Neighborhood socioeconomic status and BMI differences by immigrant and legal status: evidence from Utah

Documentation Status and Self-Rated Physical Health Among Latinx Young Adult Immigrants: the Mediating Roles of Immigration and Healthcare Stress

Previous research has demonstrated that undocumented Latinx immigrants in the USA report worse physical health outcomes than documented immigrants. Some studies suggest that immigration-related stress and healthcare related-stress may explain this relationship, but none have tested it empirically. The purpose of this study was to determine if immigration-related stress and healthcare-related stress in the USA explain the relationship between documentation status and physical health among Latinx immigrants in North Carolina. The conceptual model was tested utilizing baseline data from a longitudinal, observational, community-engaged research study of young adult (18-44 years) Latinx immigrants residing in North Carolina (N = 391). Structural equation modeling was used to determine relationships among documentation status, healthcare, and immigration stress in the past six months, and self-rated physical health. Goodness-of-fit measures indicated that data fit the model well (RMSEA = .008; CFI = 1.0; TLI = .999; SRMR = .02; CD = .157). Undocumented individuals were more likely to experience immigration stress than their documented counterparts ([Formula: see text] = - 0.37, p < 0.001). Both immigration stress ([Formula: see text] = - 0.22, p < 0.01) and healthcare stress ([Formula: see text] = - 0.14, p < 0.05) were negatively related to physical health. Additionally, immigration stress was positively related to healthcare stress ([Formula: see text] = 0.72, p < 0.001). Results demonstrate that documentation status is an important social determinant of health. Passage of inclusive immigration and healthcare policies may lessen the stress experienced by Latinx immigrants and subsequently improve physical health.

Immigrant Legal Status Disparities in Health Among First- and One-point-five-Generation Latinx Immigrants in California

Restrictive US immigration laws and law enforcement undermine immigrant health by generating fear and stress, disrupting families and communities, and eroding social and economic wellbeing. The inequality and stress created by immigration law and law enforcement may also generate disparities in health among immigrants with different legal statuses. However, existing research does not find consistent evidence of immigrant legal status disparities in health, possibly because it does not disaggregate immigrants by generation, defined by age at migration. Immigration and life course theory suggest that the health consequences of non-citizen status may be greater among 1.5-generation immigrants, who grew up in the same society that denies them formal membership, than among the 1st generation, who immigrated as adolescents or adults. In this study, we examine whether there are legal status disparities in health within and between the 1st generation and the 1.5 generation of 23,288 Latinx immigrant adults interviewed in the 2005–2017 waves of the California Health Interview Survey. We find evidence of legal status disparities in heart disease within the 1st generation and for high blood pressure and diabetes within the 1.5 generation. Non-citizens have higher rates of poor self-rated health and distress within both generations. Socioeconomic disadvantage and limited access to care largely account for the worse health of legally disadvantaged 1st- and 1.5-generation Latinx adults in California.

Exploring the physical activity of Iranian migrant women in the United Kingdom: a qualitative study

PURPOSE

This article explores the role migration has on the physical activity of Iranian migrant women living in the United Kingdom.

METHOD

This qualitative study includes 22 first-generation Iranian migrant women, aged 24-64, residing in London. Data was collected through in-depth, semi-structured, individual interviews and was analyzed thematically.

RESULTS

The findings show that for those women from traditional backgrounds, migration corresponds with liberation from social and cultural pressures experienced in Iran and greater motivation to adopt a physically active lifestyle. However, for Iranian women who had arrived in the UK more recently and had a higher social standing in Iran, migration was associated with the loss of their careers, sources of income, and social networks. These issues were compounded by a lack of cohesion in Iranian migrant communities and poor access to local physical activity resources. This resulted in diminishing motivation and the subsequent de-prioritisation of the women's physical activity, even though they had regularly engaged in physical activity in Iran.

CONCLUSION

Despite migration leading to improving physical activity for some Iranian women, for others, migration leads to marginality in Britain. Local authorities and Iranian community organizations need to adopt innovative strategies to reach out to recent Iranian migrant women.

The Weight of Being Unauthorized? Legal Status Variation in the Association between US Exposure and Obesity among Hispanic Immigrants in Los Angeles

We examine whether exposure to the US, experienced under certain conditions of disadvantage, namely immigrant legal status, is associated with body weight. Using the pooled, cross-sectional 2001 and 2008 Los Angeles Family and Neighborhood Survey (LAFANS) (n = 2063), we examine whether body mass index (BMI) and obesity vary by Hispanic immigrants' legal status and time exposure to the US. The increased risk of obesity associated with greater US exposure is more pronounced among unauthorized Hispanic immigrants compared to their legally resident coethnic peers, after adjusting for age and age-at-arrival. It is not only residing in the US that is associated with increases in body weight, but residing in the US as an unauthorized immigrant. Improved data and methods are needed to facilitate research of greater policy significance and a refined understanding of how health integration processes vary by legal status.

