic challenges serve as risk factors for obesity.

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  • Mao, W., B. Wu, I. Chi, W. Yang, and X. Dong. 2020. Neighborhood cohesion and oral health problems among older Chinese American immigrants: Does acculturation make a difference? The Gerontologist 60.2: 219–228.

    DOI: 10.1093/geront/gnz126Save Citation »Export Citation » Share Citation »

    To further advance study on social determinants of health, this study explores the association between neighborhood cohesion and oral health of Chinese American immigrants. The study also determines the moderating role of acculturation in that relationship, using data from the Population Study of Chinese Elderly in Chicago. High neighborhood social cohesion is associated with the less likelihood of problems with oral health. Ethnic enclaves also moderated the effect of neighborhood cohesion on immigrant oral health.

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  • Wang, L., and W. Hu. 2013. Immigrant health, place effect and regional disparities in Canada. Social Science & Medicine 98 (December): 8–17.

    DOI: 10.1016/j.socscimed.2013.08.040Save Citation »Export Citation » Share Citation »

    Uses the Canadian Community Health Survey to explore immigrant health from the perspective both of social determinants and spatial effects among Canadian-born, overall foreign-born, and Chinese immigrants. The study suggests differences in the levels of relationship between self-rated health and individual and lifestyle behavioral characteristics and neighborhood material deprivation. Immigrant health advantage partially explains the health of foreign-born populations but is weak among Chinese immigrants. Neighborhood material deprivation is moderately associated with poor health, and ethnic concentration is negatively associated with self-rated health.

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  • Wen, M., and T. N. Maloney. 2014. Neighborhood socioeconomic status and BMI differences by immigrant and legal status: Evidence from Utah. Economics and Human Biology 12 (January): 120–131.

    DOI: 10.1016/j.ehb.2013.03.008Save Citation »Export Citation » Share Citation »

    This study examines the body-mass index (BMI) of legal and undocumented immigrants in the United States. The findings suggest that compared to legal immigrant women, undocumented women have higher odds of being obese and overweight. On the contrary, undocumented immigrant men have lower rates of obesity and being overweight compared to legal immigrant men, with slight differences regarding the effects of neighborhood context on these groups. In other words, immigrant health advantage is higher for men than women.

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Several journals are available for immigrant health scholars to use in their research and for publications purposes. Even though some of the journals do not have immigrant health as the focus, most of them accept manuscripts related to immigrants and immigrant health. It is also important to state that most of the articles in the journals are multidisciplinary and peer reviewed. A journal that clearly and distinctly states that it pays particular attention to immigrant and minority health is the Journal of Immigrant and Minority Health. A careful review of the other journals indicates that most of the international journals have health as their focus. These journals include the International Journal of Migration, Health and Social Care, the International Journal for Equity in Health, the International Journal of Environmental Research and Public Health, and the International Journal of Epidemiology. The other journals fall into the category of those that do not emphasize global health as their foci, but they do accept manuscripts related to health and minority populations, including immigrant health. Examples of these include the Journal of Community Health, the Journal of Health Politics, Policy and Law, the Journal of Health Care for the Poor and Underserved, and the Journal of Racial and Ethnic Health Disparities. Also, both the Journal of Ethnic and Migration Studies and the International Migration Review have migration as the main concentration. Other journals, though they do not have as their emphasis immigrant health, do not publish extensively on the subject matter either. Some such journals are Social Science & Medicine and the American Journal of Public Health.

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