The Healthy Immigrant Effect: The role of educational selectivity in the good health of migrants

Prevalence of Chronic Pain by Immigration Status and Latino Ethnicity

OBJECTIVE

The goal of this study was to evaluate the Latino paradox and healthy migrant hypotheses by estimating the association between the prevalence of chronic pain, immigration status, and Latino ethnicity.

METHODS

This cross-sectional study analyzed pooled data from 85,395 adult participants of the 2019-2021 National Health Interview Survey. The dependent variables were any pain and chronic pain in the past 3 months. The independent variables were immigration status (US born, naturalized citizen, non-citizen) and Latino ethnicity.

RESULTS

Chronic pain was prevalent for nearly a quarter of US born non-Latino adults (24%) and non-citizen non-Latino adults had the lowest prevalence at 8%. In multivariable adjusted models, US born non-Latino immigration status and ethnicity was associated with a higher probability of reporting chronic pain in the last 3 months compared to US born Latino adults (-3.0%; 95% CI = -4.4%, -1.6%), naturalized citizen non-Latino adults (-4.7%; 95% CI = -5.9%, -3.4%), naturalized citizen Latino adults (-6.7%; 95% CI = -8.5%, -4.9%), non-citizen non-Latino adults (-3.1%; 95% CI = -4.7%, -1.5%), and non-citizen Latino adults (-8.9%; 95% CI = -10.8%, -7.0%).

CONCLUSION

US Born non-Latino adults reported the highest prevalence of chronic pain and non-citizen Latino adults reported the lowest prevalence of chronic pain providing support for the Latino paradox and healthy migrant effect hypotheses.

Religious minority identity associates with stress and psychological health among Muslim and Hindu women in Bangladesh and London

OBJECTIVES

This study examined the association of minority religious identification (Hindu or Muslim) with self-reported stress and psychological symptoms among sedentee and immigrant Bangladeshi women.

METHODS

Women, aged 35-59 (n = 531) were drawn from Sylhet, Bangladesh and London, England. Muslim immigrants in London and Hindu sedentees in Sylhet represented minority religious identities. Muslim sedentees in Sylhet and Londoners of European descent represented majority religious identities. In bivariate analyses, minority religious identity was examined in relation to self-reported measures of stress, nervous tension, and depressed mood. Logistic regression was applied to examine the relationship between these variables while adjusting for marital status, parity, daily walking, and perceived financial comfort.

RESULTS

In bivariate analyses, religious minorities reported more stress than religious majorities in all group comparisons (p < .05), and minority Muslims reported more nervous tension and depressed mood than majority Muslims (p < .05). In logistic regression models, minority Muslims had greater odds of high stress than majority Muslims (OR 2.00, 95% CI 1.18-3.39). Minority Muslims had greater odds of stress (OR 3.05, 95% CI 1.51-6.17) and nervous tension (OR 3.37, 95% CI 1.66-6.87) than majority Londoners. Financial comfort reduced odds of stress and symptoms in all models.

CONCLUSIONS

Socioeconomic situation, immigration history, and minority ethnicity appear to influence the relationship between religious identity and psychosomatic symptoms in Bangladeshi women. Attention to personal and socioeconomic context is important for research examining the association between religion and mental health.

Fertility and immigration: Do immigrant mothers hand down their fertility pattern to the next generation? Evidence from Norway

We examined whether the fertility pattern of immigrant mothers is handed down to the next generation. Our analyses were carried out on population register data. These data contained information on all immigrants to Norway from 123 countries during the period 1935-1995. We examined whether there was a relationship between the fertility rate in the country of origin and the number of children for generations 1.5 and 2 in Norway. We estimated three models: fixed effects for country of origin, fixed effects for region, and no fixed effects. The three specifications yielded estimates with overlapping confidence intervals. We interpret the estimates from the models with fixed effects for region, and the model with no fixed effects as upper-bound estimates. They show that an increase of 1.00 in the fertility rate in the country of origin leads to an average increase in the number of children of 0.12 (no fixed effects) or 0.14 (fixed effects for region) for immigrant women in generations 1.5 and 2. The estimate from the model with fixed effects for country of origin was small and not statistically significant at the conventional level. We interpret this as a lower-bound estimate. Our upper-bound estimates for generations 1.5 and 2 are smaller than the estimates for generation 1, i.e. there has been a decrease in the fertility rate from the first to the second generation. As a result, if the proportion of the population with an immigrant background continues to increase, it may increase at a slower rate in the future.

High self-selection of Ukrainian refugees into Europe: Evidence from Kraków and Vienna

Almost eight million Ukrainians have fled their country to escape the Russian full-scale invasion. To provide empirical evidence on how beneficiaries of temporary protection who reside in the immediate proximity of Ukraine differ from those who went further and reside in Western European countries, two large-scale rapid-response surveys were conducted in Kraków, Poland, and Vienna, Austria, in spring 2022. Data include information on socio-demographic characteristics, human capital, and return intentions of 472 and 1,094 adult Ukrainian refugees in Poland and Austria, respectively. Contributing to the growing empirical evidence on consistent assortative patterns in refugee inflows into Europe, our findings show that regularities in patterns of self-selection also occur in forced migration contexts where legal routes to safety apply. According to the analysed convenience sample, a tentative conclusion is that the further Ukrainian refugees moved to the West, the more self-selected they tend to be in the key dimensions of formal educational attainment, previous employment, language skills, and urbanity. Results indicate that willingness to stay in Kraków is significantly lower than willingness to remain in Vienna. This suggests that public financial support and living conditions, rather than diaspora networks, are decisive factors in shaping the decision to stay, move to another location or return to Ukraine. The aim to start a new life elsewhere may drive the motivation to choose a more distant destination instead of a neighboring country that allows to return rather quickly. Host countries should be aware of these specific characteristics of their refugee populations and adapt their integration policies accordingly.

Life's Essential 8 and Incident Hypertension Among US Hispanic/Latino Adults: Results From the Hispanic Community Health Study/Study of Latinos

BACKGROUND

Life's Essential 8 (LE8) is a new metric to define cardiovascular health. We aimed to describe LE8 among Hispanics/Latinos and its association with incident hypertension.

METHODS AND RESULTS

The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is a study of Hispanic/Latino adults aged 18 to 74 years from 4 US communities. At visit 1 (2008-2011), information on behavioral and clinical factors (diet, smoking status, physical activity, sleep duration, body mass index, blood pressure, cholesterol, fasting glucose, and medication use) were measured and used to estimate an LE8 score (range, 0-100) for 14 772 participants. Hypertension was defined as systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg, or self-reported use of antihypertensive medications. Among the 5667 participants free from hypertension at visit 1, we used Poisson regression models to determine the multivariable adjusted association between LE8 and incident hypertension in 2014 to 2017. All analyses accounted for the complex survey design of the study. Mean population age was 41 years, and 21.6% (SE, 0.7) had high cardiovascular health (LE8 ≥80). Mean LE8 score (68.2; SE, 0.3) varied by Hispanic/Latino background (P<0.05), ranging from 72.6 (SE, 0.3) among Mexican Americans to 62.2 (SE, 0.4) among Puerto Ricans. Each 10-unit decrement in LE8 score was associated with a 22% increased risk of hypertension over ≈6 years (incident density ratio, 1.22 [95% CI, 1.16-1.29]).

