This Article Abstract Full Text (PDF) Services Download to citation manager Citing Articles Citing Articles via HighWire PubMed PubMed Citation

Duration or Disadvantage? Exploring Nativity, Ethnicity, and Health in Midlife

^a Population Research Center, The University of Texas at Austin
^b LBJ School of Public Affairs, The University of Texas at Austin
^c Department of Sociology, The University of Texas at Austin

Jacqueline L. Angel, LBJ School of Public Affairs, P.O. Box Y, The University of Texas at Austin, Austin, TX 78713 E-mail: jangel{at}mail.utexas.edu.

	Abstract

TOP Abstract Background Cultural Assimilation or... Methods Results Discussion References

 
Objectives. This study examined nativity as a risk factor for poor physical and emotional health for an ethnically diverse population making the transition into retirement. The authors addressed whether the health disadvantage observed for immigrants lessens with increased time spent in the country (supporting theories of assimilation) or increases with duration of residence (supporting theories of cumulative disadvantage).

Methods. The sample was drawn from Waves 1 and 2 of the Health and Retirement Study (HRS), an in-depth economic, social, and health database of persons in midlife and beyond. The analyses were restricted to 9,912 native-born and 1,031 foreign-born individuals.

Results. The data revealed that after socioeconomic factors were controlled, foreign-born individuals were at higher risk of poor emotional health than their native-born counterparts. Although aging immigrants displayed worse health than the native-born population, this disadvantage was mediated by duration of residence (young age at migration) and socioeconomic incorporation.

Discussion. These findings extend our understanding of nativity and duration as risk factors for poor physical and emotional health. Immigrants may overcome the nativity disadvantages found for emotional distress with increased duration of residence, but the pattern becomes more complicated with the inclusion of race and Hispanic ethnicity.

IN this study we considered an important dimension of population diversity, nativity, in explaining health differentials throughout the adult life course. Controlling for economic and social resources, we examined the salience of nativity with respect to self-reported health among an ethnically diverse population poised for retirement. Regardless of selection effects, adult immigrants report worse global health than native-born persons. But, does that health disadvantage lessen or intensify with duration of residence? Exploring differences between two competing approaches of assimilation enabled us to evaluate the potential positive and negative contributions of duration of residence for the health status of aging immigrants compared with that of native-born individuals.

We employed the Health and Retirement Study (HRS), a nationally representative sample of individuals nearing retirement in the United States. This dataset is uniquely suited to the proposed analyses for several reasons. First, it contains detailed health, wealth, and labor force participation information (Bound, Schoenbaum, and Waidmann 1996). Second, it provides information on nativity, including age at migration, and indicators of social isolation. Most important, the longitudinal design of HRS enables the isolation of predictor variables at Time 1 and their relationship to health outcomes at Time 2. Although not a perfect solution to the difficulties associated with disentangling the health–wealth nexus, this time order helps establish the asymmetry of a causal relationship (Bohrnstedt and Knoke 1988). Building on previous HRS investigations, these data permit an analysis of the ways in which demographic, social, and economic characteristics indirectly and directly influence the general well-being of persons approaching retirement (e.g., Kington and Smith 1997).

Individuals transitioning into retirement represent a unique study population. They are approaching the end of their working life, which represents not only changes in lifestyle, but most likely the end of asset accumulation. In terms of social networks, contacts are gained throughout the life course, yet the pre-retirement years are critical for establishing patterns of reliance in later life. In the postretirement years, when health may decline, preexisting social networks are crucial. In observing individuals approaching retirement we were able to assess the resources transferred into retirement. Most resource accumulation occurs during the working years. Therefore, differentiation in financial resources (whether by nativity or race/Hispanic ethnicity) observed at this period may be indicative of future inequality patterns and is likely to have serious health implications. By focusing on this age group, we attempted to highlight patterns of differentiation in resource access and health outcomes, patterns likely to amplify as this group moves into retirement and beyond.

	Background

TOP Abstract Background Cultural Assimilation or... Methods Results Discussion References

 
The ethnic composition of the immigrant stream into the United States has changed dramatically over the past century with recent concerns centering on its racial and ethnic composition. Differences in education, occupational attainment, and income associated with minority group membership persist throughout the life course, placing individuals at distinctly different risks of poverty and subsequent illness (Williams and Collins 1995). Evidence suggests that Blacks and Hispanics are especially affected by involuntary labor market exit or withdrawals, undermining their economic well-being in later life (Crystal, Shea, and Krishnaswami 1992; Flippen and Tienda 2000). Documenting the interplay among socioeconomic factors, nativity, and health status is fundamental for understanding racial and ethnic disparities.

Research points to the increasing importance of sociocultural characteristics in determining individual health status and well-being, especially in light of increasing ethnic diversity in the United States (Pampel 1998). Demographic characteristics, such as advanced age, gender (female), and marital status (nonmarried), are known proximate risk factors for poor self-health ratings (e.g., Maddox 1962; Verbrugge 1983). Socioeconomic factors, such as education, income, and employment, are also very powerful determinants (Feinstein 1993). House, Landis, and Umberson 1988, for example, found that social assets, such as presence of children in the household and friendship networks in the community, are associated with good health (see also Kawachi, Kennedy, and Glass 1999).

