Diminished Health Returns of Own and Parental Education for Immigrants in the United States
Source: By:Shervin Assari,Adolfo Cuevas
DOI: https://doi.org/10.30564/jpr.v2i4.2419
Abstract:Background: Educational attainment is a strong social determinant of health. Marginalization-related Diminished Returns (MDRs), however, refer to smaller health effects of socioeconomic status, particularly educational attainment for marginalized groups compared to mainstream populations. While multiple studies have documented MDRs of educational attainment for racial, ethnic, and sexual minorities, there are no previous studies on MDRs of education among immigrants.
Aims: To understand if the MDRs phenomenon also applies to immigrants, we compared immigrant and non-immigrant American adults for the effects of their own and parental educational attainment on subjective health.
Methods: This study used a cross-sectional design and borrowed data from the General Social Survey (1972-2018). GSS is a series of nationally representative surveys in the U.S. Our analytical sample included 38,399 adults who were either non-immigrants (n = 34903; 90.9%) or immigrants (n = 3496; 9.1%). The main independent variables were own and parental educational attainment measured as four-level categorical variables. The dependent variable (DV) was poor subjective health, measured using a single item. Age, sex, marital status, and year of the survey were the covariates. Immigration status was the moderator.
Results: Overall, individuals with higher educational attainment of own and parents reported better subjective health. We, however, found significant interactions between immigration status and both own and parental educational attainment on subjective health, which was suggestive of weaker protective effects of own and parental educational attainment against poor subjective health in immigrants than non-immigrant individuals.
Conclusions: In the United States, immigrant adults experience poor subjective health disproportionate to their own and their parents educational attainment. That means we may observe worse than expected health of immigrants across all educational levels and social classes. Public policies should go beyond equal access to education by empowering marginalized people to leverage their education and secure better outcomes.
References:[1]Derose, K.P., et al. Review: immigrants and health care access, quality, and cost. Med Care Res Rev, 2009, 66(4): 355-408. [2] Alkaid Albqoor, M., et al. Self-rated health of Middle Eastern immigrants in the US: a national study. Public Health, 2019, 180: 64-73. [3] Abdul-Malak, Y. Healthy Immigrants? Exploring Depressive Symptoms Among Caribbean and Mexican Immigrants. J Racial Ethn Health Disparities, 2019. [4] Miller, L.S., J.A. Robinson, D.A. Cibula. Healthy Immigrant Effect: Preterm Births Among Immigrants and Refugees in Syracuse, NY. Matern Child Health J, 2016. 20(2): 484-93. [5] Vang, Z.M., et al. Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada. Ethn Health, 2017, 22(3): 209-241. [6] Teruya, S.A., S. Bazargan-Hejazi, The Immigrant and Hispanic Paradoxes: A Systematic Review of Their Predictions and Effects. Hisp J Behav Sci, 2013, 35(4): 486-509. [7] Choi, S.H. Testing healthy immigrant effects among late life immigrants in the United States: using multiple indicators. J Aging Health, 2012, 24(3): 475-506. [8] Garcia-Perez, M. Converging to American: Healthy Immigrant Effect in Children of Immigrants. Am Econ Rev, 2016, 106(5): 461-6. [9] Calvo, R., D.C. Carr, C. Matz-Costa. Another Paradox? The Life Satisfaction of Older Hispanic