CONCLUSIONS

Only 1 in 5 Hispanic/Latino adults had high cardiovascular health, and LE8 varied substantially across Hispanic/Latino background groups. Improvements in other components of cardiovascular health may result in a lower risk of developing hypertension.

Income mortality paradox by immigrants' duration of residence in Sweden: a population register-based study

BACKGROUND

Studies have shown that, compared with the general native population, immigrants display weaker or absent income gradients in mortality. The aim of this study is to examine the extent to which the income gradient is modified by immigrants' duration of residence in Sweden.

METHODS

Swedish register data from 2004 to 2016 were used to study the association between individual income and all-cause mortality among foreign-born and Swedish-born individuals at ages 25-64 years. Based on relative indices of inequality (RIIs) and slope indices of inequality (SIIs) derived from Poisson regressions, we measured relative and absolute mortality differentials between the least and most advantaged income ranks. The analyses were stratified by sex, immigrants' European or non-European origin, and immigrants' duration of residence in Sweden.

RESULTS

The relative income inequality in mortality among immigrant men was less than half (RII: 2.32; 95% CI: 2.15 to 2.50) than that of Swedish-born men (RII: 6.25; 95% CI: 6.06 to 6.44). The corresponding RII among immigrant women was 1.23 (95% CI: 1.13 to 1.34) compared with an RII of 2.75 (95% CI: 2.65 to 2.86) among Swedish-born women. Inequalities in mortality were lowest among immigrants who resided for less than 10 years in Sweden, and most pronounced among immigrants who resided for more than 20 years in the country. Corresponding analyses of absolute income inequalities in mortality based on the SII were largely consistent with the observed relative inequalities in mortality.

CONCLUSIONS

Income inequalities in mortality among immigrants differ by duration of residence in Sweden, suggesting that health inequalities develop in the receiving context.

Research on racial/ethnic inequities in oral health over the past 80 years: The role of racism

AIM

This study aims to (1) describe trends in explanations provided for racial/ethnic inequities in dental caries and periodontitis, and (2) explore the patterns of relatedness among explanations for these inequities.

MATERIALS AND METHODS

Highly cited publications based on studies indexed in the Scopus database were retrieved and assessed for eligibility. Explanations for racial/ethnic inequities were classified into eight different, but interrelated domains. We assessed trends and examined the relations among explanations using multiple correspondence analysis.

RESULTS

A total of 200 articles among the most cited publications were selected. The proportion of studies invoking racism as an explanation for racial inequities in oral health increased from 0% to 14.3%, from 1937 to 2020. The proportions of individual socio-economic factors increased from 52.0% to 82.9%, and dental care from 28.0% to 62.9%. The remaining explanations were stable: psychological/behavioural processes (62.5%), biological factors (49.5%), contextual/area-level effects (24.0%) and immigrant paradox (4.0%). Multiple correspondence analysis revealed a smaller axial distance between racism and the following categories: studies from Brazil, recent publications and Blacks/Hispanics/mixed-race groups. Publications about immigrants were axially closer to the high-income countries category.

CONCLUSIONS

Our findings call on dental researchers to consider racism as a cause for existing racial/ethnic inequities in oral health.

Service access experiences of immigrant and refugee caregivers of autistic children in Canada: A scoping review

Primary caregivers are the main mediators of care for children with an autism diagnosis in Canada, and the navigation process to gain access to autism-related services is known to be a major burden. These challenges to service access are compounded for newcomers to Canada, which include immigrants and refugees. The purpose of this scoping review is to describe the available research on Canadian newcomer caregiver experiences navigating and accessing autism-related services. After a systematic search and screening process, 28 studies were included. Data were extracted regarding the populations, study aims, and themes reported. Included studies characterized barriers and facilitators to service access and navigation specific to immigrants, while limited information was available for refugees. Based on the existing literature, the authors provide recommendations for possible research approaches, populations to include, and themes to examine in future research to promote health equity in Canadian autism service access.

Prevalence of cardiovascular risk factors among Asian migrant workers in South Korea

BACKGROUND

The burden of non-communicable diseases is rapidly increasing among young adults in middle- and low-income countries. Asian migrant workers continue to be a significant contributor to South Korea's economy; however, their cardiovascular health is neglected. We explored the prevalence of cardiovascular risk factors among Asian migrant workers in South Korea.

METHODS

Cross-sectional survey, anthropometric measurements, blood pressure measurements, and biochemical tests including triglyceride, high-density lipoprotein, low-density lipoprotein, total cholesterol, fasting blood sugar, HbA1c, and C-reactive protein levels were conducted in 141 Asian migrant workers in South Korea.

RESULTS

The mean age of the participants was 31.3 (5.6) years. Of the participants, 14.8% were current smokers, and 47.5% consumed alcohol. The prevalence of overweight/obesity was 32.4%. The prevalence of hypertension and dyslipidemia were 51.2% and 64.6%, respectively. Of the participants, 98.5% had an increased waist circumference; elevated HbA1C and C-reactive protein was seen in 20.9% and 4.3%, respectively. The prevalence of metabolic syndrome was 5.5%. Clustering of two or more risk factors was seen in 45% of the participants. Factors associated with a high risk of cardiovascular diseases (clustering of two or more risk factors) were age (odds ratio 1.16, p < 0.01) and smoking (4.98, p < 0.05).

CONCLUSION

The prevalence of cardiovascular risk factors was alarmingly high among Asian migrant workers employed in South Korea. Efforts to mitigate and eliminate those risk factors are urgently required.

Do immigrants benefit from selection? Migrant educational selectivity and its association with social networks, skills and health

Recent scholarship suggests that immigrant selectivity - the degree to which immigrants differ from non-migrants in their sending countries - can help us understand their labour market outcomes in the receiving country. The selectivity hypothesis rests on three assumptions: first, that immigrants differ from non-migrants in their observed characteristics, such as education; second, that there is an association between such observed selection and (usually) unobserved characteristics, and third that this association drives positive relationships between observed selection and immigrant outcomes. While there is some evidence for a relationship between the degree of immigrants' selectivity and their children's outcomes, a comprehensive assessment of these assumptions for immigrants' own labour market outcomes remains lacking. We use high-quality, nationally representative data for the UK, with large numbers of immigrants from a wide range of different origins and with a rich set of measures of networks, traits and characteristics, as well as economic outcomes, not typically found in surveys of immigrants. This enables us to conduct a comprehensive assessment of the selectivity hypothesis and its assumptions. We find that immigrants to the UK are on average positively selected on educational attainment. However, counter to theoretical assumptions, educational selection has little association with labour market outcomes: it is not or negatively associated with employment; and it is only associated with pay for those with tertiary qualifications and with occupational position for women. We show that the general lack of economic benefits from selection is consistent with an absence of association between educational selectivity and (typically unobserved) mechanisms assumed to link selection and labour market outcomes: social networks, cognitive and non-cognitive skills, and mental and physical health. We contextualise our findings with heterogeneity analysis by migration regime, sending country characteristics, level of absolute education and location of credential.