Few investigations have examined the role of nativity in explaining general health status (Findley 1988). Foreign-born persons appear to enjoy a mortality advantage over individuals born in the United States (Hummer, Rogers, Nam, and LeClere 1999; Markides and Coreil 1986; Rosenwaike 1987; Vega and Amaro 1994; Vega et al. 1998; Weeks, Rumbaut, and Ojeda 1999). However, increased time spent in the United States erases much of the mortality advantage associated with nativity status. Individuals less acculturated in terms of language proficiency and social mores (such as immigrants) exhibit higher rates of social isolation and compromised health (J. L. Angel and Angel 1992; J. L. Angel, Angel, McClellan, and Markides 1996; Kossoudji 1989). Access to formal and informal support systems (e.g., the lay-referral network) may differ by nativity and in some cases decrease immigrant access to assistance (LeClere, Jensen, and Biddlecom 1994). Consequently, immigrants may be less likely or able than native-born individuals to seek assistance, because they either lack health insurance (R. J. Angel and Angel 1996) or have no lay or professional referral networks available. Nevertheless, few studies have focused on the interaction between nativity, duration, and race/Hispanic ethnicity as it affects health.

Immigrants, on average, report fewer financial resources, including health insurance, than the native-born population, which adversely affects their health through lowered social class (Poston 1994; Santiago and Muschkin 1996; Tienda, Jensen, and Bach 1984; Zsembik, Drevenstedt, and McLane 1997). Recent research has indicated that financial assets are more important than sociocultural factors, such as nativity (Hao and Johnson 2000). Several studies have shown that immigrants often find themselves in lower paying, physically demanding, and dangerous occupations (Borjas and Bronnars 1990; Elkeles and Seifert 1996). Specifically, analyses of the 1985–86 National Health Interview Survey revealed that the Mexican-origin foreign-born persons who had fewer than 12 years of education and low family incomes (below $20,000) were more inclined to indicate "fair" or "poor" health than were native-born persons (see Loue and Bunce 1999, for a review of the literature).

Immigrants face many challenges in their efforts to attain economic integration. Even the racial and ethnic composition of immigrant streams affects the process of socioeconomic inclusion, reinforcing health disparities (Williams and Collins 1995). As the proportion of Black and Hispanic immigrants grows, attempts to delineate the risk factors associated with nativity, independent of the risk factors associated with race and ethnicity, become increasingly complex (Martin and Soldo 1997). Several studies have suggested that the process of assimilation has deleterious health consequences. However, cultural assimilation differs depending on the nature of the socioeconomic experience in the nation of origin (Rumbaut 1997). Migrants into the United States are favorably selected from their origin populations (Lindstrom 1994; Massey 1994). Immigrants are positively selected for young age, good general health, and high social capital (Hummer et al. 1999; Smith and Edmonston 1997; Tienda, Jensen, and Bach 1984). Positive selectivity explains findings in which immigrants display health and economic advantages when compared with U.S. native-born individuals.

	Cultural Assimilation or Cumulative Disadvantage?

TOP Abstract Background Cultural Assimilation or... Methods Results Discussion References

 
Traditional views of immigrant assimilation into U.S. society primarily focus on the process of linguistic and social adaptation (Schlesinger 1992). Relying upon the experience of the early 1900s, a period of high immigration from Europe into the United States, such frameworks focus on immigrants who are socially and linguistically diverse but racially homogenous. Predicated on the assumptions that the chief barrier to assimilation is linguistic and that over time linguistic and cultural barriers between immigrants and native-born persons will dissipate, these viewpoints suggest that higher levels of integration are positively correlated with time spent in the United States. Assimilation theory suggests that differences in self-reported health between native- and foreign-born persons are functions of duration of residence, that is, immigrants with long tenure in the United States have health profiles indistinguishable from those of native-born persons (Amaro, Whitaker, Coffman, and Heeren 1990; Rogers 1991; Samet, Schraag, Howard, Key, and Pathak 1982; Vega et al. 1998; Wei, Valdez, Mitchell, Haffner, Stern, and Hazuda 1996). Numerous studies have interpreted the positive correlation between length of residence and socioeconomic incorporation as evidence to support the assimilation hypothesis (cf. Bean, Berg, and Van Hook 1996; Zsembik et al. 1997).

However, time spent in the United States has complex and not always positive health consequences. Immigrants, because of positive selectivity, initially demonstrate favorable health behaviors (Findley 1988). Even if immigrants engage in risky lifestyles and unhealthy behaviors, such as cigarette smoking and excessive alcohol use, they may be protected by the salubrious effects of a culture of origin that reduces the risks associated with such behaviors (Finch, Boardman, Kolody, and Vega 2000; Rogers 1991; Vega et al. 1998). These countervailing forces of assimilation (negative) and selectivity (positive) take place in the context of socioeconomic disadvantage (Elkeles and Seifert 1996; Santiago and Muschkin 1996).

