Shorter stay, longer life: age at migration and mortality among the older Mexican-origin population

Generation and age of immigration on later life cognitive performance in KHANDLE

OBJECTIVES

We examined the association of generational status and age at immigration with later life cognitive outcomes in a diverse sample of Latinos and Asian Americans.

DESIGN

Baseline data were obtained from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, and a prospective cohort is initiated in 2017.

SETTING

Older adults in Northern California.

PARTICIPANTS

Our cohort consisted of Asians (n = 411) and Latinos (n = 340) who were on average 76 years old (SD = 6.8).

MEASUREMENTS

We used multivariable linear regression models to estimate associations between generational status and age at immigration (collapsed into one five-level variable) with measures of verbal episodic memory, semantic memory, and executive function, adjusting for age, gender, race and ethnicity, and own- and parental education.

RESULTS

Generational status and age at immigration were associated with cognitive outcomes in a graded manner. Compared to third-generation or higher immigrants, first-generation immigration in adulthood was associated with lower semantic memory (β = -0.96; 95% CI: -1.12, -0.81) than immigration in adolescence (β = -0.68; 95% CI: -0.96, -0.41) or childhood (β = -0.28; 95% CI: -0.49, -0.06). Moreover, immigration in adulthood was associated with lower executive function (β = -0.63; 95% CI: -0.78, -0.48) than immigration in adolescence (β = -0.49; 95% CI: -0.75, -0.23). Similarly, compared to third-generation individuals, first-generation immigrants had lower executive functioning scores.

CONCLUSIONS

Our study supports the notion that sociocontextual influences in early life impact later life cognitive scores. Longitudinal studies are needed to further clarify how immigration characteristics affect cognitive decline.

Gender, Age of Migration, and Cognitive Life Expectancies Among Older Latinos: Evidence From the Health and Retirement Study

OBJECTIVES

Migration and gender are important factors that differentiate the Latino immigrant experience in the United States. We investigate the association between nativity status, age of migration, and cognitive life expectancies among a nationally representative sample of Latino adults aged 50 and older to explore whether age of migration and gender influence cognitive aging across the life course.

METHODS

This study used data from the Health and Retirement Study (1998-2016) to estimate Sullivan-based life tables of cognitive life expectancies by nativity, age of migration, and gender for older Latino adults. Cognitive status was based on the Langa-Weir algorithm. We test for both within-group (i.e., nativity and age of migration) and gender differences to explore the overall burden of disease among this rapidly growing population.

RESULTS

Foreign-born Latinos, regardless of age of migration or gender, spend a greater number of years after age 50 with cognitive impairment/no dementia than U.S.-born Latinos. However, the number of years spent with dementia varied by subgroup with midlife immigrant men and late-life immigrant men and women exhibiting a significant disadvantage relative to the U.S.-born. Furthermore, we document a gender disadvantage for all Latino women, regardless of immigrant status.

DISCUSSION

The robust relationship between nativity, age of migration, and cognitive aging suggests that older foreign-born Latinos experiencing cognitive decline may place serious burdens on families. Future research should target the needs of different subgroups of older Latinos who are entering their last decades of life to develop culturally appropriate long-term care programs.

Diminished Advantage or Persistent Protection? A New Approach to Assess Immigrants' Mortality Advantages Over Time

Much research has debated whether immigrants' health advantages over natives decline with their duration at destination. Most such research has relied on (pooled) cross-sectional data and used years since immigration as a proxy for the duration of residence, leading to the challenge of distilling the duration effect from the confounding cohort-of-arrival and age-of-arrival effects. Because longitudinal studies tend to use self-rated health as the outcome, the changes they observed may reflect shifts in immigrants' awareness of health problems. We illuminate the debate by examining how immigrants' mortality risk-a relatively unambiguous measure tied to poor health-changes over time compared to natives' mortality risk. Our analysis uses the National Health Interview Survey (1992-2009) with linked mortality data through 2011 (n = 875,306). We find a survival advantage for U.S. immigrants over the native-born that persisted or amplified during the 20-year period. Moreover, this advantage persisted for all immigrants, regardless of their race/ethnicity and gender or when they began their U.S. residence. This study provides unequivocal evidence that immigrant status' health protection as reflected in mortality is stable and long-lasting.

Gender-Based Pathways to Cognitive Aging in the Mexican-Origin Population in the United States: The Significance of Work and Family

OBJECTIVES

This study uses the life course perspective to explore the role of key midlife factors (occupation and number of children) for gender- and nativity-based pathways to cognitive aging for older Mexican Americans.

METHOD

Using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE, 1993/1994-2016, n = 2,779), this study presents (a) cognitive impairment trajectories over 20 years of data and (b) multinomial logistic regression analyses of trajectory group membership by lifetime occupation and number of children, controlling for educational attainment.

RESULTS

For older Mexican American men, lifetime employment in agricultural occupations is associated with elevated risk for late-life cognitive impairment. Delayed risk for impairment is observed for U.S.-born men who were employed in factory work (e.g., production and repair) and in Mexican-born men who were employed in occupations with skilled or supervisory requirements. For all women, labor force participation, especially in skilled occupations, is related to a delayed risk of cognitive impairment. Number of children is unrelated to impairment for men; however, women with five or more children (compared to women with two to four children) are at risk for consistent and rapid cognitive impairment in late life.

DISCUSSION

Late-life cognitive health disparities that disproportionately impact the Mexican American population can be addressed by improving access to educational and occupational opportunities in early and midlife. This study points to key areas of intervention within work and the home for the Mexican-origin population.

Quantifying Lifecourse Drivers of International Migration: A Cross-national Analysis of Mexico and the United States

BACKGROUND

Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder-mediators of the effect of migration on health.

METHODS

We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW.

RESULTS

Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models.

CONCLUSIONS

Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration.