Common mental disorders in Peruvian immigrant in Chile: a comparison with the host population

BACKGROUND

The Inner Santiago Health Study (ISHS) aimed to (i) estimate the prevalence of common mental disorders (CMD; i.e. depressive and anxiety disorders) among immigrants of Peruvian origin in Chile; (ii) determine whether such immigrants are at higher risk of CMD when compared with the native-born geographically matched population (i.e. non-immigrants); and (iii) identify factors associated with higher risk of any CMD among this immigrant group. A secondary aim was to describe access to mental health services by Peruvian immigrants meeting criteria for any CMD.

METHODS

Findings are based on a population-based cross-sectional household mental health survey of 608 immigrant and 656 non-immigrant adults (18-64 years) residing in Santiago de Chile. Diagnoses of ICD-10 depressive and anxiety disorders and of any CMD were obtained using the Revised Clinical Interview Schedule. The relationships between demographic, economic, psychosocial, and migration-specific predictor variables, and risk of any CMD were analyzed with a series of stepwise multivariate logistic regression models.

RESULTS

The one-week prevalence of any CMD was 29.1% (95% CI: 25.2-33.1) among immigrants and 34.7% (95% CI: 30.7-38.7) among non-immigrants. Depending on the statistical model used in the pooled sample, we found the prevalence of any CMD among non-immigrants to be higher (OR=1.53; 95% CI: 1.05-2.25) or similar (OR=1.34; 95% CI: 0.94-19.2) when compared with immigrants. In the multivariate stepwise regression of any CMD in immigrants only, the prevalence was higher for females, those with primary compared to higher education, in debt and exposed to discrimination. Conversely, higher levels of functional social support, sense of comprehensibility, and manageability were associated with a lower risk of any CMD in immigrants. In addition, no differences were observed between immigrants and non-immigrants reporting any CMD in mental health service utilization.

CONCLUSION

Our results evidence high levels of current CMD in this immigrant group, particularly amongst women. However, lower adjusted prevalence of any CMD in immigrants compared to non-immigrants was limited to preliminary statistical models, thus failing to provide clear support for a "healthy immigrant effect". The study sheds new light on differences in CMD prevalence by immigrant status in Latin America by examining differential exposure to risk factors in immigrant versus non-immigrant groups.

Negotiating precarity: Recent immigrants' perceptions of waiting for public healthcare in Ontario, Canada

Canada is widely known for its universal publicly funded health care system. While its health care system is an important part of Canadian identity, recent immigrants living in some provinces and territories are not covered by the publicly funded healthcare system until they have met a minimum residency requirement. This article seeks to understand the multiple manifestations of financial and emotional precarity that recent immigrants face as they navigate a lack of access to health care during their first three months of arrival in Ontario. This paper draws on qualitative semi-structured interview data from 46 recent immigrants who came from 12 different countries and had been living in Ontario, Canada. We found that the wait period to obtain health care often added to the prohibitive costs associated with immigration and settlement. During the wait period, recent immigrants faced financial burdens and their inability to access publicly funded hospitals and medical services when needed which resulted in feelings of vulnerability, anxiety, and emotional hardship. Given the financial and emotional precarities faced by recent immigrants during the wait period, we argue that the Canadian 'universal' healthcare system excludes and creates barriers to timely and equitable access to healthcare services for recent immigrants. We recommend to permanently eliminate the wait period policy to ensure the health and wellbeing of recent immigrants.

Navigating the quality-of-life impacts of a chronic inflammatory disease (CID) among South Asian children and parents

This study investigates quality-of-life impacts (QOL) associated with managing a chronic inflammatory disease (CID) among first and second generation South Asian children and parents in the Greater Toronto Area, Ontario. While empirical evidence on both the rise of CIDs among immigrants and the QOL impacts of managing a CID is increasing, little attention has been given to the QOL impacts of managing a CID among immigrant adult children and their families. Drawing on analysis of 24 in-depth interviews with adult children and parents (14 adult children, 10 parents) the results indicate that first and second generation South Asian adult children and parents experience challenges acquiring a CID diagnosis (e.g., bureaucratic issues, transportation, inconsistent and unavailable physician care), and encounter multidimensional short- and long-term QOL implications associated with CID management. These challenges are compounded further by culturally insensitive care and language barriers in the health system. QOL impacts associated with CID management among adult children ranged from comfort and peace of mind due to increased ability to participate in daily life, while others reported intensified anxiety, stress and depression due to their inability to fully engage in daily life. Although all parents reported heightened stress due to their child's CID diagnosis and new management regimens, parents employed different coping mechanisms that created new short term QOL challenges for their families. The findings suggest that a patient centered approach to CID diagnosis and management, informed by personal experiences, cultural sensitivities and lived experiences of QOL representations are needed to mitigate negative QOL outcomes across a patient's life and deliver appropriate evidence informed care for those in need.

Reasons for Migration, Post-Migration Sociocultural Characteristics, and Parenting Styles of Chinese American Immigrant Families

With the growing percentage of Chinese immigrants in the U.S. population, it is crucial to understand how pre-migration factors (such as reasons for migration) are related to the adjustment of families in the host country. The present study examined reasons for migration and their associations with post-migration sociocultural factors and parenting styles in a community-based sample of Chinese American immigrant families (N = 258) living in the San Francisco Bay Area. The parents' self-reported reasons for migration included family reasons (55.1%, e.g., family reunification), betterment reasons (18.0%, e.g., better education and occupational opportunities), and both family and betterment reasons (26.9%). Those who migrated for betterment reasons reported significantly higher parental education and per capita income than the family reason group (p < 0.001) and significantly higher income than the combined reason group (p = 0.007). No significant group differences emerged in cultural orientations and parenting styles after controlling for socioeconomic factors. The findings suggested that Chinese immigrant families who migrated solely for better education and occupational opportunities had significantly higher post-migration socioeconomic status than other reason groups. These differences have relevance for programs and services for new immigrants, as families might need different types of support (e.g., socioeconomic vs. relational) depending on their motivations for migration and post-migration socioeconomic resources.

Differences in birth weight between immigrants' and natives' children in Europe and Australia: a LifeCycle comparative observational cohort study

OBJECTIVE

Research on adults has identified an immigrant health advantage, known as the 'immigrant health paradox', by which migrants exhibit better health outcomes than natives. Is this health advantage transferred from parents to children in the form of higher birth weight relative to children of natives?