Cumulative disadvantage, a perspective guided by conflict theory, provides an alternative interpretation to the health benefits of assimilation (Dowd and Bengtson 1978). This perspective focuses on persistent barriers to immigrant adaptation. Immigrants are unlikely to lose their disadvantaged social or economic status. The negative effects of this marginalization are cumulative and are likely to increase with duration. Simply put, duration of residence correlates not with increased integration but with exposure to the detrimental effects of social and economic disadvantage. The cumulative disadvantage and cultural assimilation approaches both emphasize economic factors, such as income, education, and employment. These variables, often associated with membership in the lower classes, increase the risk of poor health.

Related theoretical approaches concerning immigrant adaptation focus on social capital (Portes 1995), a widely observed explanatory variable in personal health and well-being. Some immigrants develop additional networks with increased duration; for others, the process of acculturation is assisted by social networks at the place of destination. Immigration disrupts access to location-specific ties and may diminish access to formal and informal means of support in the country of origin. Research has shown the ability of immigrants to develop new networks at their points of destination and the positive influence such networks have on health and well-being (J. L. Angel and Angel 1992; Portes and Rumbaut 1990). Studies on family reliance have underscored the importance of age at migration, because elderly Mexican immigrants arriving during childhood are less dependent on their families than those immigrating in later life (R. J. Angel, Angel, Lee, and Markides 1999). This indicates that although some forms of social capital may be positively influenced by duration of residence, reliance on other forms (such as kin networks) may be negatively influenced by duration of residence.

Guided by these two perspectives, we considered a set of three interrelated hypotheses:

1. Hypothesis 1: Immigrants approaching retirement tend to display worse physical and emotional health than native-born individuals.
   
2. Hypothesis 2: Increased duration of residence mitigates the negative effect of nativity on health.
   
3. Hypothesis 3: The ability of duration of residence to mitigate the immigrant disadvantage in health varies among immigrants, with Blacks and Hispanics benefiting less from increased duration than non-Hispanic Whites.
   

	Methods

TOP Abstract Background Cultural Assimilation or... Methods Results Discussion References

 
Data were drawn from Waves 1 and 2 of the HRS. This study, funded by the National Institute on Aging (NIA), contains longitudinal socioeconomic and health information from a nationwide sample of Americans born between 1931 and 1941 and their spouses (Heeringa and Connor 1995). Of the entire population contacted through the HRS (N = 13,142), 12,652 completed Wave 1 interviews. Selective attrition between Waves 1 and 2 are as follows: (a) 231 deceased; (b) 136 aged into the Assets and Health Dynamics Survey (AHEAD); and (c) 689 lost to follow-up. Our analyses included respondents who participated in Waves 1 and 2, yielding 11,596 valid observations. We restricted our sample to 9,912 native-born and 1,031 foreign-born men and women. For cell size consideration, we expanded the category of individuals approaching retirement to include 168 spouses between the ages of 42 and 50. Although this detracted from the nationally representative nature of the HRS sample (because spouses are not randomly selected), it enabled stronger comparative analyses of native- and foreign-born persons by race and ethnicity, which was the chief focus of this study.

Measures
We viewed nativity not as a dichotomous status but rather as a characteristic that affects the ways in which individuals interact with social institutions. Previous research has indicated that duration of residence often mitigates the influence of nativity for individuals. With increased duration of residence, foreign-born individuals increase their opportunities to assimilate into American society. They are able to develop coping strategies that improve their ability to interact with social institutions, although such strategies are systematically tied to social location, cultural distance, and economic position (Alba and Nee 1997). The analyses divide immigrants into three life course stages of migration for theoretical and statistical motivations. Life course stage of migration is likely to influence the relative economic welfare of elderly immigrants (Zsembik et al. 1997). Late-life migrants are more dependent upon family than are native-born persons or those immigrating earlier in life and are less likely to have private pensions and social security retirement income (R. J. Angel et al. 1999). In our analyses, the first life course stage of migration included respondents who arrived in the United States prior to age 15 (childhood); they may have an economic profile that resembles that of native-born persons. The second stage included those who arrived in the United States between ages 15 and 34 (young adulthood); they have ample opportunity for economic integration. The third stage included individuals who arrived in the United States at or after age 35 (mature adulthood); they have less opportunity for social and economic assimilation.

In the statistical models, we relied on these age at migration categories. Supplemental analyses were conducted with age at migration as a continuous variable and measured as the proportion of life spent in the United States. Both measures yielded similar results across the independent variables. We believe the categorical approach best reflects the nonlinear nature of the relationship between duration and health. As mentioned earlier, the age structure of the sample was relatively homogenous, with the vast majority of respondents approximately 55 years old. Because of the truncated age structure of the sample, life course stage of migration and duration of residence were functionally equivalent.

We measured socioeconomic status in three ways: economic status, education, and employment disruption. Income reflected the financial resources of the respondent at Time 1; the analyses compared individuals earning less than $20,000 annually to those earning more than $20,000. Financial assets reflected accumulated savings. We compared individuals in the bottom third of reported nonhousing assets (less than $10,075) to those in higher terciles. Similar relative measures of economic status have been used in other analyses of HRS data (Kington and Smith 1997). Home ownership was the third measure of economic status, representing the most common form of equity in the United States. Individuals not owning a home were compared to those who owned their home, regardless of mortgage status. Response rates for each of the economic measures were incomplete, and as a result, we included dummy variables indicating missing data to preserve sample size.

