Stress-Associated Poor Health Among Adult Immigrants with a Language Barrier in the United States

  • Hongliu Ding
  • Lee Hargraves
Original Research


The healthy migrant hypothesis supported by the ‘Hispanic paradox’ suggests that immigrants are healthier than non-immigrants. To test the generalizability of this hypothesis, we studied the stress-associated health status of adult immigrants with a language barrier in the USA. Three stress-related conditions (Unhappiness, Depression, and Anxiety) and self-reported health status were ascertained from participants of the Community Tracking Study Health Survey conducted in 2003. The associations between these conditions as well as the immigrants’ length of time living in the USA and health were assessed. Our results demonstrated that the three stress-related conditions were significantly associated with a dramatically elevated poor health status (Unhappiness: OR = 5.22, 95% CI: 4.43–6.14; Depression: OR = 3.03, 95% CI: 2.31–3.98; Anxiety: OR = 5.12, 95% CI: 3.53–7.41). Compared to US citizens without a language barrier, immigrants with a language barrier were more likely to report poor health (OR = 2.15, 95% CI: 1.66–2.78). After adjustment for stressors, the likelihood of reporting poor health among immigrants with a language barrier decreased significantly (OR = 1.75, 95% CI: 1.05–2.91). In addition, these immigrants were more likely to report poor health within the first 10 years of their living in the USA (≤5 years: OR = 2.79, 95% CI: 1.94–4.02; 6–10 years: OR = 2.68, 95% CI: 1.86–3.86). In summary, immigrants who have a language barrier were generally more stressed, especially at the beginning of their lives as immigrants. The combined effect of stress and a language barrier led to poorer health in these immigrants. Thus, the healthy migrant hypothesis may not be generalizable to this population.


Stress Health status Emigration and immigration 



We thank Dr. Terry S. Field and Mrs. Nancye Aroneo for their help in the preparation of this manuscript.