SETTING

Western Europe and Australia.

PARTICIPANTS

We use data from nine birth cohorts participating in the LifeCycle Project, including five studies with large samples of immigrants' children: Etude Longitudinale Française depuis l'Enfance-France (N=12 494), the Raine Study-Australia (N=2283), Born in Bradford-UK (N=4132), Amsterdam Born Children and their Development study-Netherlands (N=4030) and the Generation R study-Netherlands (N=4877). We include male and female babies born to immigrant and native parents.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome is birth weight measured in grams. Different specifications were tested: birth weight as a continuous variable including all births (DV1), the same variable but excluding babies born with over 4500 g (DV2), low birth weight as a 0-1 binary variable (1=birth weight below 2500 g) (DV3). Results using these three measures were similar, only results using DV1 are presented. Parental migration status is measured in four categories: both parents natives, both born abroad, only mother born abroad and only father born abroad.

RESULTS

Two patterns in children's birth weight by parental migration status emerged: higher birth weight among children of immigrants in France (+12 g, p<0.10) and Australia (+40 g, p<0.10) and lower birth weight among children of immigrants in the UK (-82 g, p<0.05) and the Netherlands (-80 g and -73 g, p<0.001) compared with natives' children. Smoking during pregnancy emerged as a mechanism explaining some of the birth weight gaps between children of immigrants and natives.

CONCLUSION

The immigrant health advantage is not universally transferred to children in the form of higher birth weight in all host countries. Further research should investigate whether this cross-national variation is due to differences in immigrant communities, social and healthcare contexts across host countries.

Epidemiology of chronic multimorbidity and temporary migration in a rural South African community in health transition: A cross-sectional population-based analysis

Introduction

In sub-Saharan African settings, the increasing non-communicable disease mortality is linked to migration, which disproportionately exposes sub-populations to risk factors for co-occurring HIV and NCDs.

Methods

We examined the prevalence, patterns, and factors associated with two or more concurrent diagnoses of chronic diseases (i.e., multimorbidity) among temporary within-country migrants. Employing a cross-sectional design, our study sample comprised 2144 residents and non-residents 18-40 years interviewed and with measured biomarkers in 2018 in Wave 1 of the Migrant Health Follow-up Study (MHFUS), drawn from the Agincourt Health and Demographic Surveillance System (AHDSS) in rural north-eastern South Africa. We used modified Poisson regression models to estimate the association between migration status and prevalent chronic multimorbidity conditional on age, sex, education, and healthcare utilisation.

Results

Overall, 301 participants (14%; 95% CI 12.6-15.6), median age 31 years had chronic multimorbidity. Multimorbidity was more prevalent among non-migrants (14.6%; 95% CI 12.8-16.4) compared to migrants (12.8%; 95% CI 10.3-15.7). Non-migrants also had the greatest burden of dual-overlapping chronic morbidities, such as HIV-obesity 5.7%. Multimorbidity was 2.6 times as prevalent (PR 2.65. 95% CI 2.07-3.39) among women compared to men. Among migrants, men, and individuals with secondary or tertiary education manifested lower prevalence of two or more conditions.

Discussion

In a rural community with colliding epidemics, we found low but significant multimorbidity driven by a trio of conditions: HIV, hypertension, and obesity. Understanding the multimorbidity burden associated with early adulthood exposures, including potential protective factors (i.e., migration coupled with education), is a critical first step towards improving secondary and tertiary prevention for chronic disease among highly mobile marginalised sub-populations.

Just a question of time? Explaining non-take-up of a public health insurance program designed for undocumented immigrants living in France

State Medical Aid is a public health insurance program that allows undocumented immigrants with low financial resources to access health care services for free. However, the low take-up rate of this program might threaten its efficiency. The purpose of this study is therefore to provide the determinants of such a low take-up rate. To this end, we rely on the Premier Pas survey. This is an original representative sample of undocumented immigrants attending places of assistance to vulnerable populations in France. Determinants of State Medical Aid take-up are analyzed through probit and Cox modeling. The results show that only 51% of those who are eligible for the State Medical Aid program are actually covered, and this proportion is higher among women than among men. The length of stay in France is the most important determinant of take-up. It is worth noting that State Medical Aid take-up is not associated with chronic diseases or functional limitations and is negatively associated with poor mental health. There is, therefore, mixed evidence of health selection into the program. Informational barriers and vulnerabilities experienced by undocumented immigrants are likely to explain this low take-up.

Assessment of the quality and content of clinical practice guidelines (CPGs) for vitamin D and for immigrants using the AGREE-II instrument: a protocol for systematic review

INTRODUCTION

Worldwide, more immigrants experience vitamin D (vitD) deficiency than non-immigrants, which is attributed to ethnic variations, place or region of birth, skin pigmentation, clothing style, and resettlement-related changes in diet, physical activity, and sun exposure. Current recommendations in clinical practice guidelines (CPGs) concerning vitD are inadequate to address vitD deficiency among immigrants. CPGs may also lack guidance for physicians on vitD supplementation for immigrants. Moreover, there are concerns about the overall quality of these CPGs.

OBJECTIVES

This systematic review will collate and critically appraise CPGs relevant to immigrants' health and vitD. Moreover, we will evaluate whether the CPGs of vitD including recommendations for immigrants and clarify whether the CPGs of immigrants include recommendations on vitD.

METHODS

A systematic search of Ovid MEDLINE® ALL, EMBASE, and Turning Research Into Practice (TRIP) electronic databases, guideline repositories, and gray literature will be conducted to identify relevant CPGs. Two reviewers will independently evaluate the methodological quality of the retrieved guidelines using the Appraisal of Guidelines, Research, and Evaluation-II (AGREE-II) instrument. CPGs scoring ≥60% in at least four domains, including "rigor of development," will be considered high quality.

CONCLUSION

Evaluating the quality and content of relevant CPGs may support researchers in developing national and global guidelines for immigrants. Furthermore, it may support vitD testing, nutritional counseling, and supplementation for vulnerable immigrant sub-populations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021240562.

Knowledge, Attitudes and Practices of Indian Immigrants in Australia towards Oral Cancer and Their Perceived Role of General Practitioners: A Cross-Sectional Study

Oral cancer is highly prevalent in the Indian subcontinent. With the increasing immigration of Indians to Australia, a potential rise in oral cancer cases can be expected if they continue engaging in oral cancer risk practices. Unfortunately, little is known on this topic in the Australian context. This study aimed to generate new insights into this area by examining Indian immigrants’ knowledge, attitudes and practices regarding oral cancer in Australia and their perceived role of general practitioners in raising oral cancer awareness. Exploring these aspects could determine the oral cancer risk behaviours of Indians in Australia along with any contributing factors which could help identify potential preventative strategies. A cross-sectional survey was undertaken of 164 Indians across Australia. Data were analysed using SPSS software with descriptive statistics. Respondents had varying levels of knowledge about oral cancer (mean total score 61%), particularly around risk factors such as alcohol and areca nut use as well as oral cancer-related signs/symptoms. The majority (87.7%) had not received any information about oral cancer in a health care setting but were receptive (71–90%) to general practitioners playing a more active role in this area. Respondents were engaging in positive preventative oral health care though few were currently (6.7%) or previously (14.7%) chewing tobacco preparations. Further research is needed through larger studies to confirm the study findings and inform the development of culturally tailored strategies particularly involving general practitioners, to raise oral cancer awareness and provide early screening for Indian immigrants.

