The healthy immigrant effect: a test of competing explanations in a low income population

ABSTRACT

Evidence in support of the healthy immigrant effect (HIE) has been mixed and explanations for it divergent. Research on the HIE is reviewed and seven explanatory hypotheses are presented. Support for these hypotheses is evaluated with data collected in a phone survey of patients in a Massachusetts public health program for economically disadvantaged persons. Variation in physical health, depression, and smoking reflect the HIE, but the explanations for this pattern vary across these health indicators. The Spanish translation of one response choice obscures the healthy immigrant pattern for SRH – which is apparent after taking language into account, while variation in perceived change in health – another self-report measure with different response choices – comports with the HIE. There is no support for a unique effect of ethnic identity – a key aspect of acculturation, nor for a unique effect of social status in this low income sample. The findings help explain the bases for discrepancies in prior research and suggest new research directions when investigating the healthy immigrant effect, including considering the comparison group and the distribution of social status in the population studied, using an alternative to the standard SRH question with Spanish and Portuguese speakers, and distinguishing physical and mental health and health-related behaviours.

KEYWORDS:

• Immigration
• self-reported health
• depression
• smoking
• health inequalities
• acculturation
• barriers to health care

Acknowledgements

We are grateful for the support of the Massachusetts Department of Public Health for the collaboration of Mary Lou Woodford, RN, Anita Christie, RN, Heather Nelson, PhD, and for the assistance of Xavier Lazcano, MA, Lisa-Marie Guzman, MA, Angela Cody, MA, Jessica Callea, MA, Aliaksandra Sakhar, and Jacqueline Fawcett, PhD, FAAN, as well as for survey expertise and management provided by the Center for Survey Research and Anthony Roman, MA, Dragana Bolcic-Jankovic, MA, and Rumel Mahmood, MA.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Russell K. Schutt http://orcid.org/0000-0003-2569-6086

Additional information

Funding

This work received support from the Massachusetts Department of Public Health (INTF3406HH2706811045).