Acculturation strategies, age at migration, and self-rated health: An empirical study on internal migrants in China

Berry's bidimensional acculturation model categorizes acculturation status (integration, assimilation, separation, marginalization) by preference toward host and origin cultures. According to Berry's theory, different acculturation strategies yield different health outcomes, and age at migration moderates the relationship between acculturation and health outcome. Previous research has applied this model to understand acculturation's influence on international migrants' health outcomes, but rarely for internal migrants. This research examines these relationships using a national survey on Chinese internal migrants. Using propensity score weighting, the results align with previous findings that integration strategy-using migrants reported optimal health status, separation/assimilation strategy-using migrants reported suboptimal health, and marginalization strategy-using migrants reported the worst health, suggesting the model can explain health disparities among internal migrants. Moreover, older age at migration deteriorates health outcomes and moderates health disparities among migrants employing different acculturation strategies. However, age at migration's moderating effect is significant only among inter-provincial migrants. Embracing the host society inhibits health deterioration among inter-provincial migrants with older age at migration, whereas rejecting or embracing both societies facilitates health deterioration among intra-provincial migrants.

Africans Who Arrive in the United States before 20 Years of Age Maintain Both Cardiometabolic Health and Cultural Identity: Insight from the Africans in America Study

The overall consensus is that foreign-born adults who come to America age < 20 y achieve economic success but develop adverse behaviors (smoking and drinking) that lead to worse cardiometabolic health than immigrants who arrive age ≥ 20 y. Whether age of immigration affects the health of African-born Blacks living in America is unknown. Our goals were to examine cultural identity, behavior, and socioeconomic factors and determine if differences exist in the cardiometabolic health of Africans who immigrated to America before and after age 20 y. Of the 482 enrollees (age: 38 ± 1 (mean ± SE), range: 20–65 y) in the Africans in America cohort, 23% (111/482) arrived age < 20 y, and 77% (371/482) arrived age ≥ 20 y. Independent of francophone status or African region of origin, Africans who immigrated age < 20 y had similar or better cardiometabolic health than Africans who immigrated age ≥ 20 y. The majority of Africans who immigrated age < 20 y identified as African, had African-born spouses, exercised, did not adopt adverse health behaviors, and actualized early life migration advantages, such as an American university education. Due to maintenance of cultural identity and actualization of opportunities in America, cardiometabolic health may be protected in Africans who immigrate before age 20. In short, immigrant health research must be cognizant of the diversity within the foreign-born community and age of immigration.

Gender and Age of Migration Differences in Mortality Among Older Mexican Americans

OBJECTIVES

Using a gendered life course perspective, we examine whether the relationship between age of migration and mortality is moderated by gender among a cohort of older Mexican Americans.

METHODS

Data from the Hispanic Established Populations for the Epidemiological Study of the Elderly and recently matched mortality data are used to estimate Cox proportional hazard models.

RESULTS

Our findings indicate that the relationship between age of migration and mortality is moderated by gender, suggesting a more nuanced perspective of the immigrant mortality paradox. Among men, midlife migrants exhibit an 18% lower risk of mortality compared to their U.S.-born co-ethnics, possibly due to immigrant selectivity at the time of migration. Conversely, late-life migrant women exhibit a 17% lower risk of mortality relative to U.S.-born women, attributed in part to socio-cultural characteristics that influence lifestyle risk factors across the life course.

DISCUSSION

Selection mechanisms and acculturation processes associated with the immigrant experience are contingent on both age and gender, suggesting the utility of an integrated life course approach to contextualize the mortality profiles of older immigrants. These findings demonstrate the heterogeneity among immigrants and highlight the need to understand gender differences in the migration process when assessing the immigrant mortality paradox.

Gender Differences in Cognitive Function among Older Mexican Immigrants

This paper uses data from the Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) to study the cognitive function of Mexican-born older adults residing in the United States (Mexican immigrants). We find that, once differences in socioeconomic factors are accounted for, the cognitive function of male Mexican immigrants is statistically indistinguishable from that of male non-Hispanic (NH) whites, but the cognitive scores of female Mexican immigrants remain significantly below those of their NH white counterparts. We explore four potential hypotheses that may explain the cognition gap for female Mexican immigrants. Namely, we investigate whether the relative incidence of risk factors for dementia, when compared to NH whites, is higher for female than for male Mexican immigrants (the "risk factor hypothesis"); whether the mortality rate of male Mexican immigrants with low cognition is higher, relative to their white counterparts, than that of female Mexican immigrants (the "survival bias hypothesis"); whether female Mexican immigrants are less positively selected than their male counterparts in terms of predisposition to cognitive decline when compared with either the non-migrant Mexican population or the population of return migrants (the "differential selection hypothesis"); and whether male immigrants are better acculturated to life in the United States than female immigrants (the "acculturation hypothesis). We find no support for the risk-factor, survival, or acculturation hypotheses but we find evidence suggesting that the differential selection hypothesis may explain part of the female cognitive gap. Our results imply that older Mexican females currently residing in the U.S. may be at elevated risk for dementia and should be targeted by campaigns aimed at preventing or diagnosing the condition.

Age of Migration and Cognitive Function Among Older Latinos in the United States

BACKGROUND

Age of migration has been shown to have a robust association with Latino immigrant health outcomes; however, the relationship between timing of migration and cognition is less understood.

OBJECTIVE

To examine associations between race/ethnicity, nativity, age of migration, and cognitive aging among US-born (USB) non-Latino Whites (NLW) and USB and foreign-born Latinos 50 years and older.

METHODS

We used longitudinal biennial data from the Health and Retirement Study (HRS; 2006-2014) to fit generalized linear and linear latent growth curve models for: 1) global cognition (Modified Telephone Interview for Cognitive Status; TICS-M); 2) memory and attention subdomains of TICS-M; and 3) cognitive dysfunction. We also tested for sex modifications.

RESULTS

In age and sex adjusted models, all Latino subgroups, independent of nativity and age of migration, had lower global and domain-specific cognitive scores and higher propensity of cognitive impairment classification compared to USB-NLWs. Differences between USB Latinos, but not other Latino subgroups, and USB-NLWs remained after full covariate adjustment. Latinas, independent of nativity or age of migration, had poorer cognitive scores relative to NLW females. Differences between all Latinos and USB-NLWs were principally expressed at baseline. Racial/ethnic, nativity, and age of migration grouping was not associated with slope (nor explained variance) of cognitive decline.