Low education, a proximate risk factor for poor health, was coded as a binary variable. Respondents without a high school diploma or General Equivalency Diploma (GED) were compared with those with at least a high school diploma or GED (reference category).

Our measure of employment status focused on individuals who indicated they were unemployed, looking for work, or laid off at Time 1 of the study. Individuals reporting any of these employment difficulties were compared with those who were gainfully employed or who were not identified as seeking employment at Time 1.

Social connectedness measured the quality of the respondent's perceived community integration at Time 1. Social isolation was measured by reported familiarity with neighbors, who reflect a potential source of informal support and social integration. Here, as in measures of economic status, response rates necessitated the inclusion of a dummy variable for missing data for us to preserve sample size.

The demographic variables included age (measured continuously), gender, and marital status (unmarried). We created two dummy variables indicating whether the respondent was African American or Hispanic. To clarify the direction of the relationship, we focused on independent variables measured at Time 1 to predict health status reported at Time 2.

Criterion Variables
Personal health, the dependent variable, is a complex and multifaceted concept (R. J. Angel and Williams 2000). Self-assessed health generally reflects an individual's perceptions of his or her physical and emotional state, providing a global indicator of well-being. Self-assessed health reports do not always coincide with clinical evaluations (Maddox 1962), but they are exceptionally robust in predicting mortality (Idler and Benyamini 1997), disability (Ferraro, Farmer, and Wybraniec 1997), expectations for health services (Wolinsky and Tierney 1998), and psychological well-being (Buckley 1998).

Investigations of self-reported health across racial and ethnic groups are complicated by the possibility of different conceptions of subjective well-being (Johnson and Wolinsky 1994; Jylha, Guralnik, Ferrucci, Jokela, and Heikkinen 1998). Limited research has suggested that potential racial/ethnic differences exist in the assessment of health (R. J. Angel and Williams 2000), potentially contributing to observed group differentials in self-rated health (Williams and Collins 1995). However, similar predictors of self-reported health status (socioeconomic status, marital status, etc.) operate consistently across groups (Lillie-Blanton and Laveist 1996). In meta-analyses, self-assessments of health (however conceptualized) were just as predictive of mortality for racial/ethnic minorities as for non-Hispanic Whites (Idler and Benyamini 1997), a finding supported by McGee, Liao, Cao, and Cooper 1999. Even though actors may perceive their health differently, poor self-assessed health generates adverse health outcomes consistently across groups, making the identification of health risk factors, such as nativity, important.

In the HRS, two questions asked respondents to rate their general physical and emotional health: first, "Would you say your health is excellent, very good, good, fair, or poor?" and second, "How good do you feel or how stressed, anxious, or depressed do you feel now?" As has been suggested in previous investigations of immigrant health, we employed a dichotomous measure of self-rated health. Persons reporting either fair or poor health were coded 1, and if they identified themselves to be in excellent, very good, or good health (reference category) they were coded 0. Respondents reporting either fair or poor emotional health (i.e., emotional distress) were coded 1 and were coded 0 if otherwise (excellent, very good, or good health). Although the full array of response categories facilitates a wider distribution of responses, there is no reason to assume that the conceptual distance between categories is equal (i.e., the data are ordinal, not continuous). The response categories of fair and poor represent mortality risks that are substantially higher than those of any other response (Idler and Benyamini 1997). In our analyses, therefore, we employed logistic models to determine proximate risk factors for poor physical and emotional health (see J. L. Angel, Buckley, and Finch in press; Hendershot 1988).

Besides using universal self-assessments of health, we captured overall physical functioning by employing a modified version of the Katz, Ford, Moskowitz, Jackson, and Joffe 1963 basic activities of daily living (ADL) summary index. This measure, although less prevalent in our study group, provides an excellent indicator of impaired daily functioning. Respondents are asked to report any difficulty in performing five basic activities of daily living, that is, bathing, dressing, eating, walking across a room, and getting in and out of bed. Because we employed binomial logistic regressions, we partitioned this variable into two categories: 1 = "at least some ADL disability" and 0 = "no ADL difficulty."

The relationship between resources and self-rated physical and emotional health is complex. Are the poor more likely to suffer ill health or are those in ill health more likely to be poor? It is difficult to disentangle the specific effects of wealth on health because of the effect of health on wealth. In our analyses we used the panel aspect of our data to minimize the endogeneity problem. The dependent variables for our models were measured at Wave 2 (1995), whereas independent variables were either ascribed (i.e., gender, age, race) or measured at Wave 1 (1992). Measures obtained in 1995 cannot go backward in time to affect measures that were obtained in 1992; therefore, the estimates of the parameters were less affected by endogeneity bias because of the time ordering of our data (Davis 1985). We did not generalize about the total mutual, reciprocal effects across the entire life course between health and socioeconomic conditions but rather limited the analysis to isolating the net effects of particular independent variables on these specific dependent variables for persons at this stage of the life course.

