Social Patterning in Body Mass Index (BMI) Among Contemporary Immigrant Groups: The Emergence of a Gradient

Experiences of victimization before resettlement and chronic disease among foreign-born people in the United States

Stressful experiences are common among migrants and may have health implications. With the only US nationally representative data set on migration, the New Immigrant Survey, we used survey-adjusted descriptive and multivariate regression methods to examine whether victimization prior to resettlement was associated with obesity, cardiovascular disease, diabetes, arthritis, cancer, and chronic lung disease. Among foreign-born people who obtained lawful permanent residence in the US in 2003-04, 6.7 per cent reported victimization before arriving in the US. Those who had experienced victimization more often suffered from chronic conditions than people without such experiences: they were 32 per cent more likely to suffer from at least one chronic condition (p < 0.05), especially cancer (4.36, p < 0.05), arthritis (1.77, p < 0.01), and cardiovascular disease (odds ratio 1.32, p < 0.05). These relationships were in part mediated by differences in healthcare access after arriving in the US between those who had experienced victimization and those who had not. Victimization may have consequences for integration and later-life chronic disease.

Immigration and health among non-Hispanic whites: The impact of arrival cohort and region of birth

Immigration is central to our understanding of U.S. racial and ethnic health disparities, yet relatively little is known about the health of white immigrants - a group whose ethnic origins have become increasingly diverse. To the extent that whites are included in social stratification research, they are typically used as the reference category for gauging health inequities, with little attention to diversity among them. This study addresses this question using nationally representative data from the American Community Survey (2008-2017). We disaggregate non-Hispanic whites by nativity, region of birth, and period of arrival in the U.S. and examine differences in physical disability among adults aged 40 and older (n = 12, 075, 638). The analysis finds that foreign-born whites have a slightly lower prevalence of disability than U.S.-born whites, and this varies by arrival cohort. Immigrants who arrived in the 1981-1990 and 1991-2000 cohorts have a smaller advantage over U.S.-born whites than immigrants in the earlier and later cohorts. Compositional changes in the region of birth of white immigrants, especially the influx of eastern Europeans and Middle Easterners during the 1980s and 1990s, explained this variation. These findings challenge the oft-assumed notion that whites are a monolithic group and highlight growing intra-ethnic heterogeneity that is obscured by the aggregate category. Our findings also suggest that the standard practice of using whites as the reference for benchmarking health inequities may mask health inequities not only among them, but also between whites and other racial and ethnic populations.

How does whole of government action address inequities in obesity? A case study from Australia

Background

There are many factors across different sectors that contribute to inequities in obesity levels. This implies the need for action across different government departments and policy domains (hereafter referred to as whole of government multisectoral action). In this study we explored the public policy attention given to inequities in obesity using an Australian case study.

Methods

Interviews were conducted with 33 stakeholders involved in the development and implementation of the whole of government Healthy Weight Initiative (HWI). A thematic analysis was undertaken to identify ways in which government policy makers and implementers explicitly or implicitly described how actions delivered through the HWI addressed inequities in obesity within the population.

Results

The analysis revealed that the focus of the HWI was predominantly aimed at the general population, with minimal attention given to addressing the social distribution of obesity. The reasons for this were explained in terms of five themes: (1) rationale for a population wide approach; (2) when to apply an equity lens, (3) issues of government responsibility, (4) philosophically opposing concepts of equity, and (5) tensions across departments as a result of competing concepts of equity.

Conclusions

It is important to create a shared understanding plus a concern for addressing inequities in public policy, regardless of whether or not a universal population-wide or a targeted approach is being applied. It is also important that policies and programs address the social distribution of obesity while understanding local contexts and needs. In striving to develop policy that brings an explicit focus on health equity, policymakers must consider the sociological, political, economic, and philosophical tensions at play between different policy actors and government departments, and identify how to navigate these without reverting to siloed working.

Variation in the education gradient of body weight in contemporary China

Using data from the 1991–2009 China Health and Nutrition Surveys, this paper examines the temporal–spatial variation in the education gradient of body weight relative to height among Chinese adults, and how the variation is associated with levels of economic development. We find different variation patterns for men and women. For women, the education gradient in body weight shifted from being positive to being negative over time for China as a whole, as well as across regions with different levels of economic development. In contrast, for men, higher education remained consistently associated with higher body weight over the 18-year period studied in China as a whole, as well as across regions with different levels of economic development.