CONCLUSION

Older US-born Latinos, regardless of sex exhibit poorer cognitive function than older USB-NLWs and foreign-born Latinos. Social determinants that differentially affect cognitive function, particularly those that compensate for education and sex differences among US-born Latinos and foreign-born Latinos, require further exploration.

Healthy Immigrants? Exploring Depressive Symptoms Among Caribbean and Mexican Immigrants

Are there disparities in depressive symptoms among immigrant groups from different countries? With data from the New Immigrant Survey (2003), which includes immigrants from Mexico, Haiti, Dominican Republic, Cuba, and Jamaica, this paper examines the odds of depressive symptoms using a series of logistic regression analyses. It draws on segmented assimilation and the cumulative inequality theories to understand and explicate the extent to which immigrants' demographic characteristics, pre-immigration experiences, and acculturation in the USA might have an impact on immigrants' mental health outcomes. Being from Haiti; Dominican Republic; Cuba; and a woman, with unfavorable childhood health, and migrated at an early age were statistically significant predictors of depressive symptoms. Compared to Mexican immigrants, Cuban and Dominican immigrants reported higher odds of depressive symptoms, controlling for gender, age, education, and pre-immigration experiences. By contrast, Haitian and Jamaican immigrants reported lower odds of depressive symptoms. Female immigrants had higher odds of reporting depressive symptoms compared to their male counterparts. Relative to immigrants with good childhood health, those with unfavorable childhood health had higher odds of reporting worse health outcomes. In the logistic regression models, immigrants who migrated at older age reported lower odds of depressive symptoms. By shedding light on the health status of understudied Caribbean immigrant groups in comparison with Mexican immigrants, this study challenges the healthy migrant effect and serves as a starting point to guide policies that aim at decreasing health disparities among different immigrant groups.

Life Expectancies With Depression by Age of Migration and Gender Among Older Mexican Americans

BACKGROUND AND OBJECTIVES

Prior studies examining depression among older Mexican Americans suggest both women and immigrants are at higher risk of depressive symptomatology than males and U.S.-born Mexican Americans. We use data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine whether life expectancy with depression and without depression varies by nativity, age of migration, and gender.

RESEARCH DESIGN AND METHODS

Sullivan-based life tables were used to estimate depression life expectancies among Mexican Americans aged 65 years and older residing in the Southwestern United States. Depression is based on the 20-item Center for Epidemiological Studies Depression scale (CES-D). The CES-D is a continuous scale (0-60) with higher values indicating worse mental health. We dichotomize depression as a score of 16 or greater.

RESULTS

Immigrant women, particularly those who migrated in late-life (after age 50) are at a significant disadvantage in the number of years after age 65 lived with depression and the ratio of years spent without depression relative to U.S.-born women. Among men, only late-life immigrants were disadvantaged in the number of years spent with depression. Early- and mid-life immigrant males did not differ from U.S.-born males.

DISCUSSION AND IMPLICATIONS

Our results highlight the heterogeneity among older Mexican Americans in life expectancies with depression. These findings illustrate the importance of considering age of migration as a high-risk factor for depression among Mexican-origin immigrants. Including this risk factor as a part of depression screening is a key step for timely interventions in preventing disability and comorbidities associated with untreated depression.

The influence of immigrant generation on obesity among Asian Americans in California from 2013 to 2014

Objectives

We aimed to examine the association between immigrant generation and obesity among Californian adults and Asian Americans.

Methods

We pooled weighted data (n = 2,967) on Asian Americans from the 2013–2014 California Health Interview Survey. Overweight and obesity were defined using body mass indices (BMI) of 25 kg/m² and 30 kg/m², respectively, in non-Asians, compared with BMI of 23 kg/m² (for being overweight) and 27.5 kg/m² (for being obese) in Asians. First-generation or immigrant Asian Americans were defined as those born outside of the U.S. Second-generation Asian Americans were defined as those born in the U.S. with at least one foreign-born parent. All other Asian participants were classified as third-generation or higher. Multiple logistic regression analyses were used with adjustment for age, sex, family income, smoking status, marital status, education, physical activity, and fast food consumption.

Results

Overall, 23.3% of the Asian population was obese, and 40.0% was overweight. The percentage of 1^st, 2^nd, and 3^rd generation were 72.7%, 22.6%, and 4.6%, respectively. Overall, 1^st generation of Asians had lower odds of being obese compared to Whites (OR = 0.34, 95%CI = 0.26–0.45). Multiple logistic regression analyses showed that overall, 2^nd generation (OR = 1.69, 95%CI = 1.10–2.60) and 3^rd generation (OR = 2.33, 95%CI = 1.29–4.22) Asians had higher odds of being obese compared to 1^st generation Asians. Among Chinese, compared to the 1^st generation, the 3^rd generation had increased likelihood of being obese (OR = 6.29, 95%CI = 2.38–16.6).

Conclusion

Compared to Whites, Hispanics, and Blacks, Asian immigrants are less likely to be obese. Among Asians, 2^nd and 3^rd generations were more likely to be obese compared to 1^st generation. The obesity rate seems to increase the longer Asian immigrants remain in the U.S.

Stress, migration, and allostatic load: a model based on Mexican migrants in Columbus, Ohio

Background

Immigration is a disruptive event with multiple implications for health. Stressors, including family separation, acculturation, job insecurity, restricted mobility, sojourns, dangerous border crossings, stigmatization, and marginalization, shape immigrant health in ways we are only beginning to untangle. Around the world, there are over 200 million international migrants. In 2015, there were 43.2 million immigrants living in the US, 26.8% of whom were born in Mexico. Investigating how stress affects health among migrants facilitates better understanding of their experiences.