  1. 1.
    US Census Bureau: Profile of selected social characteristics 2000. Supplementary survey summary tables 2001.Google Scholar
  2. 2.
    Schmidley, AD. Profile of the foreign-born population in the United States: 2000. Current population reports, series P23-206. Washington, DC: US Census Bureau; 2001. Accessed 6 April 2008.
  3. 3.
    Stephen EH, Foote K, Hendershot GE, Schoenborn CA. Health of the foreign-born population: United States, 1989–90. Adv Data. 1994;241:1–12.PubMedGoogle Scholar
  4. 4.
    Singh GK, Yu SM. Adverse pregnancy outcomes: differences between US- and foreign-born women in major US racial and ethnic groups. Am J Public Health. 1996;86(6):837–43.PubMedGoogle Scholar
  5. 5.
    Wei M, Valdez RA, Mitchell BD, Haffner SM, Stern MP, Hazuda HP. Migration status, socioeconomic status, and mortality rates in Mexican Americans and non-hispanic whites: the San Antonio heart study. Ann Epidemiol. 1996;6(4):307–13. doi: 10.1016/S1047-2797(96)00026-9.PubMedCrossRefGoogle Scholar
  6. 6.
    Frisbie WP, Cho Y, Hummer RA. Immigration and the health of Asian and Pacific Islander adults in the United States. Am J Epidemiol. 2001;153(4):372–80. doi: 10.1093/aje/153.4.372.PubMedCrossRefGoogle Scholar
  7. 7.
    Palloni A, Arias E. Paradox lost: explaining the hispanic adult mortality advantage. Demography. 2004;41(3):385–415. doi: 10.1353/dem.2004.0024.PubMedCrossRefGoogle Scholar
  8. 8.
    Hummer RA. Adult mortality differentials among hispanic subgroups and non-hispanic whites. Soc Sci Quart. 2000;81(1):459–76.Google Scholar
  9. 9.
    Sorlie PD, Backlund E, Johnson NJ, Rogot E. Mortality by hispanic status in the United States. J Am Med Assoc. 1993;270(20):2464–8. doi: 10.1001/jama.270.20.2464.CrossRefGoogle Scholar
  10. 10.
    Pumariega AJ, Rothe E, Pumariega JB. Mental health of immigrants and refugees. Community Ment Health J. 2005;41(5):581–97. doi: 10.1007/s10597-005-6363-1.PubMedCrossRefGoogle Scholar
  11. 11.
    Finch BK, Kolody B, Vega WA. Perceived discrimination and depression among Mexican-origin adults in california. J Health Soc Behav. 2000;41(3):295–313. doi: 10.2307/2676322.PubMedCrossRefGoogle Scholar
  12. 12.
    U.S. Census: Population reports 2000. Accessed 6 April 2008.
  13. 13.
    Aroian KJ, Wu B, Tran TV. Health care and social service use among Chinese immigrant elders. Res Nurs Health. 2005;28(2):95–105. doi: 10.1002/nur.20069.PubMedCrossRefGoogle Scholar
  14. 14.
    Jang M, Lee E, Woo K. Income, language, and citizenship status: factors affecting the health care access and utilization of Chinese Americans. Health Soc Work. 1998;23(2):136–45.PubMedGoogle Scholar
  15. 15.
    Lucas JW, Barr-Anderson DJ, Kington RS. Health status, health insurance, and health care utilization patterns of immigrant black men. Am J Public Health. 2003;93(10):1740–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Sohn L. The health and health status of older Korean Americans at the 100-year anniversary of Korean immigration. J Cross Cult Gerontol. 2004;19(3):203–19. doi: 10.1023/B:JCCG.0000034219.97686.69.PubMedCrossRefGoogle Scholar
  17. 17.
    Kuo J, Porter K. Health status of Asian Americans: United States, 1992–94. Adv Data. 1998;298:1–16.PubMedGoogle Scholar
  18. 18.
    Williams DP, Hampton A. Barriers to health services perceived by Marshallese immigrants. J Immigr Health. 2005;7(4):317–26. doi: 10.1007/s10903-005-5129-8.CrossRefPubMedGoogle Scholar
  19. 19.
    Read JG, Emerson MO, Tarlov A. Implications of black immigrant health for U.S. racial disparities in health. J Immigr Health. 2005;7(3):205–12. doi: 10.1007/s10903-005-3677-6.PubMedCrossRefGoogle Scholar
  20. 20.
    Center for Studying Health System Change: Community Tracking Study Household Survey, 2003: [United States] [computer file]. ICPSR04216-v2. Washington, DC: Center for Studying Health System Change [producer], 2006. Ann Arbor, MI: Inter-University Consortium for Political and Social Research [distributor], 2007-12-03.Google Scholar
  21. 21.
    SF-12TM. Standard US Version 1.0, Copyright 1994 The Health Institute; New England Medical Center, distributed by Medical Outcomes Trust.Google Scholar
  22. 22.
    McGee DL, Liao Y, Cao G, Cooper RS. Self-reported health status and mortality in a multiethnic US cohort. Am J Epidemiol. 1999;149(1):41–6.PubMedGoogle Scholar
  23. 23.
    White K, Borrell LN. Racial/ethnic neighborhood concentration and self-reported health in New York City. Ethn Dis. 2006;16(4):900–8.PubMedGoogle Scholar
  24. 24.
    Moody-Ayers S, Lindquist K, Sen S, Covinsky KE. Childhood social and economic well-being and health in older age. Am J Epidemiol. 2007;166(9):1059–67. doi: 10.1093/aje/kwm185.PubMedCrossRefGoogle Scholar
  25. 25.
    Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Public Health. 1996;86(10):1370–8.PubMedGoogle Scholar
  26. 26.
    Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health. J Health Psychol. 1997;2(3):335–51. doi: 10.1177/135910539700200305.CrossRefGoogle Scholar
  27. 27.
    Timmins CL. The impact of language barriers on the health care of Latinos in the United States: a review of the literature and guidelines for practice. J Midwifery Wom Heal. 2002;47(2):80–96. doi: 10.1016/S1526-9523(02)00218-0.CrossRefGoogle Scholar
  28. 28.
    Hummer RA, Rogers R, Nam CB, Le Clere FB. Race ethnicity, nativity and U.S. adult mortality. Soc Sci Quart. 1999;80:136–53.Google Scholar
  29. 29.
    Marmot MG, Syme SL. Acculturation and coronary heart disease in Japanese-Americans. Am J Epidemiol. 1976;104(3):225–47.PubMedGoogle Scholar
  30. 30.
    Rubalcava LN, Teruel GM, Thomas D, Goldman N. The healthy migrant effect: new findings from the Mexican family life survey. Am J Public Health. 2008;98(1):78–84. doi: 10.2105/AJPH.2006.098418.PubMedCrossRefGoogle Scholar
  31. 31.
    Office of Policy and Planning, U.S. Immigration and Naturalization Service: Estimates of the unauthorized immigrant population residing in the United States: 1990 to 2000 (January 2003). Accessed 6 April 2008.

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Meyers Primary Care InstituteUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Family Medicine and Community HealthUniversity of Massachusetts Medical SchoolWorcesterUSA

Personalised recommendations