The Health of Immigrant Youth in Denmark: Examining Immigrant Generations and Origin

First-generation migrants tend to have better health than those of native ancestry, while second-generation migrants often are affected by negative health assimilation. Less is known about immigrants arriving before their teens, the 1.5 generation, or those with one native and one immigrant parent, the 2.5 generation. We apply logistic regression models to study physical and mental health outcomes for immigrant youth across generations using Danish register data. We take heterogeneities into account studying gender and origin differences. Our analysis shows that first- and 1.5-generation immigrants have better physical health than natives, while the physical health of the second and 2.5 generations is the same or worse than natives. For mental health, the 2.5 generation is the only group with worse outcomes than natives, which we relate to identification struggles translating into poorer mental health. When studying potential heterogeneities, we find that males belonging to the second generation with an African background have a higher likelihood of hospitalization for a mental health issue.

Self-Rated Health Among Italian Immigrants Living in Norway: A Cross-Sectional Study

Background

Most studies on immigrant health focus on immigrant groups coming from extra-European and/or low-income countries. Little attention is given to self-rated health (SRH) in the context EU/EEA migration. To know more about health among European immigrants can provide new insights related to social determinants of health in the migration context. Using the case of Italian immigrants in Norway, the aim of this study was to (i) examine the levels of SRH among Italian immigrants in Norway as compared with the Norwegian and the Italian population, (ii) examine the extent to which the Italian immigrant perceived that moving to Norway had a positive or negative impact on their SRH; and (iii) identify the most important factors predicting SRH among Italian immigrants in Norway.

Methods

A cross-sectional survey was conducted among adult Italian immigrants in Norway (n = 321). To enhance the sample's representativeness, the original dataset was oversampled to match the proportion of key sociodemographic characteristics of the reference population using the ADASYN method (oversampled n = 531). A one-sample Chi-squared was performed to compare the Italian immigrants' SRH with figures on the Norwegian and Italian populations according to Eurostat statistics. A machine-learning approach was used to identify the most important predictors of SRH among Italian immigrants.

Results

Most of the respondents (69%) rated their SRH as "good" or "very good". This figure was not significantly different with the Norwegian population, nor to the Italians living in Italy. A slight majority (55%) perceived that their health would have been the same if they continued living in Italy, while 23% perceived a negative impact. The machine-learning model selected 17 variables as relevant in predicting SRH. Among these, Age, Food habits, and Years of permanence in Norway were the variables with the highest level of importance, followed by Trust in people, Educational level, and Health literacy.

Conclusions

Italian immigrants in Norway can be considered as part of a "new mobility" of high educated people. SHR is shaped by several interconnected factors. Although this study relates specifically to Italian immigrants, the findings may be extended to other immigrant populations in similar contexts.

Disability and Self-Rated Health: Exploring Foreign- and U.S.-Born Differences Across Adulthood

There is limited inquiry regarding how immigrant status intersects with disability to influence health across adulthood. As the U.S. population continues to age, especially immigrants, understanding how disability influences health is imperative. Using 2010–2018 National Health Interview Survey data (n = 461,010) and logistic regression models, we investigate how differences in reporting Activity of Daily Living (ADL) disability influence reports of self-rated health (SRH) between foreign- and U.S.-born respondents (ages 25+) by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) by age group (25–64 and 65+). Among those ages 25–64, foreign-born respondents generally report lower or similar rates of fair/poor SRH and ADL disability when compared to their U.S.-born peers. Among those ages 65+, we find that foreign-born respondents are at greater risk of fair/poor SRH compared to their U.S.-born peers. Additionally, while having ADL disability greatly increases the likelihood of fair/poor SRH, the impact of this association differs by race/ethnicity/nativity and age. Among those 25–64, having ADL disability appears to be especially, negatively impactful for SRH among foreign-born groups, particularly Hispanics and non-Hispanic Whites. However, among those ages 65+, having ADL disability is less impactful on the SRH of foreign-born respondents, especially non-Hispanic Blacks and Hispanics. Our findings shed new light on marginalization-related diminished returns by showing how ADL disability influences SRH differently between foreign-born groups across adulthood.

Cohort, Policy, and Process: The Implications for Migrant Fertility in West Germany

Although a growing literature explores the relationship between migration and fertility, far less scholarship has examined how migrant childbearing varies over time, including across migrant cohorts. I extend previous research by exploring migrant-cohort differences in fertility and the role of changing composition by education and type of family migration. Using 1984-2016 German Socio-Economic Panel data, I investigate the transition into first, second, and third birth among foreign-born women in West Germany. Results from an event-history analysis reveal that education and type of family migration-including marriage migration and family reunions-contribute to differences in first birth across migrant cohorts. Specifically, more rapid entry into first birth among recent migrants from Turkey stems from a greater representation of marriage migrants across arrival cohorts, while increasing education is associated with reduced first birth propensities among recent migrants from Southern Europe. I also find variation in the risk of higher parity transitions across migrant cohorts, particularly lower third birth risks among recent arrivals from Turkey, likely a result of changing exposures within origin and destination contexts. These findings suggest that as political and socioeconomic circumstances vary within origin and destination contexts, selection, adaptation, and socialization processes jointly shape childbearing behavior.

Nativity-Related Disparities in Preeclampsia and Cardiovascular Disease Risk Among a Racially Diverse Cohort of US Women

IMPORTANCE

Preeclampsia is an independent risk factor for future cardiovascular disease and disproportionally affects non-Hispanic Black women. The association of maternal nativity and duration of US residence with preeclampsia and other cardiovascular risk factors is well described among non-Hispanic Black women but not among women of other racial and ethnic groups.

OBJECTIVE

To examine differences in cardiovascular risk factors and preeclampsia prevalence by race and ethnicity, nativity, and duration of US residence among Hispanic, non-Hispanic Black, and non-Hispanic White women.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional analysis of the Boston Birth Cohort included a racially diverse cohort of women who had singleton deliveries at the Boston Medical Center from October 1, 1998, to February 15, 2016. Participants self-identified as Hispanic, non-Hispanic Black, or non-Hispanic White. Data were analyzed from March 1 to March 31, 2021.

EXPOSURES

Maternal nativity and duration of US residence (<10 vs ≥10 years) were self-reported.

MAIN OUTCOME AND MEASURES

Diagnosis of preeclampsia, the outcome of interest, was retrieved from maternal medical records.

