Immigration, Gender, and Health Behaviors in the United States

Lorena Lopez-Gonzalez, University of Texas at Austin
Veronica C. Aravena, University of Texas at Austin

Introduction and Preliminary Conceptual Framework The immigration health literature consistently indicates nativity differences in health behaviors among adult immigrants, yet with few exceptions, there is a dearth of research that examines whether these differentials are influenced by gender. The overall purpose of this study is to examine the association between immigration and health behaviors, with special emphasis given to gender-specific models. The conceptual framework for this study will concentrate on two key points: the behavioral differences between foreign- and native-born persons and the need for sex-specific models. Researchers often cite the existence of health differentials, in both physical health and health behaviors, between foreign- and native-born individuals. And the epidemiological paradox indicates that, at least in the case of Mexican migration to the U.S. and Puerto Ricans, these health differentials may be wider among women. (Landale et al. 1999; Hummer et al. 1999, Frisbie et al. 1998; Rumbaut and Weeks 1996; Singh and Yu 1996; Markides and Coreil 1986; Tyler and Clyburn 1974). In turn, migration research indicates that growing numbers of women are migrating to the U.S. (Cerrutti and Massey 2001; Zlotnik 1995) and that most female migration into the U.S. is undertaken for family reunification reasons (Durand et al. 2001). This differs from the traditional pattern of international male migration, the majority of whom are labor migrants. Moreover, regardless of the sex or reason for migrating, findings consistently indicate that migrants are positively selected for a variety of determinants including health (Abraido et al. 1999; Swallen 1996). Given this, we expect: (1) that immigrants as a whole will exhibit better overall health behaviors than native-born, (2) that immigrant women in particular will exhibit better overall health behaviors than their native-born counterparts and both foreign- and native-born men, and (3) that more acculturated female and male migrants will exhibit health behavior that is more similar to the native-born than their less-acculturated counterparts. Data and Methods Data are drawn from the National Health Interview Survey (NHIS) for 1998-2000. The resulting sample includes 85,713 adults 25 years or older, with information about health and sociodemographic characteristics for each individual. We use the 1998-2000 surveys because information on acculturation is richer beginning in 1998 as the question on citizenship status was not included in the adult sample until that year. The large size and consistency of the NHIS is particularly useful for calculating nationally representative health estimates among relatively small sub-populations (e.g. immigrants) in that data can be pooled across multiple years (Cho et al. 2002; Rogers et al. 2000; Adams and Marano 1995). In addition, NHIS response rates are excellent, ranging between 90 and 95 percent. We focus on four health behaviors. The first is cigarette smoking, for which the basic categories are never smoked, former smoker, and current smoker. As is the norm in similar research (Rogers et al. 2000, Hummer et al. 1998), we further divide current smoker into two categories: (1) light smokers: less than one pack a day and (2) heavy smokers: one pack or more a day. Also of interest is alcohol use, for which possible categories are never drank alcohol, former alcohol drinker and current drinker. Following recent research, we further divide current drinker into two categories: (1) light drinkers: individuals who, on average, drank less than 3 drinks a day less than 3 days a week and (2) heavy drinkers: individuals who, on average, drank 3 or more drinks a day more than 3 days a week. Third, we consider quantity and quality of exercise. Categories for this measure include never exercise, moderate exercise and vigorous exercise--with the distinction between moderate and vigorous based on respondent’s self-identification. Finally, we include body mass index (BMI), categories for which include underweight, normal weight, overweight and obese weight, based on recent categories delineated in related research (Rogers et al. forthcoming). Demographic and socioeconomic variables included in the analysis are age, race/ethnicity, marital status, region, acculturation, education, employment status and income. We place special emphasis on the acculturation variable as we expect that the consideration of citizenship status along with the traditional measures of duration and nativity will provide a more complete measure of immigrant acculturation. The amount of missing data for all variables was negligible, with the exception of family income. In this case, data were imputed using age, sex, race/ethnicity, education, region and a dummy indicator for whether or not the family income total was below $20,000 or more. Following a descriptive analysis, we use weighted multinomial logistic regression modeling to analyze each health behavior. The first model for each health behavior includes basic demographic controls, the acculturation measure and gender. The second model for each health behavior is estimated including SES variables. In the third and fourth models for each behavior we follow the same procedure; however, outcomes are estimated separately for women and men. Models one and two address the preliminary questions of whether or not acculturation and sex differentials exist between women and men, and whether or not those differentials can be explained by sociodemographic characteristics. The last two models seek more specific answers to the same question by examining the degree of those differentials by gender and how nativity/acculturation may work differently for women and men to influence health behavior. Preliminary Descriptive Results (At this time, the descriptive analysis of two health behaviors is complete: cigarette smoking and alcohol use – the following section is based on results from those analyses) Table 1 shows the percent distribution for the cigarette smoking and alcohol use variables for women and men. As previous research has indicated, women are much more likely than men to be lifetime abstainers, 30.6% versus 13.7%, and far less likely than men to be heavy drinkers, 6.2% versus 17.1%. The number of light drinkers does not vary much between women and men, 46.7% and 51.3%. The total number of women and men who currently smoke is somewhat different, 21% and 26.1%. While light smoking does not vary by gender, men are nearly twice as likely to be heavy smokers. Table 2 shows the percent distribution for cigarette smoking and alcohol use for women and men by nativity status. As expected, alcohol use among U.S.-born women and men is higher than among foreign-born individuals. Most notably, the percentage of lifetime abstainers among foreign-born women is much higher than U.S.-born women, 52.3% versus 26.6%, and the percentage of heavy drinkers among U.S.-born women is more than twice that among foreign-born women, 6.9% versus 2.9%. Among the men, the difference between the U.S.-born and foreign-born is still evident, but smaller. For example, U.S.-born men are less likely to be lifetime abstainers than foreign-born men, but the disparity is only 12.2% versus 21.6%. Interestingly, the percentage of U.S.-born women who are light drinkers is relatively equal to the number of men in the same category, regardless of nativity, approximately 50% for all three groups. Overall, though, it appears that they are huge differences in alcohol use between foreign- and native-born women and smaller differences among men. For both, though, the foreign-born exhibit healthier behavior. Similar findings are evident with cigarette smoking. The largest percentage of women and men are lifetime non-smokers. Notably, however, almost 77% of foreign-born women versus only 55.6% of U.S.-born women are never smokers. Among men, 54% of the foreign-born are never smokers compared to 42.4% of the native-born. Again, as with drinking, nativity differentials are wider for women. (Table 3 Percentages of Demographic, Acculturation, and Socioeconomic Characteristics by Sex). (Table 4 Percentages of Demographic and Socioeconomic Characteristics by Nativity)