Methods

Here, we review existing research on stress and how allostatic load varies among migrants with specific attention to Mexican migrants in the US. Next, we explore research incorporating biomarkers of allostasis and narratives of migration and settlement to examine disease risks of Mexican migrants residing in Columbus, Ohio. This mixed-methods approach allowed us to examine how social stressors may influence self-reports of health differentially from associations with assessed discrimination and physiological biomarkers of health.

Results

These data sources are not significantly associated. Neither narratives nor self-reports of health provide significant proxies for participants’ physiological health.

Conclusions

We propose, the pairing of objectively assessed health profiles with narratives of migration better illustrate risks migrants face, while allowing us to discern pathways through which future health challenges may arise. Immigration and acculturation to a new nation are biologically and culturally embedded processes, as are stress and allostatic responses. To understand how the former covary with the latter requires a mixed-methods bioethnographic approach. Differences across multiple social and physiological systems, affect individual health over time. We propose incorporating physiological biomarkers and allostatic load with migrants’ narratives of their migration to unravel complex relationships between acculturation and health.

Physical Functioning and Disability Trajectories by Age of Migration Among Mexican Elders in the United States

Objectives

To address a gap in our understanding of the long-term consequences of nativity and age of migration for the health of the Mexican elderly population.

Method

We employ age graded latent growth curve models stratified by gender to examine the extent of physical functioning and disability, measured in terms of performance-oriented mobility assessments (POMAs) and activities of daily living (ADLs) after age 65 in a large longitudinal sample of Mexican-origin individuals.

Results

Self-care measured ADLs show no age of migration differences. However, physical capacity measured POMAs differ significantly for men and women by age of migration. Migrants who arrived in midlife have fewer functional limitations at age 65 but have steeper increase in POMAs with age.

Discussion

With a rapidly changing demographic profile that includes a large number of aging Mexican-origin immigrants, our society must implement social and health policies to ameliorate the negative health outcomes among immigrant and U.S.-born minority groups.

Physical Functioning and Disability Trajectories by Age of Migration Among Mexican Elders in the United States

Objectives

To address a gap in our understanding of the long-term consequences of nativity and age of migration for the health of the Mexican elderly population.

Method

We employ age graded latent growth curve models stratified by gender to examine the extent of physical functioning and disability, measured in terms of performance-oriented mobility assessments (POMAs) and activities of daily living (ADLs) after age 65 in a large longitudinal sample of Mexican-origin individuals.

Results

Self-care measured ADLs show no age of migration differences. However, physical capacity measured POMAs differ significantly for men and women by age of migration. Migrants who arrived in midlife have fewer functional limitations at age 65 but have steeper increase in POMAs with age.

Discussion

With a rapidly changing demographic profile that includes a large number of aging Mexican-origin immigrants, our society must implement social and health policies to ameliorate the negative health outcomes among immigrant and U.S.-born minority groups.

Age of Migration Differentials in Life Expectancy With Cognitive Impairment: 20-Year Findings From the Hispanic-EPESE

Background and Objectives

To examine differences in life expectancy with cognitive impairment among older Mexican adults according to nativity (U.S.-born/foreign-born) and among immigrants, age of migration to the United States.

Research Design and Methods

This study employs 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent cognitively healthy and cognitively impaired prior to death among older Mexican adults residing in the southwestern United States. We combine age-specific mortality rates with age-specific prevalence of cognitive impairment, defined as a Mini-Mental Status Exam score of less than 21 points to calculate Sullivan-based life table models with and without cognitive impairment in later life.

Results

Foreign-born Mexican immigrants have longer total life expectancy and comparable cognitive healthy life expectancy regardless of gender compared to U.S.-born Mexican-Americans. However, the foreign-born spend a greater number of years after age 65 with cognitive impairment relative to their U.S.-born counterparts. Furthermore, we document an advantage in life expectancy with cognitive impairment and proportion of years after age 65 cognitively healthy among mid-life immigrant men and women relative to early- and late-life migrants.

Discussion and Implications

The relationship between nativity, age of migration, and life expectancy with cognitive impairment means that the foreign-born are in more need of support and time-intensive care in late life. This issue merits special attention to develop appropriate and targeted screening efforts that reduce cognitive decline for diverse subgroups of older Mexican-origin adults as they age.

Let's walk! Age reattribution and physical activity among older Hispanic/Latino adults: results from the ¡Caminemos! Randomized trial

Background

Many older Hispanics/Latinos are physically inactive and suffer the harmful health consequences associated with prolonged periods of inactivity. Negative age attributions that equate getting older with “slowing down” reinforce this inactive behavior. We implemented a community-based exercise intervention among insufficiently active older Hispanics/Latinos with a randomized trial of an attribution-retraining program, ¡Caminemos! (Let’s Walk!), and measured the effect of the program on walking behavior.

Methods

Five hundred and seventy-two older Hispanics/Latinos (≥60 years) were enrolled in an exercise program that randomly assigned participants to the exercise class and one of two conditions: (a) treatment (attribution retraining to dispel the notion that physical activity inevitably ceases with age) or (b) control (generic health education). Data were collected at baseline and follow-up (1, 12, and 24 months). Physical activity was determined through pedometer data and the Yale Physical Activity Survey. We also measured the intervention effects on age-expectations, self-efficacy expectations, and outcome expectations for physical activity. Mixed-effects regression models were used to determine intervention effects on prospective measures of physical activity and intrapersonal expectations.

Results

The sample had a mean age of 73 years (SD = 6.8) and was 77% female, and 76% of the sample reported income <$20,000. At baseline, control and treatment groups walked about 3000 steps/day. By 24 months, participants in both arms of the intervention maintained greater than 10,000 mean steps/day, but the difference between the groups was not statistically significant. In analyses adjusted for age, sex, education, income, health status, and acculturation, participants in both trial arms increased their mean numbers of steps at 12 and 24 months, with the treatment group showing a greater number of mean steps compared to the controls at 12 months.