	Results

TOP Abstract Background Cultural Assimilation or... Methods Results Discussion References

 
Table 1 presents summary descriptive statistics and sample means for the independent variables used in the multivariate analyses. Each indicator was measured at baseline and reflected one of three life domains: demographic structure, economic position, or social integration. These explanatory variables spanned a broad range of factors previous investigators have clearly shown to be related to social constructions (self-rated) of health, either directly or indirectly (R. J. Angel and Williams 2000).

Table 2 contrasts the native-born to foreign-born men and women on five health measures. A profile of poor health among foreign-born persons emerges. Foreign-born men and women reported worse physical health and lower levels of emotional well-being. Because of the age structure of the population, only a small percentage of the sample had problems carrying out ADLs, but more of those who had difficulties were immigrants. Overall, these data reveal that compared with native-born men and women, foreign-born men and women had worse health in 1995, consistent with other studies assessing nativity differences in various health outcomes (R. J. Angel and Angel 1996; Santiago and Muschkin 1996) and supporting our first hypothesis.

Table 5 presents logistic regression results identifying the net effect of socioeconomic predictors on health and daily functioning. Each of the dependent variables (ADL limitation, poor self-rated health, and emotional distress) was analyzed in a two-step process. Model 1 included age at migration and exogenous variables, with Model 2 adding indicators of socioeconomic status and social integration. The results show that age at migration affected each of the three health outcomes; however, the effect declined dramatically when we controlled for socioeconomic factors. In predicting ADL limitations, immigrants exhibited a higher risk of disability regardless of life course stage of migration. Childhood immigrants, young adult immigrants, and midlife immigrants were each significantly more likely than native-born individuals to report ADL disability, 86%, 64%, and 99%, respectively. In terms of self-assessed health, a similar pattern was revealed in Model 1, but the relative risk was much stronger for young adult and midlife migrants, with midlife migrants more than twice as likely to report poor health than others. However, in Model 2, the effect of migration disappeared. The results for emotional distress were more consistent across Models 1 and 2. In both models, childhood migrants were statistically indistinguishable from native-born persons. The effect of duration of residence was further shown by the higher risk associated with midlife migration when compared with young adult migration. Midlife migrants were nearly three times more likely to report emotional distress in Model 1 and nearly two times more likely to report emotional distress in Model 2. Results for emotional distress supported our second hypothesis because migrants with longer duration of residence exhibited lower risk of poor health.

As expected, sociocultural variables substantially influenced health. As noted previously, the addition of these variables erased the effect of immigration for physical health indicators. Two of our three measures of financial wealth, low income and few assets, increased the log odds of a respondent's reporting poor physical and emotional health. The interpretation of these variables was complicated by their highly correlated dummies for missing information. Employment problems at Wave 1 increased the risk of poor health assessments at Wave 2 but were not associated with ADL limitation. This finding indicates that employment difficulties were not associated with objective physical limitations. Last, social isolation, measured as unfamiliarity with neighbors, exhibited a modest but consistent effect on health across the three dependent variables. Socially isolated individuals were 30% more likely to have compromised ADLs, 15% more likely to report worse general health, and 17% more likely to report emotional distress.

The observed disadvantage of being foreign born appeared to be erased when socioeconomic characteristics were controlled. Immigration generally, and duration of residence specifically, did not appear to affect physical indicators of health. However, our expectations concerning immigrant risk and the importance of duration were borne out in the results on emotional distress. Midlife immigrants reported substantially higher risk for emotional distress (84%), whereas young adult migrants faced a moderate risk (37%). Childhood immigrants, those with the longest duration of residence, resembled native-born individuals. The composition of immigrants by race and Hispanic ethnicity varied dramatically by age at migration. To further specify our findings on duration, we next performed analyses including race and ethnicity to address our third hypothesis.

Although the initial multivariate logistic regressions assessed the impact of duration on health (physical and emotional) and ADL disability after social resources were controlled, they did not account for race. In the next analyses (Table 6 ), we included terms for race (Black) and Hispanic ethnicity and in the final stage tested interaction terms for race and duration. In Model 1, it was clear that Black and Hispanic respondents faced a statistically higher risk of poor physical and emotional health, yet the inclusion of race and Hispanic ethnicity did not substantively alter the results in the previous table. Black respondents were 67% more likely to report compromised ADLs, 63% more likely to report poor self-rated health, and 23% more likely to report emotional distress than non-Hispanic Whites. Hispanics faced even higher health risks (74%, 113%, and 88%, respectively).

The models in Table 6 suggest a complicated picture. Blacks and Hispanics were at significantly higher risk for poor health than non-Hispanic Whites, with the exception of recent Black immigrants. Models not including race may conclude that the emotional health disadvantage for immigrants diminishes with increased duration, but this may not be the case. Increased duration of residence may enable immigrants to acquire the socioeconomic rewards indicative of native-born persons, explaining why the inclusion of socioeconomic indicators washes out the predictive values of age at migration. At the same time, in comparison with native-born persons, minority immigrants facing the disadvantages associated with being Black in the United States may find the barrier of race makes it more difficult to overcome the status of being an immigrant.