Immigrants in the United States. J Aging Health, 2017, 29(1): 3-24. [10] Crimmins, E.M., et al. Hispanic paradox in biological risk profiles. Am J Public Health, 2007, 97(7): 1305- 10. [11] Drummond, M.B. The Hispanic paradox unraveled? Am J Respir Crit Care Med, 2011, 184(11): 1222-3. [12] Eguia, E., et al. Racial and Ethnic Postoperative Outcomes After Surgery: The Hispanic Paradox. J Surg Res, 2018, 232: 88-93. [13] Espinoza, S.E., I. Jung, H. Hazuda. The Hispanic paradox and predictors of mortality in an aging biethnic cohort of Mexican Americans and European Americans: the san antonio longitudinal study of aging. J Am Geriatr Soc, 2013, 61(9): 1522-9. [14] Patel, K.V., et al. Evaluation of mortality data for older Mexican Americans: implications for the Hispanic paradox. Am J Epidemiol, 2004, 159(7): 707- 15. [15] Shor, E., D. Roelfs, Z.M. Vang. The “Hispanic mortality paradox” revisited: Meta-analysis and meta-regression of life-course differentials in Latin American and Caribbean immigrants’ mortality. Soc Sci Med, 2017, 186: 20-33. [16] Turra, C.M., N. Goldman, Socioeconomic differences in mortality among U.S. adults: insights into the Hispanic paradox. J Gerontol B Psychol Sci Soc Sci, 2007, 62(3): S184-92. [17] Cortes-Bergoderi, M., et al. Cardiovascular mortalityin Hispanics compared to non-Hispanic whites: a systematic review and meta-analysis of the Hispanic paradox. Eur J Intern Med, 2013, 24(8): 791-9. [18] Unreported Deaths Affect the ‘Hispanic Paradox’ and the ‘Black-White Mortality Crossover.’. Natl Bur Econ Res Bull Aging Health, 2017(4): 1-2. [19] Hunt, K.J., et al. All-cause and cardiovascular mortality among diabetic participants in the San Antonio Heart Study: evidence against the “Hispanic Paradox”. Diabetes Care, 2002, 25(9): 1557-63. [20] Bennet, L., M. Lindstrom, Self-rated health and social capital in Iraqi immigrants to Sweden: The MEDIM population-based study. Scand J Public Health, 2018, 46(2): 194-203. [21] Benyamini, Y., et al. Health, cultural and socioeconomic factors related to self-rated health of longterm Jewish residents, immigrants, and Arab women in midlife in Israel. Women Health, 2014, 54(5): 402- 24. [22] Cavallaro, R. Education, culture, and socialization of immigrants; activities and proposals of the Council of Europe. Studi Emigr, 1980, 17(57): 61-8. [23] Mensch, B.S., et, al. Evidence for causal links between education and maternal and child health: systematic review. Trop Med Int Health, 2019, 24(5): 504-522. [24] Zajacova, A. Education, gender, and mortality: does schooling have the same effect on mortality for men and women in the US? Soc Sci Med, 2006, 63(8): 2176-90. [25] Ross, C.E., J. Mirowsky. Refining the association between education and health: the effects of quantity, credential, and selectivity. Demography, 1999, 36(4): 445-60. [26] Ross, C.E., J. Mirowsky. The interaction of personal and parental education on health. Soc Sci Med, 2011, 72(4): 591-9. [27] Mehta, N., S. Preston. Are major behavioral and sociodemographic risk factors for mortality additive or multiplicative in their effects? Soc Sci Med, 2016. 