RESULTS

A total of 6096 women (2400 Hispanic, 2699 non-Hispanic Black, and 997 non-Hispanic White) with a mean (SD) age of 27.5 (6.3) years were included in the study sample. Compared with Hispanic and non-Hispanic White women, non-Hispanic Black women had the highest prevalence of chronic hypertension (204 of 2699 [7.5%] vs 65 of 2400 [2.7%] and 28 of 997 [2.8%], respectively), obesity (658 of 2699 [24.4%] vs 380 of 2400 [15.8%] and 152 of 997 [15.2%], respectively), and preeclampsia (297 of 2699 [11.0%] vs 212 of 2400 [8.8%] and 71 of 997 [7.1%], respectively). Compared with their counterparts born outside the US, US-born women in all 3 racial and ethnic groups had a significantly higher prevalence of obesity (Hispanic women, 132 of 556 [23.7%] vs 248 of 1844 [13.4%]; non-Hispanic Black women, 444 of 1607 [27.6%] vs 214 of 1092 [19.6%]; non-Hispanic White women, 132 of 776 [17.0%] vs 20 of 221 [9.0%]), smoking (Hispanic women, 98 of 556 [17.6%] vs 30 of 1844 [1.6%]; non-Hispanic Black women, 330 of 1607 [20.5%] vs 53 of 1092 [4.9%]; non-Hispanic White women, 382 of 776 [49.2%] vs 42 of 221 [19.0%]), and severe stress (Hispanic women, 76 of 556 [13.7%] vs 85 of 1844 [4.6%]; non-Hispanic Black women, 231 of 1607 [14.4%] vs 120 of 1092 [11.0%]; non-Hispanic White women, 164 of 776 [21.1%] vs 26 of 221 [11.8%]). After adjusting for sociodemographic and cardiovascular risk factors, birth status outside the US (adjusted odds ratio [aOR], 0.74 [95% CI, 0.55-1.00]) and shorter duration of US residence (aOR, 0.62 [95% CI, 0.41-0.93]) were associated with lower odds of preeclampsia among non-Hispanic Black women. However, among Hispanic and non-Hispanic White women, maternal nativity (aOR for Hispanic women, 1.07 [95% CI, 0.72-1.60]; aOR for non-Hispanic White women, 0.98 [95% CI, 0.49-1.96]) and duration of US residence (aOR for Hispanic women <10 years, 1.04 [95% CI, 0.67-1.59]; aOR for non-Hispanic White women <10 years, 1.20 [95% CI, 0.48-3.02]) were not associated with preeclampsia.

CONCLUSIONS AND RELEVANCE

Nativity-related disparities in preeclampsia persisted among non-Hispanic Black women but not among Hispanic and non-Hispanic White women after adjusting for sociodemographic and cardiovascular risk factors. Further research is needed to explore the interplay of factors contributing to nativity-related disparities in preeclampsia, particularly among non-Hispanic Black women.

Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys

AIMS

This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries.

METHODS

We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT's European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma (n=11,401), Roma neighbours (n=5857) and the general population (n=101,579) stratified by gender, and adjusted by age, country and educational level.

RESULTS

There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications.

CONCLUSIONS

These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population's social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.

Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012-2016

As the fastest growing racial group in the United States, understanding the health patterns of Asians is important to addressing health gaps in American society. Most studies have not considered the unique experiences of the ethnic groups contained in the Asian racial group, implying that Asians have a shared story. However, we should expect differences between the ethnic groups given the differences in their timing and place of migration, socioeconomic status, and racialized experiences in the United States. We estimate the life expectancy of the six largest Asian ethnic groups-Chinese, Asian Indians, Filipinos, Vietnamese, Koreans, and Japanese-analyzing data from the Multiple Cause of Death File (2012-2016) and the American Community Survey (2012-2016) in the United States at the national and regional levels. Nationally, Chinese had the highest life expectancy (males e0 = 86.8; females e0 = 91.3), followed by Asian Indians, Koreans, Japanese, Filipinos, and Vietnamese, generally reflecting the pattern expected given their educational attainment, our primary indicator of socioeconomic status. We also found regional differences in life expectancy, where life expectancy for Asians in the West was significantly lower than all other regions. These findings suggest the presence of underlying selection effects associated with settlement patterns among new and traditional destinations. Our results underline the necessity of studying the experiences of the different Asian ethnic groups in the United States, permitting a better assessment of the varying health needs within this diverse racial group.

Selection, experience, and disadvantage: Examining sources of health inequalities among naturalized US citizens

Objectives

We integrated major theories in immigrant health and assimilation into a single analytical framework to quantify the degrees to which demographic composition, pathways to citizenship, and socioeconomic assimilation account for physical and mental health disparities between naturalized immigrants by region of origin.

Methods

Using the restricted data from the 2015–2016 California Health Interview Survey, we decomposed differences in physical and mental health into demographic factors, path to citizenship, and socioeconomic characteristics by region of origin using the Karlson, Holm, and Breen (KHB) method.

Results

Differences in socioeconomic status mediated most of the disparity in physical health between naturalized immigrants from different regions. Factors associated with major immigrant health theories—demographic composition, pathways to citizenship, and socioeconomic assimilation—did not mediate disparities in mental health.

Conclusion

This article argues that the study of health disparities among immigrants must simultaneously account for differences in demographic composition, immigration experience, and socioeconomic disadvantage. The findings also underscore the need for theory development that can better explain mental health disparities among immigrants.

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Socioeconomic disadvantage accounted for poorer physical health among naturalized citizens who were born in Mexico.

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Psychological distress is pervasive among naturalized citizens from Central and Latin America.

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Differences in SES mediated the disparity in physical health between naturalized immigrants from different regions.

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Demographic characteristics, time to citizenship, and SES did not mediate disparities in mental health.

Living Conditions and the Mental Health and Well-being of Refugees: Evidence from a Large-Scale German Survey

Refugees are at an increased risk of mental health problems and low subjective well-being. Living circumstances in the host country are thought to play a vital role in shaping these health outcomes, which, in turn, are prerequisites for successful integration. Using data from a representative survey of 4325 adult refugees who arrived in Germany between 2013 and 2016, we investigated how different living conditions, especially those subject to integration policies, are associated with psychological distress and life satisfaction using linear regression models. Our findings show that an uncertain legal status, separation from family, and living in refugee housing facilities are related to higher levels of distress and decreased life satisfaction. Being employed, contact to members of the host society, and better host country language skills, by contrast, are related to reduced distress and higher levels of life satisfaction. These associations should inform decision making in a highly contested policy area.