	Discussion

TOP Abstract Background Cultural Assimilation or... Methods Results Discussion References

 
This study highlights the complex interplay of nativity, duration of residence, and race/ethnicity on health profiles. The results are as anticipated in the first hypothesis; immigrants face a self-assessed health disadvantage. Nativity is a proximate risk factor for ADL disability, poor physical health, and emotional distress, but the effect largely operates through socioeconomic characteristics.

Our findings provide limited support for our second research hypothesis, countering arguments that assimilation into American society adversely affects health (Findley 1988; Vega et al. 1998). We find a monotonic increase in the proportion of immigrants reporting ADL disability and poor physical and emotional health as a function of lower duration of residence. Respondents immigrating early in life resemble native-born individuals, whereas individuals immigrating in young adulthood or midlife are significantly different. This may be a result of lower health care access in their country of origin than that for child immigrants and native-born persons.

Our third hypothesis is not strongly supported. It is clear that in the United States, analyses of duration should take into account the changing racial/ethnic composition of immigrants. The dramatic racial differences among immigrants across time may preclude a clear delineation of the effects of duration. Race complicates the effects of duration on emotional health. It may be the case that the adverse effects of race/ethnicity lessen the positive effects of assimilation and integration associated with increased duration of residence. Across our models, Blacks and Hispanics (both native and foreign born) face a significant self-assessed health disadvantage. Only further empirical analyses into the relationship between duration as it relates to race and Hispanic ethnicity will clarify these patterns.

Although intriguing, these results are preliminary. Two major avenues for further work examining the salience of nativity on health emerge. First, as data allow, investigators should pursue more sophisticated longitudinal modeling opportunities to assess the dynamic determinants of health across time for aging non-Hispanic Whites, Blacks, and Hispanics. Second, additional research should focus on the precise delineation of issues such as economic assimilation and social and family support, and on detailed analyses of anticipated and actual monetary and nonmonetary remittances to children, siblings, and elderly parents. Access to structural supports, such as health insurance and supplemental medical insurance coverage (public and private), could be more fully developed in studies emphasizing the confluence of nativity and ethnicity on health as individuals near retirement. Subsequent longitudinal analyses would also benefit from assessment of the compositional effects of income and tests of specific wealth thresholds on health. This will illuminate the specific mechanisms through which income affects health and, ultimately, shed light on the endogenous relationship between income and physical well-being profiles in the years prior and subsequent to retirement. Models need to also explore the utility of household- rather than individual-based analyses.

Although our findings are only a modest step toward understanding the intricate relationship between nativity and health dynamics, they provide strong justification for continued research along these lines. Further work should address these issues; the impact of Hispanic subgroups and Asian Americans on these health outcomes would be particularly informative. Consistent with the literature, and as these analyses demonstrate, when comparing health and well-being researchers should not assume that risk factors for poor health, such as nativity, act uniformly across racial and ethnic groups.

	Acknowledgments

 
This research was supported in part by a grant funded by the National Institute on Aging (1 R03 AG16135-01) with supplementary funding from the LBJ School's Policy Research Institute. We thank four anonymous reviewers for their helpful comments.

Received for publication April 7, 2000. Accepted for publication February 28, 2001.

	References

TOP Abstract Background Cultural Assimilation or... Methods Results Discussion References

 