154: 93-9. [28] Mirowsky, J., C.E. Ross. Education, Health, and the Default American Lifestyle. J Health Soc Behav, 2015, 56(3): 297-306. [29] Montez, J.K., R.A. Hummer, M.D. Hayward. Educational attainment and adult mortality in the United States: a systematic analysis of functional form. Demography, 2012, 49(1): 315-36. [30] Montez, J.K., et al. Trends in the Educational Gradient of U.S. Adult Mortality from 1986 to 2006 by Race, Gender, and Age Group. Res Aging, 2011, 33(2): 145-171. [31]Montez, J.K., A. Zajacova. Explaining the widening education gap in mortality among U.S. white women. J Health Soc Behav, 2013, 54(2): 166-82. [32]Weng, P.H., et al. The effect of lifestyle on late-life cognitive change under different socioeconomic status. PLoS One, 2018, 13(6): e0197676. [33]Yaffe, K., et al. Effect of socioeconomic disparities on incidence of dementia among biracial older adults: prospective study. BMJ, 2013, 347: f7051. [34]Zhang, M., et al. Cognitive function in older adults according to current socioeconomic status. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn, 2015, 22(5): 534-43. [35]Aloise-Young, P.A., C. Cruickshank, E.L. Chavez. Cigarette smoking and perceived health in school dropouts: a comparison of Mexican American and non-Hispanic white adolescents. J Pediatr Psychol, 2002, 27(6): 497-507. [36]Assari, S., M. Bazargan. Education Level and Cigarette Smoking: Diminished Returns of Lesbian, Gay and Bisexual Individuals. Behav Sci (Basel), 2019, 9(10). [37]Yang, S., et al. Emergence of socioeconomic inequalities in smoking and overweight and obesity in early adulthood: the national longitudinal study of adolescent health. Am J Public Health, 2008, 98(3): 468-77. [38]Evans, D.A., et al. Education and other measures of socioeconomic status and risk of incident Alzheimer disease in a defined population of older persons. Arch Neurol, 1997, 54(11): 1399-405. [39]Ireys, H.T., et al. Schooling, employment, and idleness in young adults with serious physical health conditions: effects of age, disability status, and parental education. J Adolesc Health, 1996, 19(1): 25- 33. [40]Assari, S. Race and Ethnicity, Religion Involvement, Church-based Social Support and Subjective Health in United States: A Case of Moderated Mediation. Int J Prev Med, 2013, 4(2): 208-17. [41]Furuya, Y., et al. Health literacy, socioeconomic status and self-rated health in Japan. Health Promot Int, 2015, 30(3): 505-13. [42]Hudson, D.L., et al. Race, life course socioeconomic position, racial discrimination, depressive symptoms and self-rated health. Soc Sci Med, 2013, 97: 7-14. [43]Kestila, L., et al. Determinants of health in early adulthood: what is the role of parental education, childhood adversities and own education? Eur J Public Health, 2006, 16(3): 306-15. [44]Zajacova, A., R.A. Hummer, R.G. Rogers. Education and health among U.S. working-age adults: a detailed portrait across the full educational attainment spectrum. Biodemography Soc Biol, 2012, 58(1): 40-61. [45]Idler, E.L., Y. Benyamini. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav, 1997, 38(1): 21-37. [46]Ferraro, K.F., J.A. Kelley-Moore. Self-rated health and mortality among black and white adults: examining the dynamic evaluation thesis. J Gerontol B Psychol Sci Soc Sci, 2001, 56(4): S195-205. [47]Mavaddat, N., et al. Relationship of self-rated health with fatal and non-fatal outcomes in cardiovascular disease: a systematic review and meta-analysis. PLoS One, 2014, 9(7): e103509. [48]Shervin, A., M. Ritesh. Diminished Return of Employment on Ever Smoking Among Hispanic Whites in Los Angeles. Health Equity, 2019, 3(1): 138-144. [49]Assari, S., M. Farokhnia, R. Mistry. Education Attainment and Alcohol Binge Drinking: Diminished Returns of Hispanics in Los Angeles. Behav Sci (Basel), 2019, 9(1). [50]Assari, S., R. Mistry. Educational Attainment and Smoking Status in a National Sample of American Adults; Evidence for the Blacks’ Diminished Return. Int J Environ Res Public Health, 2018, 15(4). [51]Assari, S. Blacks’ Diminished Return of Education Attainment on Subjective Health; Mediating Effect