Conclusions

In this group of physically inactive older Hispanics/Latinos, attribution retraining in combination with an exercise class was superior to the exercise class alone with regard to increasing walking behavior. This success was sustained at 12 months (the pre-defined primary study outcome) but not at 24 months. For older Hispanics/Latinos, enrollment in an attribution-retraining exercise program can improve an inactive lifestyle.

Trial registration

clinicaltrials.gov identifier: NCT00183014.

The Role of Education in the Relationship Between Age of Migration to the United States and Risk of Cognitive Impairment Among Older Mexican Americans

Prior research indicates age of migration is associated with cognitive health outcomes among older Mexican Americans; however, factors that explain this relationship are unclear. This study used eight waves from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the role of education in the risk for cognitive impairment (CI) by nativity, age of migration, and gender. Foreign-born women had a higher risk for CI than U.S.-born women, regardless of age of migration. After adjusting for education, this risk remained significant only for late-life migrant women (risk ratio [RR] = 1.28). Foreign-born men who migrated at >50 had significantly higher risk for CI compared to U.S.-born men (RR = 1.33) but not significant after adjusting for education. Findings from a decomposition analysis showed education significantly mediated the association between age of migration and CI. This study highlights the importance of education in explaining the association between age of migration and CI.

An observational study of immigrant mortality differences in Norway by reason for migration, length of stay and characteristics of sending countries

BACKGROUND

Knowledge of mortality differentials in immigrant groups depending on their reason for migration, length of stay in host countries and characteristics of sending countries may be beneficial for policy interventions aimed to improve various immigrant groups' health and welfare.

METHODS

We employed discrete-time hazard regression models with time-varying covariates to compare the death risk of immigrants to those of Norwegian-born natives using linked register data on the Norwegian population aged 25-79 during 1990-2015. More than 492,000 deaths occurred in around 4.6 million individuals. All analyses were adjusted for sex, age, calendar time and sociodemographic characteristics.

RESULTS

Immigrants had an 11% survival advantage overall. Those immigrating due to work or education had the lowest death risk, whereas refugees had the highest death risk (albeit lower than that of natives). Death risks increased markedly with length of stay, and were most pronounced for those having spent more than 40% of their lives in Norway. Net of reason for migration, only minor differences were observed depending on Human Development Index characteristics of sending countries.

CONCLUSION

Independent of reason for migration and characteristics of sending countries, those who immigrate to Norway in adulthood appear to be particularly healthy. The higher death risk associated with prolonged lengths of stay suggests that disadvantageous 'acculturation' or stress factors related to the post-migration period may play a role in the long run. The health and welfare of long-term immigrants thus warrants further research.

Prevalence and Trends in Morbidity and Disability Among Older Mexican Americans in the Southwestern United States, 1993-2013

This study examines the prevalence of morbidity and disability among older Mexican Americans using 5-year age groups. Twenty-year panel data from the Hispanic Established Populations for the Epidemiological Study of the Elderly are used to make detailed comparisons by nativity and gender. Results show that prevalence rates for most chronic conditions for both males and females do not vary by nativity. For disabilities, nativity is a significant predictor of increased instrumental activity of daily living disability for foreign-born females and reduced activity of daily living disability for U.S.-born males. Additionally, results show significant interactions between nativity and age cohorts, with the gap increasing with age for males and decreasing with age for females. These results have important implications for health services and health policy. Given the rapid aging of the Mexican American population, the prevention and treatment of medical conditions, particularly among the foreign-born, should be a major public health priority to reduce dependence from disabilities.

The Influence of Exercise on Cognitive Function in Older Hispanic/Latino Adults: Results From the "¡Caminemos!" Study

Purpose of the Study

We examined the prospective effect of an evidence-based exercise intervention (¡Caminemos!) on cognitive function among older Hispanic/Latino adults and the potential synergistic effects (if any) of an attribution-retraining intervention given to a random sample to counter negative ascriptions of the aging process.

Design and Methods

We analyzed baseline and follow-up (1- and 2-year) data collected from Hispanics/Latinos ≥60 years (N = 571) who participated in ¡Caminemos! across 27 senior centers. All participants were randomly assigned to either (a) the treatment group-a 1-hr attribution-retraining session plus a 1-hr exercise class or (b) the control group-health education plus a 1-hr exercise class. Mixed-effects linear regression was used to determine the effects of the exercise class and the attribution-retraining component on longitudinal changes in cognitive functioning, as measured by the Modified Mini-Mental State (3MS) examination.

Results

In analyses adjusted for age, sex, education, income, and medical comorbidities, participants in both trial arms displayed higher cognitive functioning scores at the 1-year (β = 1.76, p = .001) and 2-year (β = 1.37, p = .013) follow-ups when compared with original baseline scores. However, we found no significant difference in cognitive function between the treatment versus control conditions (β = 0.41, p = .582), nor were any differences found across groups over time.

Implications

The exercise intervention improved cognitive function in older Hispanics/Latinos, regardless of whether it was supplemented with the age-related attribution retraining. These findings suggest that limited access to exercise programs may be a greater obstacle in forestalling cognitive decline in older Hispanics/Latinos than the negative beliefs they might hold of the aging process.

Age of Migration and the Incidence of Cognitive Impairment: A Cohort Study of Elder Mexican-Americans

BACKGROUND AND OBJECTIVES

To explore nativity and age of migration differentials in the incidence of cognitive impairment among older Mexican-Americans.

RESEARCH DESIGN AND METHODS

We employ maximum-likelihood discrete time hazard models to estimate risk ratios of cognitive impairment in a sample of 2,708 Mexican-Americans 65 and older who were cognitively healthy at baseline over a follow-up period of up to 20 years.

RESULTS

Late-life immigrant women have a 46% higher risk of cognitive impairment compared to U.S.-born Mexican-American women. Conversely, midlife immigrant men have a 29% lower risk of cognitive impairment compared to U.S.-born Mexican-American men. The incidence of cognitive impairment did not differ for early-life and midlife immigrant women relative to U.S.-born women or for early- and late-life immigrant men compared to U.S.-born men.