Disentangling contributions of demographic, family, and socioeconomic factors on associations of immigration status and health in the United States

BACKGROUND

In the United States, immigration policy is entwined with health policy, and immigrants' legal statuses determine their access to care. Yet, policy debates rarely take into account the health needs of immigrants and potential health consequences of linking legal status to healthcare. Confounding from social and demographic differences and lack of individual-level data with sensitive immigration variables present challenges in this area of research.

METHODS

This article used the restricted California Health Interview Survey (CHIS) to assess differences in self-rated health, obesity, and severe psychological distress. Between US-born citizens, naturalised citizens, lawful permanent residents (LPR), undocumented immigrants, and temporary visa holders living in California.

RESULTS

Results show that while immigrant groups appear to have poorer health on the surface, these differences were explained predominantly by older age among naturalised citizens and by lower-income and education among LPRs and undocumented immigrants. Favourable family characteristics acted as protective factors for immigrants' health, especially among disadvantaged immigrants.

CONCLUSION

Immigration policy that limits access to healthcare and family support may further widen the health disadvantage among immigrants with less legal protection.

Length of residence and obesity risk among North African immigrant women in Italy

Obesity is one of the major risks for chronic health conditions. Immigrants from low- and middle-income to high-income countries show a tendency to weight gain, with the country of origin, lifestyle habits, socioeconomic status and length of residence as the main factors involved. Thus, the aim of this study was to analyze the association between fat distribution and obesity with length of residence and other socio-demographic variables in a sample of North African women migrated to Italy. Socio-demographic variables were collected by structured face-to-face interview. For the assessment of weight status and body composition, various anthropometric traits were directly measured by an expert anthropometrist. Data were analyzed using ANCOVA adjusted for age to test the differences between length of residence (divided into three groups) and logistic regression models adjusted for covariates to test the association between overweight and/or obesity and length of residence. Significant differences between the three groups were observed in waist circumference (p = 0.004), waist-to-hip ratio (p = 0.001), and upper arm muscularity (p = 0.025), with higher values in those with longer duration of residence. In the crude logistic regression model length of residence resulted positively associated with obesity with the odds of being obese increased by 2.4 times in long term immigrants [OR 2.364 (0.766; 7.296)]. After adjusting for covariate the association remained significant [OR 3.584 (0.779; 16.480)], and being poorly educated [OR 5.737 (0.641; 51.363)], unemployed [OR 6.892 (0.940; 50.528)] and not practicing regular physical activity [OR 17.736 (1.569; 200.418)] increased the odds ratio of being obese. In conclusion, length of residence, socioeconomic status, and physical activity were significantly correlated with obesity, with a longer duration of residence being positively associated with central fat adiposity and upper arm muscle area in North African migrant women.

Policies of Exclusion: Implications for the Health of Immigrants and Their Children

Public policies play a crucial role in shaping how immigrants adapt to life in the United States. Federal, state, and local laws and administrative practices impact immigrants' access to education, health insurance and medical care, cash assistance, food assistance, and other vital services. Additionally, immigration enforcement activities have substantial effects on immigrants' health and participation in public programs, as well as effects on immigrants' families. This review summarizes the growing literature on the consequences of public policies for immigrants' health. Some policies are inclusive and promote immigrants' adaptation to the United States, whereas other policies are exclusionary and restrict immigrants' access to public programs as well as educational and economic opportunities. We explore the strategies that researchers have employed to tease out these effects, the methodological challenges of undertaking such studies, their varying impacts on immigrant health, and steps that can be undertaken to improve the health of immigrants and their families.

Legal Status, Time in the USA, and the Well-Being of Latinos in Los Angeles

In the USA, undocumented Latino immigrants may have poorer health because of barriers to health care, stressors, and detrimental effects of immigration enforcement. Previous immigrant health research, however, suggests that recently arrived Latino immigrants have better health than US-born Latinos and their health deteriorates over time. Given the current environments that undocumented immigrants face, legal status is a structural factor that likely influences the patterns of immigrant health. Therefore, the aim of this study was to examine the extent to which physical and mental health differed by legal status and duration in the USA for the Latino population in Los Angeles County, California. We conducted analysis of Latino respondents (n = 1396) to the Los Angeles Family and Neighborhood Survey (L.A.FANS) Wave II. We examined self-reported health, depression measured by the Composite International Diagnostic Interview-Short Form, and blood pressure collected by trained interviewers. Respondents reported their legal status, time in the USA, and other sociodemographic characteristics. Regression models were used to test associations between each outcome and 1) legal status and 2) legal status by duration (≤ 15 and > 15 years) in the USA. Without taking duration into account, we found no significant differences in outcomes between undocumented, documented, or US-born Latinos. Taking duration into account, shorter duration undocumented immigrants had worse self-reported health than the US born. Undocumented immigrants, regardless of duration, had higher blood pressure than documented immigrants who had been in the USA for less time and the same level of blood pressure as the US born. In contrast, shorter duration documented immigrants had lower blood pressure compared to longer duration documented immigrants and US-born counterparts, and marginally lower blood pressure than shorter duration undocumented immigrants. The findings suggest that the "health advantage" generally presumed to exist among immigrants may not affect undocumented immigrants.