of Income. Brain Sci, 2018, 8(9). [52]Assari, S., C.H. Caldwell, R.B. Mincy. Maternal Educational Attainment at Birth Promotes Future Self-Rated Health of White but Not Black Youth: A 15-Year Cohort of a National Sample. J Clin Med, 2018, 7(5). [53]Assari, S. Socioeconomic Status and Self-Rated Oral Health; Diminished Return among Hispanic Whites. Dent J (Basel), 2018, 6(2). [54]Assari, S., M. Bazargan. Educational Attainment and Self-Rated Oral Health among American Older Adults: Hispanics’ Diminished Returns. Dentistry Journal, 2019, 7(4): 97. [55]Assari, S., M. Bazargan. Educational Attainment and Subjective Health and Well-Being; Diminished Returns of Lesbian, Gay, and Bisexual Individuals. Behavioral Sciences, 2019, 9(9): 90. [56]Assari, S. Parental Education Attainment and Educational Upward Mobility; Role of Race and Gender. Behav Sci (Basel), 2018, 8(11). [57]Assari, S., B. Preiser, M. Kelly. Education and Income Predict Future Emotional Well-Being of Whites but Not Blacks: A Ten-Year Cohort. Brain Sci, 2018, 8(7). [58]Zajacova, A., N. Goldman, G. Rodriguez. Unobserved heterogeneity can confound the effect of education on mortality. Math Popul Stud, 2009, 16(2): 153-173. [59]Zajacova, A., V. Johnson-Lawrence, Anomaly in the education-health gradient: Biomarker profiles among adults with subbaccalaureate attainment levels. SSM Popul Health, 2016, 2: 360-364. [60]Zajacova, A., E.M. Lawrence, The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach. Annu Rev Public Health, 2018, 39: 273-289. [61]Zajacova, A., R.G. Rogers, V. Johnson-Lawrence, Glitch in the gradient: additional education does not uniformly equal better health. Soc Sci Med, 2012, 75(11): 2007-12. [62]Assari, S., L.M. Lapeyrouse, H.W. Neighbors, Income and Self-Rated Mental Health: Diminished Returns for High Income Black Americans. Behav Sci (Basel), 2018, 8(5). [63]Assari, S. Parental Educational Attainment and Mental Well-Being of College Students; Diminished Returns of Blacks. Brain Sci, 2018, 8(11). [64]Assari, S. Socioeconomic Determinants of Systolic Blood Pressure; Minorities’ Diminished Returns. Journal of Health Economics and Development, 2019, 1(1): 1-11. [65]Assari, S., M. Bazargan, Protective Effects of Educational Attainment Against Cigarette Smoking; Diminished Returns of American Indians and Alaska Natives in the National Health Interview Survey. International Journal of Travel Medicine and Global Health, 2019. [66]Assari, S. Education Attainment and ObesityDifferential Returns Based on Sexual Orientation. Behav Sci (Basel), 2019, 9(2). [67]Abdulrahim, S., et al. Discrimination and psychological distress: does Whiteness matter for Arab Americans? Soc Sci Med, 2012, 75(12): 2116-23. [68]Ahmed, S.R., M. Kia-Keating, K.H. Tsai. A structural model of racial discrimination, acculturative stress, and cultural resources among Arab American adolescents. Am J Community Psychol, 2011, 48(3-4): 181- 92. [69]Assari, S., M.M. Lankarani, Discrimination and Psychological Distress: Gender Differences among Arab Americans. Front Psychiatry, 2017, 8: 23. [70]Pollock, L. Discrimination and prejudice: Muslim women’s experiences of maternity care. RCM Midwives, 2005, 8(2): 55. [71]Toselli, S., et al. Psychosocial health among immigrants in central and southern Europe. Eur J Public Health, 2014, 24 (Suppl 1): 26-30. [72]Kim, Y.A., T.W. Collins, S.E. Grineski. Neighborhood context and the Hispanic health paradox: differential effects of immigrant density on childrens wheezing by poverty, nativity and medical history. Health Place, 2014, 27: 1-8. [73]Thomas, K.J. Occupational stratification, job-mismatches, and