DISCUSSION AND IMPLICATIONS

Differences in cognitive impairment risk between U.S.-born and foreign-born Mexican-American subgroups may be partly due to health selectivity. Cognitive impairment is more prevalent among immigrant groups which may result in a higher burden on family members and/or high dependency on public resources. Programs are needed that can detect decline at earlier stages and reduce the risk for cognitive impairment among older immigrants entering their last decades of life.

Aging and Disability Among Hispanics in the United States: Current Knowledge and Future Directions

BACKGROUND AND OBJECTIVES

Hispanics are the most rapidly aging minority population in the United States. Our objective is to provide a summary of current knowledge regarding disability among Hispanics, and to propose an agenda for future research.

RESEARCH DESIGN AND METHODS

A literature review was conducted to identify major areas of research. A life course perspective and the Hispanic Paradox were used as frameworks for the literature review and for identifying future areas of research.

RESULTS

Four research areas were identified: (1) Ethnic disparities in disability; (2) Heterogeneity of the U.S. older Hispanic population; (3) Risk factors for disability; and (4) Disabled life expectancy. Older Hispanics are more likely than non-Hispanic whites to be disabled or to become disabled. Disability varied by country of origin, nativity, age of migration, and duration in the United States. Important risk factors for disability included chronic health conditions, depression, and cognitive impairment. Protective factors included positive affect and physical activity. Older Hispanics have longer life expectancy than non-Hispanic whites but spend a greater proportion of old age disabled. Future research should continue to monitor trends in disability as younger generations of Hispanics reach old age. Attention needs to be given to regional variation within the United States for disability prevalence, early-life risk factors, and factors that may contribute to variation in disabled life expectancy. There is also an urgent need for interventions that can effectively prevent or delay the onset of disability in older Hispanics.

DISCUSSION AND IMPLICATIONS

Considerable research has examined disability among older Hispanics, but continued research is needed. It is important that research findings be used to inform public policies that can address the burden of disability for older Hispanic populations.

Age Trajectories of Physical Health Among Older Adults of Mexican Descent: Implications of Immigrant Status, Age at Immigration, and Gender

OBJECTIVE

This study examines consequences of immigrant status, age at immigration, and gender on age trajectories of activities of daily living (ADL) limitations and chronic conditions among older adults of Mexican descent.

METHOD

This research draws on 7 waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly and employs growth curve models.

RESULTS

All men had similar age trajectories of ADL limitations, regardless of immigrant status and age at immigration. All women experienced steeper increases in ADL limitations, although U.S.-born women and those who immigrated by age 19 had lower initial levels. Men who immigrated between ages 20 and 49 had steeper increases in chronic conditions, despite lower initial levels. U.S.-born women and those women who immigrated by age 50 had more chronic conditions at age 65.

DISCUSSION

This study highlights the multidimensional nature of physical health by demonstrating that immigrant status-gender disparities can vary by the health outcome examined.

Age of Migration Life Expectancy with Functional Limitations and Morbidity in Mexican Americans

The U.S. Mexican American population enjoys longer life expectancies relative to other racial/ethnic groups but is disproportionately affected by chronic conditions and functional limitations. Studying the impact of heterogeneity in age, time and other characteristics of migration among older Mexican Americans can inform our understanding of health disparities and healthcare needs in later-life. This research used 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess the proportion of life spent with functional limitations and one or more morbidity (according to age of migration and sex) in the U.S. Mexican-American population. The results indicate that early-life and late-life migrant women spend more years with Performance-Oriented Mobility Assessment limitations than U.S.-born women. Conversely, midlife migrant women were not statistically different from U.S.-born women in years spent disabled. In men, midlife migrants had longer life expectancies and had more disability-free years than U.S.-born men. For morbidity, late-life migrant women spent a significantly smaller proportion of their elderly years with morbidity than U.S.-born women, but late-life migrant men spent more years with morbidity than U.S.-born men. These findings illustrate that older Mexican Americans in the United States are heterogeneous in nativity and health outcomes. More years spent disabled or unhealthy may result in greater burden on family members and greater dependence on public resources. These findings have implications for the development of social and health policies to appropriately target the medical conditions and disabilities of older Mexican Americans entering late life.

Age at migration and disability-free life expectancy among the elder Mexican-origin population

BACKGROUND

Migration selectivity is thought to shape the health profiles of Mexican immigrants.

OBJECTIVE

This study examines how the experience of Mexican migration to the United States affects the health process and the quality of life in old age by age at migration, specific to sex.

METHODS

We use 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent disability-free prior to death across eight subgroups by sex, nativity, and age at migration among Mexican-origin elderly in the United States.

RESULTS

Female migrants are at a significant disadvantage in terms of IADL disability-free life expectancy relative to US-born women, particularly late-life migrants. Conversely, mid- and late-life male migrants exhibit an advantage in ADL disability-free life expectancy compared to their US-born counterparts.

CONCLUSIONS

Foreign-born Mexican elders are not a homogeneous group. This issue merits special attention in the development of community-based long-term care programs in order to appropriately target the specific needs of different subgroups of older Mexican individuals entering their last decades of life.

CONTRIBUTION

This study contributes to immigrant health literature by providing a more comprehensive documentation of nativity differentials, by distinguishing subgroups of Mexican elderly by sex, nativity, and age at migration.

Another Paradox? The Life Satisfaction of Older Hispanic Immigrants in the United States

Objective: To investigate disparities in life satisfaction among older Hispanic immigrants in the United States relative to their native-born Hispanic and non-Hispanic White counterparts, and to identify factors associated with such disparities. Method: Cross-sectional data from 9,798 individuals age 60 and above from the Health and Retirement Study (HRS) were used to estimate ordinary least squares (OLS) regression models. Results: Hispanic immigrants reported the highest levels of life satisfaction of all groups. Wealthier older adults, who were socially engaged, had social support, and experienced fewer functional limitations and lower exposure to discrimination, were more satisfied with their lives in the overall sample. Interaction effects revealed that although education was associated with greater life satisfaction only among non-Hispanic Whites, co-residing with children was associated with greater life satisfaction only among Hispanics. Discussion: Although older Hispanic immigrants had the least amount of socioeconomic resources of all groups in our study, they were the most satisfied with their lives. Possible explanations and directions for future research are discussed.