Migration Decisions, Acculturation, and Overweight among Asian and Latino Immigrant Adults in the United States

Using the 2002–2003 National Latino and Asian American Study (NLAAS), we examine relationships between acculturation, migration decisions, and overweight among Latino and Asian immigrants. Pooled logistic regression models showed no evidence that acculturation and migration decisions were related to overweight among Asians, but models for Latinos indicated that aspects of acculturation (duration of US residence and English proficiency) and migration decisions (moving to find a job) were significantly associated with overweight status. However, interaction models also highlighted the gendered nature of the acculturation–weight relationship, such that country-of-origin ties can have different implications for the overweight status of male and female immigrants.

Can the sociology of social problems help us to understand and manage 'lifestyle drift'?

Lifestyle drift is increasingly seen as a barrier to broad action on the social determinants of health. The term is currently used in the population health literature to describe how broad policy initiatives for tackling inequalities in health that start off with social determinants (upstream) approach drift downstream to largely individual lifestyle factors, as well as the general trend of investing a the individual level. Lifestyle drift occurs despite the on-going efforts of public health advocates, such as anti-obesity campaigners, to draw attention to the social factors which shape health behavior and outcomes. In this article, we explore whether the sociology of social problems can help understand lifestyle drift in the context of obesity. Specifically, we apply Jamrozik and Nocella's residualist conversion model to the problem of obesity in order to explore whether such an approach can provide greater insight into the processes that underpin lifestyle drift and inform our attempts to mitigate it.

Intergenerational persistence of health: Do immigrants get healthier as they remain in the U.S. for more generations?

It is well known that a substantial part of income and education is passed on from parents to children, generating substantial persistence in socioeconomic status across generations. In this paper, we examine whether another form of human capital, health, is also largely transmitted from generation to generation. Using data from the NLSY, we first present new evidence on intergenerational transmission of health outcomes in the U.S., including weight, height, the body mass index (BMI), asthma and depression for both natives and immigrants. We show that between 50% and 70% of the mothers' health status persists in both native and immigrant children, and that, on average, immigrants experience higher persistence than natives in BMI. We also find that the longer immigrants remain in the U.S., the less intergenerational persistence there is and the more immigrants look like native children. Unfortunately, the more generations immigrant families remain in the U.S., the more children of immigrants resemble natives' higher BMI.

Region of origin diversity in immigrant health: Moving beyond the Mexican case

Research suggests that Mexican immigrants arrive in the United States with equivalent or better health than native-born whites but lose their advantage over time. We seek to examine systematically how well the patterns of initial advantage and deteriorating health apply to immigrants originating from other regions of the world - regions that represent a growing proportion of U.S. immigrants. We begin by identifying which of the groups in our study have a health advantage compared to U.S.-born whites and to Mexican immigrants. We then we assess changes in health over time, controlling for variation in the health profiles of cohorts upon arrival. We use logistic regression of self-rated health and heart conditions with data from the 2004-2013 National Health Interview Survey. The results reveal diversity and similarity in health outcomes across world regions of origin, both on arrival and over time. By comparing and contrasting cases previously examined in isolation, we clarify and qualify theories of the immigrant health paradox and health deterioration.

Too Much of a Good Thing? Exploring the Impact of Wealth on Weight

Obesity, like many health conditions, is more prevalent among the socioeconomically disadvantaged. In our data, very poor women are three times more likely to be obese and five times more likely to be severely obese than rich women. Despite this strong correlation, it remains unclear whether higher wealth causes lower obesity. In this paper, we use nationally representative panel data and exogenous wealth shocks (primarily inheritances and lottery wins) to shed light on this issue. Our estimates show that wealth improvements increase weight for women, but not men. This effect differs by initial wealth and weight-an average-sized wealth shock received by initially poor and obese women is estimated to increase weight by almost 10 lb. Importantly, for some females, the effects appear permanent. We also find that a change in diet is the most likely explanation for the weight gain. Overall, the results suggest that additional wealth may exacerbate rather than alleviate weight problems.