child poverty: understanding the disadvantage of Black immigrants in the US. Soc Sci Res, 2015, 50: 203-16. [74]Vackova, J., I. Brabcova, Socioeconomic status and health of immigrants. Neuro Endocrinol Lett, 2015, 36 (Suppl 2): 69-77. [75]Van Hook, J., S. L. Brown, M.N. Kwenda. A decomposition of trends in poverty among children of immigrants. Demography, 2004, 41(4): 649-70. [76]Young, C. Pitfalls in comparing immigrants with the Australian-born population with particular reference to socioeconomic status. J Aust Popul Assoc, 1992, 9(1): 25-52. [77]Zunzunegui, M.V., et al. Community unemployment and immigrants’ health in Montreal. Soc Sci Med, 2006, 63(2): 485-500. [78]In Children of Immigrants: Health, Adjustment, and Public Assistance. D.J. Hernandez, Editor, 1999: Washington (DC). [79]van de Werfhorst, H.G., A. Heath. Selectivity of Migration and the Educational Disadvantages of Second-Generation Immigrants in Ten Host Societies. Eur J Popul, 2019, 35(2): 347-378. [80]Vedoy, T.F. The role of education for current, former and never-smoking among non-western immigrants in Norway. Does the pattern fit the model of the cigarette epidemic? Ethn Health, 2013, 18(2): 190-210. [81]Zhang, L., W.J. Han. Poverty Dynamics and Academic Trajectories of Children of Immigrants. Int J Environ Res Public Health, 2017, 14(9). [82]Assari, S. Unequal Gain of Equal Resources across Racial Groups. Int J Health Policy Manag, 2017, 7(1): 1-9. [83]Assari, S. Health Disparities due to Diminished Return among Black Americans: Public Policy Solutions. Social Issues and Policy Review, 2018, 12(1): 112-145. [84]Bambra, C., T.A. Eikemo. Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries. J Epidemiol Community Health, 2009, 63(2): 92-8. [85]Dragun, A., A. Russo, M. Rumboldt. Socioeconomic stress and drug consumption: unemployment as an adverse health factor in Croatia. Croat Med J, 2006, 47(5): 685-92. [86]Assari, S., M. Bazargan. Marital Status and Physical Health: Racial Differences. Int J Epidemiol Res, 2019, 6(3): 108-113. [87]Manfredini, R., et al. Marital Status, Cardiovascular Diseases, and Cardiovascular Risk Factors: A Review of the Evidence. J Womens Health (Larchmt), 2017, 26(6): 624-632. [88]Assari, S., N. Hani. Household Income and Children’s Unmet Dental Care Need; Blacks’ Diminished Return. Dent J (Basel), 2018, 6(2). [89]Assari, S. Whites but Not Blacks Gain Life Expectancy from Social Contacts. Behav Sci (Basel), 2017, 7(4). [90]Assari, S., C.H. Caldwell, M.A. Zimmerman. Family Structure and Subsequent Anxiety Symptoms; Minorities’ Diminished Return. Brain Sci, 2018, 8(6). [91]Assari, S., et al. Blacks’ Diminished Health Return of Family Structure and Socioeconomic Status; 15 Years of Follow-up of a National Urban Sample of Youth. J Urban Health, 2018, 95(1): 21-35. [92]Assari, S., C.H. Caldwell. High Risk of Depression in High-Income African American Boys. J Racial Ethn Health Disparities, 2018. 5(4): 808-819. [93]Assari, S., C.H. Caldwell. Family Income at Birth and Risk of Attention Deficit Hyperactivity Disorder at Age 15: Racial Differences. Children (Basel), 2019, 6(1). [94]Assari S. Educational Attainment Better Increases the Chance of Clinical Breast Exam for Non-Hispanic than Hispanic American Women. Hospital Practices and Research, 2019. [95]Assari, S., M. Lankarani, Educational Attainment Promotes Fruit and Vegetable Intake for Whites but Not Blacks. J, 2018, 1(1): 5. [96] Assari, S., M. Moghani Lankarani. Poverty Status and Childhood Asthma in White and Black Families: National Survey of Children’s Health. Healthcare (Basel), 2018, 6(2).