• Alba R., Nee V., 1997. Rethinking assimilation theory for a new era of immigration. International Migration Review 31:826-874.
• Amaro H., Whitaker R., Coffman G., Heeren T., 1990. Acculturation and marijuana and cocaine use: Findings from HHANES 1982–84. American Journal of Public Health 80: (Suppl.) 54-60.
• Angel J. L., Angel R. J., 1992. Age at migration, social connections, and well-being among elderly Hispanics. Journal of Aging and Health 4:480-499.
• Angel J. L., Angel R. J., McClellan J. L., Markides K. S., 1996. Nativity, declining health, and preferences in living arrangements among elderly Mexican Americans: Implications for long-term care. The Gerontologist 36:464-473.
• Angel, J. L., Buckley, C. J., & Finch, B. K. (in press). Nativity and self-assessed health among pre-retirement age Hispanics and non-Hispanic Whites. International Migration Review.
• Angel R. J., Angel J. L., 1996. The extent of private and public health insurance coverage among adult Hispanics. The Gerontologist 36:332-340.
• Angel R. J., Angel J. L., Lee G. Y., Markides K. S., 1999. Age at migration and family dependency among older Mexican immigrants: Recent evidence from the Mexican American EPESE. The Gerontologist 39:59-65.
• Angel R. J., Williams K., 2000. Cultural models of health and illness. Cuellar I., Paniagua F. A., , ed.Handbook of multi-cultural mental health: Assessment and treatment of diverse populations 25-44. Academic Press, New York.
• Bean F. D., Berg R. R., Van Hook J. V., 1996. Socioeconomic and cultural incorporation and marital disruption among Mexican Americans. Social Forces 75:593-617.
• Bohrnstedt G. W., Knoke D., 1988. Statistics for social data analysis 2nd ed. F. E. Peacock, Itasca, IL.
• Borjas, G. J., & Bronnars, S. G. (1990). Immigration and the family (Working Paper 3509). Cambridge, MA: National Bureau of Economic Research.
• Bound J., Schoenbaum M., Waidmann T., 1996. Race differences in labor force attachment and disability status. The Gerontologist 36:311-321.
• Buckley, C. (1998). I feel good: Measuring health status in rural Russia (Working Paper Series). Austin, TX: University of Texas Population Research Center.
• Crystal S., Shea D., Krishnaswami S., 1992. Educational attainment, occupational history, and stratification: Determinants of later life economic outcomes. Journal of Gerontology: Social Sciences 47:S213-S221.
• Davis J. A., 1985. The logic of causal ordering Sage, Beverly Hills, CA.
• Dowd J., Bengtson V., 1978. Aging in minority populations: An examination of the double jeopardy hypothesis. Journal of Gerontology 33:427-436.
• Elkeles T., Seifert W., 1996. Immigrants and health: Unemployment and health risks of labour migrants in the Federal Republic of Germany, 1984–1992. Social Science and Medicine 43:1035-1047.
• Feinstein J. S., 1993. The relationship between socioeconomic status and health: A review of the literature. The Milbank Quarterly 71:279-322.
• Ferraro K. F., Farmer J. M., Wybraniec J. A., 1997. Health trajectories: Long-term dynamics among Black and White adults. Journal of Health and Social Behavior 38:38-54.
• Finch B. K., Boardman J. B., Kolody B., Vega W. A., 2000. Contextual effects of acculturation on perinatal substance exposure among immigrant and native born Latinas. Social Science Quarterly 81:421-438.
• Findley S., 1988. The directionality and age selectivity of the health-migration relation: Evidence from sequences of disability and mobility in the United States. International Migration Review 22:4-29.
• Fleiss J. L., 1993. Statistical methods for rates and proportions Wiley, New York.
• Flippen C., Tienda M., 2000. Pathways to retirement: Patterns of labor force participation and labor market exit among the pre-retirement population by race, Hispanic origin, and sex. Journal of Gerontology: Social Sciences 55B:S14-S27.
• Hao L., Johnson R. W., 2000. Economic, cultural, and social origins of emotional well-being. Research on Aging 22:599-629.
• Heeringa S. G., Connor J., 1995. Technical description of the Health and Retirement Study Sample Design (HRS/AHEAD Documentation Report DR-002) University of Michigan, Ann Arbor.
• Hendershot G. E., 1988. Health of the foreign-born population: United States, 1985–1986 U.S. Department of Health and Human Services, Washington, DC.
• House J. S., Landis K. R., Umberson D., 1988. Social relationships and health. Science 241:540-545.
• Hummer R. A., Rogers R. G., Nam C. B., LeClere F. B., 1999. Race/ethnicity, nativity, and U.S. adult mortality. Social Science Quarterly 80:136-153.
• Idler E. L., Benyamini Y., 1997. Self-rated health and mortality: A review of twenty-seven communities. Journal of Health and Social Behavior 38:21-37.
• Johnson R. J., Wolinsky F. D., 1994. Gender, race, and health: The structure of health status among older adults. The Gerontologist 34:24-35.
• Jylha M., Guralnik J. M., Ferrucci L., Jokela J., Heikkinen E., 1998. Is self-rated health comparable across cultures and genders?. Journal of Gerontology: Social Sciences 53B:S144-S152.
• Katz S., Ford A. B., Moskowitz R. W., Jackson B. A., Joffe M. W., 1963. Studies of illness in the aged: The index of ADL, a standardized measure of biological and psychological functioning. Journal of the American Medical Association 185:914-919.
• Kawachi I., Kennedy B. P., Glass R., 1999. Social capital and self-rated health: A contextual analysis. American Journal of Public Health 89:1187-1193.
• Kington R. S., Smith J. P., 1997. Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases. American Journal of Public Health 87:805-810.
• Kossoudji S., 1989. Immigrant worker assimilation: Is it a labor market phenomenon?. Journal of Human Resources 24:494-527.
• LeClere F. B., Jensen L., Biddlecom A. E., 1994. Health care utilization, family context, and adaptation among immigrants to the United States. Journal of Health and Social Behavior 35:370-384.
• Lillie-Blanton M., Laveist T., 1996. Race/ethnicity, the social environment, and health. Social Science and Medicine 43:83-91.
• Lindstrom D. P., 1994. Selective emigration, cohort quality, and models of immigrant assimilation. Social Science Research 23:315-349.
• Loue S., Bunce A., 1999. The assessment of immigration status in health research National Center for Health Statistics, Hyattsville, MD.
• Maddox G. L., 1962. Some correlates of differences in self-assessment of health status among the elderly. Journal of Gerontology 17:180-185.
• Markides K. S., Coreil J., 1986. The health of Hispanics in the southwestern United States: An epidemiological paradox. Public Health Reports 10:253-265.
• Martin L. G., Soldo B. J., 1997. Introduction. Martin L. G., Soldo B. J., , ed.Racial and ethnic differences in the health of older Americans 1-9. National Academy Press, Washington, DC.
• Massey D. S., 1994. The new immigration and ethnicity in the United States. Population and Development Review 21:631-632.
• McGee D. L., Liao Y., Cao G., Cooper R. S., 1999. Self-reported health status and mortality in a multiethnic U.S. cohort. American Journal of Epidemiology 149:41-46.
• Pampel F. C., 1998. Aging, social inequality, and public policy Pine Forge, Thousand Oaks, CA.
• Portes A., 1995. The economic sociology in immigration: Essays on networks, ethnicity, and entrepreneurship Russell Sage, New York.
• Portes A., Rumbaut R. G., 1990. Immigrant America: A portrait University of California Press, Berkeley.
• Poston D., 1994. Patterns of economic attainment of foreign-born male workers in the United States. International Migration Review 28:478-502.
• Rogers R. G., 1991. Demographic characteristics of cigarette smokers in the United States. Social Biology 38:1-12.
• Rosenwaike I., 1987. Mortality differentials among persons born in Cuba, Mexico, and Puerto Rico residing in the United States, 1979–81. American Journal of Public Health 77:603-606.
• Rumbaut R. G., 1997. Paradoxes and orthodoxies of assimilation. Sociological Perspectives 40:483-511.
• Samet J. M., Schraag S. D., Howard C. A., Key C. R., Pathak D. R., 1982. Respiratory disease in a new population sample of Hispanic and non-Hispanic Whites. American Review of Respiratory Diseases 125:152-157.
• Santiago A. M., Muschkin C. G., 1996. Disentangling the effects of disability status on the supply of Anglo, Black, and Latino older workers. The Gerontologist 36:299-310.
• Schlesinger A. M., 1992. The disuniting of America Whittle Books, Knoxville, TN.
• Smith J. P., Edmonston B., 1997. The new Americans; Economic, demographic, and fiscal effects of immigration National Academy Press, Washington, DC.
• Tienda M., Jensen L., Bach R., 1984. Immigration, gender, and the process of occupational change in the United States, 1970–1980. International Migration Review 18:1021-1044.
• Vega W. A., Amaro H., 1994. Latino outlook: Good health, uncertain prognosis. Annual Review of Public Health 15:39-67.
• Vega W. A., Kolody B., Aguilar-Gaxiola S., Alderete E., Catalano R., Caraveo-Anduaga J., 1998. Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry 55:771-778.
• Verbrugge L. M., 1983. Multiple roles and physical health of women and men. Journal of Health and Social Behavior 24:16-30.
• Weeks J. R., Rumbaut R. G., Ojeda N., 1999. Reproductive outcomes among Mexican-born women in San Diego and Tijuana: Testing the migration selectivity hypothesis. Journal of Immigrant Health 1:77-90.
• Wei M., Valdez R. A., Mitchell B. D., Haffner S. M., Stern M. P., Hazuda H. P., 1996. Migration status, socioeconomic status, and mortality rates in Mexican Americans and non-Hispanic Whites: The San Antonio Heart Study. Annals of Epidemiology 6:307-313.
• Williams D. R., Collins C., 1995. U.S. socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology 21:349-386.
• Wolinsky F. D., Tierney W. M., 1998. Self-rated health and adverse health outcomes: An exploration and refinement of the trajectory hypothesis. Journal of Gerontology: Social Sciences 53B:S336-S340.
• Zsembik B. A., Drevenstedt G. L., McLane C. P., 1997. Economic well-being among older Latinos. International Journal of Sociology and Social Policy 17:34-56.