The Potential and Limitations of Cross-Context Comparative Research on Migration

This article is an overview of household survey approaches for the comparative study of international migration dynamics. Focusing on differences in the drivers of international mobility at different times and places, I highlight the problems of obtaining data with adequate representation across time periods and geographies, and discuss a broad constellation of prospective and retrospective approaches, paying particular attention to the migration ethnosurvey. I place this methodology within a broader constellation of prospective and retrospective data collection techniques, briefly describing the advantages and disadvantages of each and summarizing the commonalities and differences of ethnosurvey approaches adopted around the world. In particular, I discuss the potential and limitations of cross-context research and suggest post hoc case selection and other adjustments to ameliorate problems. I conclude with ideas about how case and sample selection can help to bolster migration studies in the future.

Religious Attendance and the Mobility Trajectories of Older Mexican Americans: An Application of the Growth Mixture Model

Although several studies have examined the association between religious involvement and physical functioning, there is no consistent empirical evidence concerning the true nature of the association. The Hispanic population is also surprisingly understudied in previous work. In this article, we employ seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the association between religious attendance and performance-based mobility trajectories among older Mexican Americans. Growth mixture estimates reveal three latent classes of mobility trajectories: (1) high, (2) moderate, and (3) low. Multinomial logistic regression estimates show that the odds of being classified as having low mobility (versus high and moderate mobility) are lower for respondents who attend religious services than for respondents who never attend. Religious attendance does not distinguish between moderate and high mobility. Our regression results confirm that religious attendance is associated with favorable mobility trajectories among older Mexican Americans.

Age at Immigration and Kidney Function among Self-Identified Healthy Africans in the United States

Kidney disease disparately affects those of African descent. Age trends have generally been established for kidney function in the overall US population, but the contribution of age at the time of immigration for African immigrants is unknown. To examine the independent and joint effects of age and age at the time of immigration, and kidney function. Estimated glomerular filtration rate (eGFR) was calculated for 93 African immigrants (60 % male; mean age = 33.5). Hierarchical regression and post hoc analyses revealed a significant age × age at the time of immigration interaction after accounting for traditional risk factors among those who immigrated at age ≤21. Younger age at the time of immigration to the US may exacerbate an inverse relationship between age and kidney function in a self-identified healthy African immigrant sample. Investigation of biopsychosocial factors associated with kidney health among African immigrants is warranted.

Longer lives, sicker lives? Increased longevity and extended disability among Mexican-origin elders

OBJECTIVES

(a) To identify factors associated with different patterns of functional decline in a longitudinal sample of older Mexican-origin individuals, and (b) to determine the proportions of life after age 65 characterized by serious functional impairment.

METHODOLOGY

We use the Hispanic Established Populations for Epidemiologic Studies of the Elderly to examine changes in objective Performance Oriented Mobility Assessments in a cohort of 3,050 Mexican-origin elders initially interviewed in 1993/1994 and recontacted 6 times over 17 years. This sample combined with an additional cohort of 902 individuals 75 and older added at wave 4 in 2004/2005 (combined sample = 3,952) is used in life table analyses to estimate the number of years after 65 characterized by serious functional impairment.

RESULTS

Three distinct patterns of functional decline emerge: (a) high initial functioning followed by decline, but not to the level of disability (48%); (b) moderate initial functioning followed by decline to the level of disability (37.5%); and (c) initial disability followed by continued poor functioning (14.5%). Life table analyses reveal that subjects spent over half of the period after 65 with serious functional limitations. Significant gender and nativity differentials emerge.

DISCUSSION

Protracted morbidity that accompanies increases in life expectancy has serious implications for the physical, social, and economic well-being of older individuals and their families, as well as for health and long-term care policy.

Immigrant generation and diabetes risk among Mexican Americans: the Sacramento area Latino study on aging

OBJECTIVES

We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican-origin population.

METHODS

We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes.

RESULTS

Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant.

CONCLUSIONS

Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

Negative Acculturation and Nothing More? Cumulative Disadvantage and Mortality during the Immigrant Adaptation Process among Latinos in the United States

Foreign- and U.S.-born Hispanic health deteriorates with increasing exposure and acculturation to mainstream U.S. society. Because these associations are robust to (static) socioeconomic controls, negative acculturation has become their primary explanation. This overemphasis, however, has neglected important alternative structural explanations. Examining Hispanic mortality using the 1998–2006 U.S. National Health Interview Survey-Linked Mortality File according to nativity, immigrant adaptation measures, and health behaviors, this study presents indirect but compelling evidence that suggests negative acculturation is not the only or main explanation for this deterioration.

Las generaciones de inmigrantes y sus descendientes y el riesgo de diabetes en la población de los Estados Unidos de origen o ascendencia mexicana: el Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA)

Objetivo. Se investigó si la aculturación de los inmigrantes y sus descendientes y la generación a la que pertenecen, un marcador de la asimilación, se relacionan con el riesgo de diabetes en una población de adultos mayores de ascendencia u origen mexicano.

Métodos. Se analizaron los datos sobre 1 789 adultos de 60 a 101 años de edad del Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA). Se determinó la presencia de diabetes tipo 2 con base en el uso de medicamentos antidiabéticos, la mención por el paciente del diagnóstico de un médico, o una glucosa en ayunas de 126 mg/dL o mayor. Se aplicó un modelo de regresión logística para la prevalencia de diabetes.