Impacts of internal migration experience on health among middle-aged and older adults-Evidence from China

As a life course factor, internal migration plays a role in shaping health condition in middle age and later life. Using data from the 2014 and 2015 China Health and Retirement Longitudinal Study (CHARLS), the present study examined the impacts and mechanism of internal migration experience on the health of middle-aged and older adults in China. Internal migration experience had significant negative impacts on health, whether in relation to self-reported health or number of chronic diseases. The impact increased with the frequency of internal migration. Compared to individuals that had not migrated, those who first migrated between age 18-35 had a worse overall health status. Initial internal migration occurring below age 18 significantly increased the number of chronic diseases. Medical service was found to be an important mechanism in the impact of internal migration experience on health. Given the insufficient protections related to internal migration, enhanced formal social support, especially healthcare services, should be implemented to mitigate the health disparities associated with internal migration.

Parental migrant status and health inequalities at birth: The role of immigrant educational selectivity

Immigrants tend to exhibit better health than natives despite immigrants' more disadvantaged socioeconomic status. This paradox has often been attributed to immigrants' pre-migration selectivity. However, most empirical studies investigating the role of selectivity have focused on adult health; less attention has been paid to children's birth outcomes outside the U.S. context. Using data from the Etude Longitudinale Française depuis l'Enfance (ELFE), a nationally representative sample of over 18000 births in France in 2011, we investigate the role of immigrant parents' educational selectivity in shaping four birth outcomes: birthweight, low birthweight, prematurity, and being born small for gestational age. Results from linear and logistic regressions confirm a health advantage for children of immigrants compared to natives despite lower parental socioeconomic status, mainly among children of Middle Eastern and North African parents. Immigrant parents' positive pre-migration educational selectivity explains most of this health advantage, predominantly among children with two immigrant parents. Further, mediation analyses indicate that the effect of educational selectivity is partially mediated by parental health behaviors, particularly smoking during pregnancy. Furthermore, analyses suggest that selectivity improves birth outcomes only for children of recent arrivals, with less than five years of residence in France. The beneficial effect of selectivity declines with length of residence, suggesting that a process of "unhealthy assimilation," coupled with the cumulative exposure to health risks and disadvantaged living conditions, may lead to the erosion of the protective effect of immigrant selectivity.

Risk of Stillbirth Among Foreign-Born Mothers in the United States

The objective of this study is to assess the impact of maternal nativity on stillbirth in the US. We utilized the US Birth Data and Fetal Death Data for the years 2014-2017. Our analysis was restricted to live and stillbirths (N= of 14,867,880) that occurred within the gestational age of 20-42 weeks. The fetuses-at risk approach was used to generate stillbirth trends by gestational age. Adjusted Cox proportional hazards regression model was utilized to estimate the association between maternal nativity and stillbirth. Overall, the gestational week-specific prospective risk of stillbirth was consistently higher for native-born than their foreign-born mothers. Foreign-born mothers were 20% less likely to experience stillbirth than their native-born counterparts (AHR = 0.80; 95% CI = 0.78-0.81). Delineating the factors influencing the observed effect of maternal nativity on birth outcomes should be a research priority to inform strategies to address adverse birth outcomes in the US.

Impact of Maternal Age on the Foreign-Born Paradox

To examine the effect of maternal age on the risk of preterm birth and its phenotypes in foreign-born compared to native-born mothers. The 2014-2017 US Birth and Fetal Death data were analyzed (N = 14,867,880). Log-binomial regression models were used to estimate adjusted prevalence ratios (APR), quantifying the association between mother's nativity and preterm birth and its phenotypes, stratified by maternal age. Foreign-born mothers had a 13% lower probability of preterm birth compared to their native-born counterparts (APR, 0.87 [95% CI 0.86-0.87]). This protective effect persisted across all preterm phenotypes. Stratification by maternal age showed a slightly elevated risk in preterm and moderate-to-late preterm for adolescent mothers. Our study supports the existence of the "foreign-born paradox" whereby foreign-born mothers experienced lower levels of preterm birth despite the disadvantages of living in an alien socio-cultural environment. This favorable birth outcome was present primarily in foreign-born mothers aged ≥ 20 years.

Relationship of Preeclampsia With Maternal Place of Birth and Duration of Residence Among Non-Hispanic Black Women in the United States

BACKGROUND

Preeclampsia is one of the leading causes of maternal mortality in the United States. It disproportionately affects non-Hispanic Black (NHB) women, but little is known about how preeclampsia and other cardiovascular disease risk factors vary among different subpopulations of NHB women in the United States. We investigated the prevalence of preeclampsia by nativity (US born versus foreign born) and duration of US residence among NHB women.

METHODS

We analyzed cross-sectional data from the Boston Birth Cohort (1998-2016), with a focus on NHB women. We performed multivariable logistic regression to investigate associations between preeclampsia, nativity, and duration of US residence after controlling for potential confounders.

RESULTS

Of 2697 NHB women, 40.5% were foreign born. Relative to them, US-born NHB women were younger, in higher percentage current smokers, had higher prevalence of obesity (body mass index ≥30 kg/m2) and maternal stress, but lower educational level. The age-adjusted prevalence of preeclampsia was 12.4% and 9.1% among US-born and foreign-born women, respectively. When further categorized by duration of US residence, the prevalence of all studied cardiovascular disease risk factors except for diabetes was lower among foreign-born NHB women with <10 versus ≥10 years of US residence. Additionally, the odds of preeclampsia in foreign-born NHB women with duration of US residence <10 years was 37% lower than in US-born NHB women. In contrast, the odds of preeclampsia in foreign-born NHB women with duration of US residence ≥10 years was not significantly different from that of US-born NHB women after adjusting for potential confounders.

CONCLUSIONS

The prevalence of preeclampsia and other cardiovascular disease risk factors is lower in foreign-born than in US-born NHB women. The healthy immigrant effect, which typically results in health advantages for foreign-born women, appears to wane with longer duration of US residence (≥10 years). Further research is needed to better understand these associations.

Health of refugees and migrants from former Soviet Union countries in the Russian Federation: a narrative review

This narrative review was conducted to synthesize and summarize available up-to-date evidence on current health status, including both non-communicable diseases and infectious diseases, of migrants and refugees from the former Soviet Union countries in the Russian Federation. Epidemiological and sociological studies with one or more determinants of the health, as well as relevant qualitative studies characterizing risk factors, well-being indicators, and lifestyles of migrants and refugees from the former Soviet Union countries in Russia published from 2004 to 2019 in Russian and English languages were included in the review. Despite significant limitations of the available research literature in the field, some patterns in migrants' health in Russia and issues that need to be addressed were identified. In particular, the syndemic epidemics of communicable and non-communicable diseases, additively increasing negative health consequences, including cardiovascular diseases and chronic digestive system diseases, high rates of sexually transmitted infections and HIV, respiratory diseases and a growing percentage of new tuberculosis cases among migrants from the former Soviet Union countries are all of great concern. Possibly, the burden of these co-occurring morbidities is linked to commonly reported issues among this population group, such as poor nutrition and living conditions, high prevalence of unskilled manual labour, non-compliance with sanitary norms, lack of basic vaccinations, lack of basic knowledge about safe sexual practices and risky sexual behaviour, low healthcare seeking behaviour and limited access to health care. Importantly, these findings may urge the government to increase efforts and promote international collaboration in combating the threat of infectious diseases. Additionally, it was found that migrants had higher levels of anxiety and post-traumatic stress disorder, and those who stayed in the receiving country 5 years or more had a higher level of somatic pathology than those whose stay was less than 5 years. In order to ensure an adequate health system response and fulfil the main Universal Health Coverage principle of "leaving no one behind", a robust monitoring system of the health status of refugees and migrants and an integrated legal framework for the standardized and more inclusive routine care for this population in Russia is urgently needed.