This article has been cited by other articles:

				J. Roebuck Bulanda and Zhenmei Zhang Racial-Ethnic Differences in Subjective Survival Expectations for the Retirement Years Research on Aging, November 1, 2009; 31(6): 688 - 709. [Abstract] [PDF]

				D. D. Dunlop, J. Song, L. M. Manheim, M. L. Daviglus, and R. W. Chang Racial/Ethnic Differences in the Development of Disability Among Older Adults Am J Public Health, December 1, 2007; 97(12): 2209 - 2215. [Abstract] [Full Text] [PDF]

				J. L. Angel and R. J. Angel Minority Group Status and Healthful Aging: Social Structure Still Matters Am J Public Health, July 1, 2006; 96(7): 1152 - 1159. [Abstract] [Full Text] [PDF]

				A. S. London and N. A. Myers Race, Incarceration, and Health: A Life-Course Approach Research on Aging, May 1, 2006; 28(3): 409 - 422. [Abstract] [PDF]

				M. E. Coussons-Read, M. L. Okun, M. P. Schmitt, and S. Giese Prenatal Stress Alters Cytokine Levels in a Manner That May Endanger Human Pregnancy Psychosom Med, July 1, 2005; 67(4): 625 - 631. [Abstract] [Full Text] [PDF]

				R. J. Angel, J. L. Angel, and K. S. Markides Stability and Change in Health Insurance Among Older Mexican Americans: Longitudinal Evidence From the Hispanic Established Populations for Epidemiologic Study of the Elderly Am J Public Health, August 1, 2002; 92(8): 1264 - 1271. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Services Download to citation manager Citing Articles Citing Articles via HighWire PubMed PubMed Citation