Resultados. Tras ajustar por edad y sexo, se observaron asociaciones significativas pero divergentes entre las generaciones de inmigrantes y sus descendientes, la aculturación y el riesgo de diabetes. En relación con los adultos de la primera generación, los de la segunda tuvieron una razón de posibilidades (odds ratio, OR) de padecer diabetes de 1,8 (intervalo de confianza [IC] de 95% = 1,4, 2,4) y los adultos de la tercera generación tuvieron una OR de 2,1 (IC de 95% = 1,4, 3,1). Sin embargo, una mayor aculturación a los Estados Unidos se relacionó con una tasa ligeramente menor de diabetes. En el modelo completo, tras la incorporación de ajustes para tener en cuenta los factores socioeconómicos y del modo de vida, la relación entre la generación y la diabetes seguía siendo significativa, no así la relación de esta última con la aculturación.

Conclusiones. El presente estudio respalda la idea, anteriormente cuestionada, de que la asimilación se relaciona con un mayor riesgo de diabetes entre los inmigrantes de origen mexicano. Los investigadores deben analizar más detalladamente la presencia de una relación causal entre la asimilación y la salud.

Immigration and loneliness in later life

Although the loneliness of both older adults and immigrants is frequently asserted, knowledge regarding the implications of immigration for loneliness in later life is limited. In particular, little attention has been directed to the impact of factors that might differentiate individuals within the immigrant population. Using data from the 2007 General Social Survey (GSS-21) conducted by Statistics Canada, this study examined the effects of immigrant status as well as immigrant generation, length of residence in Canada and race/ethnicity on loneliness among adults aged 60 and over (N=10,553). Regression analyses (ordinary least squares) estimating both the general and age-specific effects of immigrant experience on loneliness, indicated that immigrants report higher levels of loneliness than native-born Canadians, that race/ethnicity influenced loneliness particularly among immigrants and that generational status as well as length of residence also had an impact, but one that differed across age groups. Immigration-related variables appeared less consequential for loneliness in the oldest-old (aged 80+) than in younger elderly age groups. These findings attest to the significance of immigrant status for an understanding of loneliness in later life but suggest a need to acknowledge the diversity of immigrant experiences associated with lifecourse and other factors.

[Immigrant generation and diabetes risk among Mexican Americans: the Sacramento Area Latino Study on Aging]

OBJECTIVES

We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican-origin population.

METHODS

We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes.

RESULTS

Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant.

CONCLUSIONS

Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

Immigrant generation and diabetes risk among Mexican Americans: the Sacramento Area Latino Study on Aging

OBJECTIVES

We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican-origin population.

METHODS

We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes.

RESULTS

Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant.

CONCLUSIONS

Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

Immigrant status and cognitive functioning in late-life: an examination of gender variations in the healthy immigrant effect

Although some research suggests that the healthy immigrant effect extends to cognitive functioning, it is unclear whether this general pattern varies according to gender. We use six waves of data collected from the original cohort of the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate a series of linear growth curve models to assess variations in cognitive functioning trajectories by nativity status and age at migration to the U.S.A. among women and men. Our results show, among women and men, no differences in baseline cognitive status (intercepts) between early- (before age 20) and late-life (50 and older) immigrants and U.S.-born individuals of Mexican-origin. We also find, among women and men, that middle-life (between the ages of 20 and 49) immigrants tend to exhibit higher levels of baseline cognitive functioning than the U.S.-born. Our growth curve analyses suggest that the cognitive functioning trajectories (slopes) of women do not vary according to nativity status and age at migration. The cognitive functioning trajectories of early- and late-life immigrant men are also similar to those of U.S.-born men; however, those men who migrated in middle-life tend to exhibit slower rates of cognitive decline. A statistically significant interaction term suggests that the pattern for middle-life migration is more pronounced for men (or attenuated for women). In other words, although women and men who migrated in middle-life exhibit higher levels of baseline cognitive functioning, immigrant men tend to maintain this advantage for a longer period of time. Taken together, these patterns confirm that gender is an important conditioning factor in the association between immigrant status and cognitive functioning.

Biobehavioral aspects of health and aging among people of Mexican origin

There is a growing interest in developing a deeper level of understanding of the complex phenomena that make up the aging process. Efforts to pursue questions using a multivariate and ecologically valid approaches that include biological and behavioral factors have led to significant advances in our knowledge. This special issue presents a collection of papers that represent this "biobehavioral" perspective. Little is known concerning the biobehavioral aspects of Hispanic health and there is a dearth of systematic study of how individual biological factors interact with the environmental and cultural factors to affect health outcomes among the swiftly growing older population of Mexican origin, a subgroup of older minorities that exhibits unique morbidity and mortality patterns. The group of papers here represents important contributions to understanding the health consequences in later life for individuals of Mexican descent and addresses several areas of interest including but not limited to diabetes, cognitive impairment, metabolic syndrome, frailty, socio-economic status and contextual factors that impact health. The papers presented here use interesting and useful transdisciplinary approaches that increase our knowledge of health processes in older people of Mexican descent. This special issue also provides excellent examples of the critical linkages between biological variables broadly defined and traditional social stratification, social inequalities, and social justice and the ways in which they interact. The papers taken together suggest that the processes involved in aging and health are complex, particularly in people of Mexican descent, and requires the understanding of mechanisms at multiple causes and levels of analysis.

"Vulnerability, Resiliency, and Adaptation: The Health of Latin Americans during the Migration Process to the United States"

In this paper, we offer a general outlook of the health of Latin Americans (with a special emphasis on Mexicans) during the different stages of the migration process to the U.S. given the usefulness of the social vulnerability concept and given that said vulnerability varies conspicuously across the different stages of the migration process. Severe migrant vulnerability during the transit and crossing has serious negative health consequences. Yet, upon their arrival to the U.S., migrant health is favorable in outcomes such as mortality by many causes of death and in several chronic conditions and risk factors, though these apparent advantages seem to disappear during the process of adaptation to the host society. We discuss potential explanations for the initial health advantage and the sources of vulnerability that explain its erosion, with special emphasis in systematic timely access to health care. Given that migration can affect social vulnerability processes in sending areas, we discuss the potential health consequences for these places and conclude by considering the immigration and health policy implications of these issues for the United States and sending countries, with emphasis on Mexico.