Beyond the healthy immigrant paradox: decomposing differences in birthweight among immigrants in Spain

Background

The healthy immigrant paradox refers to the unexpected health advantages of immigrant groups settled in host countries. In this population-based study we analyze immigrant advantages in birthweight decomposing differences between infants born to immigrant mothers from specific origins.

Method

Using publicly available data from Spanish Vital Statistics for the period 2007–2017, differential birthweights among several groups of immigrants were estimated with an ordinary least squares regression. The Oaxaca–Blinder regression-based decomposition method was then applied to identify the extent to which differences in birthweight between groups corresponded to compositional disparities or to other factors.

Results

Our analysis of singleton live births to migrant mothers in Spain between 2007 and 2017 (N = 542,137) confirmed the healthy immigrant paradox for certain immigrant populations settled in Spain. Compared with infants born to mothers from high-income countries, the adjusted birthweight was higher for infants born to mothers from non-high- income European countries (33.2 g, 95% CI: 28.3–38.1, P < 0.01), mothers from African countries (52.2 g, 95% CI: 46.9–57.5, P < 0.01), and mothers from Latin American countries (57.4 g, 95% CI: 52.9–61.3, P < 0.01), but lower for infants born to mothers from Asian non-high-income countries (− 31.4 g, 95% CI: − 38.4 to − 24.3, P < 0.01). Decomposition analysis showed that when compared with infants born to mothers from high-income countries, compositional heterogeneity accounts for a substantial proportion of the difference in birthweights. For example, it accounts for 53.5% (95% CI: 24.0–29.7, P < 0.01) of the difference in birthweights for infants born to mothers from non-high-income European countries, 70.9% (95% CI: 60–66.7, P < 0.01) for those born to mothers from African countries, and 38.5% (95% CI: 26.1–29.3, P < 0.01) for those born to mothers from Latin American countries.

Conclusions

Our results provide strong population-based evidence for the healthy immigrant paradox in birthweight among certain migrant groups in Spain. However, birth outcomes vary significantly depending on the origins of migrant subpopulations, meaning that not all immigrant groups are unexpectedly healthier. A significant portion of the perinatal health advantage of certain immigrant groups is only a by-product of their group composition (by age, parity, marital status, socioeconomic status, and citizenship of mother, age and migratory status of father and type of delivery) and does not necessarily correspond to other medical, environmental, or behavioral factors.

Trends in prevalence of depression and serious psychological distress in United States immigrant and non-immigrant populations, 2010 - 2016

OBJECTIVE

To examine the prevalence of depression and serious psychological distress (SPD) among adult United States (US) immigrants and US-born; and to investigate trends in depression and SPD.

METHODS

National Health Interview Survey data (2010 - 2016) was analyzed. Chi-square tests were used to measure differences in prevalence of SPD between US-born and immigrants, and differences in prevalence of depression. Logistic regression models were used to measure the association between mental health outcomes (depression, SPD) and predictors (nativity, length of residence). General linear models were used to investigate depression and SPD trends.

RESULTS

101,142 US adults were included in the analysis. Immigrants were found to be 11% (OR 0.89, 95% CI [0.85,0.95]) less likely to suffer from depression compared to US-born. US-born (p<0.0001) had a higher prevalence of depression compared to immigrants, and prevalence of depression decreased overtime (p=0.011) for immigrants and US-born individuals. Immigrants who lived in the US 15+ years were 17% (OR 1.17, 95% CI [1.00,1.36]) more likely to have SPD compared to those who were born in the US. Among immigrants, as length of residence increased the prevalence of SPD (p=0.002) and depression (p<0.0001) increased.

LIMITATIONS

This study examines immigrants as an entire population, not accounting for differences in immigrant status or immigrant ethnicity.

CONCLUSIONS

While the prevalence of depression is lower in immigrants compared to US-born, being an immigrant in the US for more than 15 years increases risk of SPD to the point of surpassing that of US-born individuals and increases risk of depression.

High Selection, Low Success: The Heterogeneous Effect of Migrants’ Access to Employment on Their Remigration

This article reconciles contrasting findings on the effect of access to employment on remigration by showing that this effect is actually heterogeneous and depends on migrants’ initial educational selection from the origin country. Combining longitudinal data from England and Wales (1971–2011) with data on educational attainment distributions in migrants’ origin countries, we find that the impact of being out of a job (unemployed or inactive) on the probability to remigrate is larger among migrants who were initially more positively selected in terms of educational attainment. This interaction effect appears stronger for male and recent migrants. Thus, in addition to migrants’ access to employment in the host country, the mismatch between migrants’ initial selection — that partly captures their premigration expectations — and their employment status at destination helps explain remigration behaviors.

Self-Perceived Health among Migrants Seen in Médecins du Monde Free Clinics in Europe: Impact of Length of Stay and Wealth of Country of Origin on Migrants' Health

Health of migrants is a widely studied topic. It has been argued that migrant health may deteriorate over time. Though migrants are a “hard to reach” population in survey data, this paper builds on a unique dataset provided by Médecins du Monde from five countries. We study self-perceived health (SPH) in connection with socio-economic and demographic factors and length of stay. Results differ for men and women. Compared to other documented migrants, asylum seekers have a 50–70% greater chance of having worse health. Migrants with better living conditions have a 57–78% chance of being in better health. Male migrants with a job have between a 82–116% chance of being in good health. The probability for women from poorer countries to have a better physical SPH after three months of residing in the host country is six-fold that of women from richer countries. This paper contributes widely to the knowledge of health of migrants. Contrary to other evidence, health of women migrants from poorer countries tends to improve with length of stay.

Status Loss: The Burden of Positively Selected Immigrants

Immigrants experience an ambiguous social position: on the one hand, they tend to be positively selected on resources from the origin country; on the other, they often occupy the lower rungs of the status ladder in receiving countries. This study explores the implications of this ambiguity for two important individual outcomes: subjective social status and perceived financial situation. We study the diverse sample of immigrants in the European Social Survey and use the fact that, due to country differences in educational distributions, a given education level can entail a very different rank in the sending and receiving countries. We document a robust relationship whereby immigrants who ranked higher in the origin than in the destination country see themselves as being comparatively worse off. This finding suggests that the social position before migration provides an important reference point by which immigrants judge their success in the new country.