Documenting legal status: a systematic review of measurement of undocumented status in health research

Background

Undocumented status is rarely measured in health research, yet it influences the lives and well-being of immigrants. The growing body of research on undocumented status and health shows the need to assess the measurement of this legal status. We discuss the definition of undocumented status, conduct a systematic review of the methodological approaches currently taken to measure undocumented status of immigrants in the USA, and discuss recommendations for advancement of measurement methods.

Methods

We conducted a systematic review of 61 studies indexed in PubMed, conducted in the USA, and published from 2004 to 2014. We categorized each of the studies’ data source and type, measurement type, and information for classifying undocumented participants. Studies used self-reported or proxy measures of legal status.

Results

Information to classify undocumented participants included self-reported status, possession of a Social Security number, possession of health insurance or institutional resources, concern about deportation, and participant characteristics. Findings show it is feasible to collect self-reported measures of undocumented status.

Conclusions

We recommend that researchers collect self-reported measures of undocumented status whenever possible and limit the use of proxy measures. Validated and standardized measures are needed for within and across country measurement. Authors should provide methodological information about measurement in publications. Finally, individuals who are undocumented should be included in the development of these methodologies.

Trial registration

This systematic review is not registered.

Rural-Urban Disparities in Obesity Prevalence Among Working Age Adults in the United States: Exploring the Mechanisms

PURPOSE

Higher prevalence rates of overweight and obesity in rural America have been consistently reported, but sources of these disparities are not well known. This study presented patterns and mechanisms of these disparities among working age Americans.

DESIGN

Cross-sectional study.

SETTING

United States of America.

PARTICIPANTS

The study included 10 302 participants of the 2003-2008 National Health and Nutrition Examination Survey (NHANES) who were 20 to 64 years old, not pregnant, and with a body mass index ranging from 18.5 to 60.

MEASURES

Individual-level data were from NHANES including age, gender, race/ethnicity, immigrant status, education, and family income. The outcomes were prevalence of obesity and prevalence of overweight and obesity combined. Neighborhood data were constructed from the 2000 US Census providing tract-level information on family median income and built environmental features and from the 2006 ESRI ArcGIS 9.3 Data DVD providing tract-level park location information.

ANALYSIS

Geographic information system (GIS) methods were used to create a measure of spatial distance to local parks capturing park accessibility. Random intercept logistic and ordinal logit regression analyses were performed.

FINDINGS

Multivariate regression results showed that the odds of obesity was higher in rural areas compared to urban areas (odds ratio = 1.358, P < .001) net of demographic controls and that this gap was largely attributable to individual educational attainment and neighborhood median household income and neighborhood built environmental features. After controlling for these hypothesized mediators, the elevated odds associated with rural residence was reduced by nearly 94% and rendered statistically insignificant.

CONCLUSIONS

In this nationally representative cross-sectional sample, rural-urban obesity disparities were large and explained by rural-urban educational differences at the individual level and economic and built environmental differences at the neighborhood level.

Can socioeconomic factors explain geographic variation in overweight in Norway?

We explore if the geographic variation in excess body-mass in Norway can be explained by socioeconomic status, as this has consequences for public policy. The analysis was based on individual height and weight for 198,311 Norwegian youth in 2011, 2012 and 2013, stemming from a compulsory screening for military service, which covers the whole population aged seventeen. These data were merged with municipality-level socioeconomic status (SES) variables and we estimated both ecological models and two-level models with a random term at the municipality level. Overweight was negatively associated with income, education and occupation at municipality level. Furthermore, the municipality-level variance in overweight was reduced by 57% in females and 40% in males, when SES factors were taken into account. This suggests that successful interventions aimed at reducing socioeconomic variation in overweight will also contribute to reducing the geographic variation in overweight, especially in females.

The impact of migration on body weight: a review

Immigrants may be more vulnerable to obesity as a result of the immigration process. The aim of this article is to summarize current knowledge about the impact of immigration on body mass index (BMI). A systematic review was performed in accordance with PRISMA guidelines through a database search of scientific articles (last updated in August 2014). Thirty-nine articles were included and assessed. Results varied according to ethnic background, country of origin and host country. A consistent positive association between BMI and time since immigration was found among Hispanic, European and African immigrants. Less than half of the studies observed a positive association among Asian immigrants. The quality of the majority of the studies assessed was poor, reflecting a need to improve methodology and concept definition. Immigration appears to have a deteriorative effect on BMI. Underlying causes may include changes in nutrition and physical activity, psychological and social factors, and genetic susceptibility and these aspects should be included as moderator variables in future studies.