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Immigrant Legal Status and Health: Legal Status Disparities in Chronic Conditions and Musculoskeletal Pain Among Mexican-Born Farm Workers in the United States

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Demography

Abstract

Immigrant legal status determines access to the rights and privileges of U.S. society. Legal status may be conceived of as a fundamental cause of health, producing a health disparity whereby unauthorized immigrants are disadvantaged relative to authorized immigrants, a perspective that is supported by research on legal status disparities in self-rated health and mental health. We conducted a systematic review of the literature on legal status disparities in physical health and examined whether a legal status disparity exists in chronic conditions and musculoskeletal pain among 17,462 Mexican-born immigrants employed as farm workers in the United States and surveyed in the National Agricultural Workers Survey between 2000 and 2015. We found that unauthorized, Mexican-born farm workers have a lower incidence of chronic conditions and lower prevalence of pain compared with authorized farm workers. Furthermore, we found a legal status gradient in health whereby naturalized U.S. citizens report the worst health, followed by legal permanent residents and unauthorized immigrants. Although inconsistent with fundamental cause theory, our results were robust to alternative specifications and consistent with a small body of existing research on legal status disparities in physical health. Although it is well known that Mexican immigrants have better-than-expected health outcomes given their social disadvantage, we suggest that an epidemiologic paradox may also apply to within-immigrant disparities by legal status. We offer several explanations for the counterintuitive result.

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Notes

  1. In addition to the publicly available data, the DOL granted us use of restricted data containing detailed reports of musculoskeletal pain.

  2. The DOL uses a worksite survey in order to obtain a nationally representative sample of farm workers. No universal lists of U.S. farm workers exist, and telephone and address frames exclude farm workers who live in irregular housing or in housing for short periods. The NAWS uses the U.S. Bureau of Labor Statistics agricultural employer census as its sampling frame. Employers are randomly selected, and workers are randomly drawn from a sampling frame of farmworkers developed at each sampled site. Although farmworkers are selected at the worksite, interviewers do their best to interview farm workers off the work site, before or after the workday, or during lunch or a break. All interviews are completely voluntary and confidentiality is strictly maintained.

  3. Approximately 10 % of U.S. agricultural workers are estimated to hold H-2A visas (Wilson 2013). Estimating the size of the H-2A population is complicated by the nature of data on the H-2A program. The Department of Homeland Security reports H-2A admissions, and some H-2A farm workers enter the United States more than once per year; the State Department reports H-2A job certifications, and some H-2A farm workers hold multiple jobs (Martin 2017). In the NAWS data, farm workers who hold temporary visas include refugees, asylees, and immigrants with temporary protective status, U visas, T visas, border crossing cards, and some student visas. Excluding H-2A visa holders makes our analysis of temporary visa holders nongeneralizable to all temporary visa-holding farm workers but should not bias our results for other legal status categories.

  4. We compared our results for health conditions for all years (2000 to 2015) with the NIOSH years, and results were similar.

  5. Results are consistent when we use multiple imputation for all missing values.

  6. Although we are not aware of studies that have directly assessed the validity of the NAWS questions on legal status, the NAWS data have been used as the standard-bearer for the development of other techniques for identifying the legal status of respondents in survey data, such as the “three-card method” proposed by the Government Accountability Office (GAO 2006). A recent study assessed the validity of direct measurement of immigrant legal status in the Survey of Income and Program Participation and the Los Angeles Family and Neighborhood Survey and found that the questions did not discourage participation and appeared to be answered accurately (Bachmeier et al. 2014).

  7. Giving greater credence to the person’s response on period of entry or other information over their reported legal status reflects the assumption that respondents will be more likely to misreport sensitive information.

  8. Personal correspondence with Daniel Carroll at the DOL. More recent estimates of the recoding are not available. We were not able to identify farm workers who were recoded.

  9. Among those under age 40, authorized farm workers have higher levels of education.

  10. The survey asks whether the farm worker has seen a health care provider in the past two years, but this question captures both access to and need for health care.

  11. This is an imprecise measure of duration in the United States because it does not account for periods of return to Mexico. However, the variable is highly correlated with a variable measuring how long the farm worker has been employed in farm work in the United States (rho = .87), and we find that English language proficiency, property ownership, and insurance coverage all increase with years in the United States, as expected.

References

  • Allison, P. D. (2009). Missing data. In R. E. Millsap & A. Maydeu-Olivares (Eds.), The SAGE handbook of quantitative methods in psychology (pp. 72–90). London, UK: SAGE.

    Chapter  Google Scholar 

  • Arcury, T. A., Grzywacz, J. G., Sidebottom, J., & Wiggins, M. F. (2013). Overview of immigrant worker occupational health and safety for the agriculture, forestry, and fishing (AgFF) sector in the southeastern United States. American Journal of Industrial Medicine, 56, 912–924.

    Google Scholar 

  • Arenas, E., Goldman, N., Pebley, A. R., & Teruel, G. (2015). Return migration to Mexico: Does health matter? Demography, 52, 1853–1868.

    Article  Google Scholar 

  • Asad, A. L., & Clair, M. (2016). Racialized legal status as a social determinant of health. Social Science & Medicine, 199, 19–28.

    Article  Google Scholar 

  • Austin, P. C., & Stuart, E. A. (2015). Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Statistics in Medicine, 34, 3661–3679.

    Article  Google Scholar 

  • Bachmeier, J. D., Van Hook, J., & Bean, F. D. (2014). Can we measure immigrants’ legal status? Lessons from two U.S. surveys. International Migration Review, 48, 538–566.

    Article  Google Scholar 

  • Bean, F. D., Leach, M. A., Brown, S. K., Bachmeier, J. D., & Hipp, J. R. (2011). The educational legacy of unauthorized migration: Comparisons across U.S.-immigrant groups in how parents’ status affects their offspring. International Migration Review, 45, 348–385.

    Article  Google Scholar 

  • Berk, M. L., & Schur, C. L. (2001). The effect of fear on access to care among undocumented Latino immigrants. Journal of Immigrant Health, 3, 151–156.

    Article  Google Scholar 

  • Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M.-E. D., Beyeler, N., & Quesada, J. (2015). Immigration as a social determinant of health. Annual Review of Public Health, 36, 375–392.

    Article  Google Scholar 

  • Connor, A., Layne, L., & Thomisee, K. (2010). Providing care for migrant farm worker families in their unique sociocultural context and environment. Journal of Transcultural Nursing, 21, 159–166.

    Article  Google Scholar 

  • Davis, K. G., & Kotowski, S. E. (2007). Understanding the ergonomic risk for musculoskeletal disorders in the United States agricultural sector. American Journal of Industrial Medicine, 50, 501–511.

    Article  Google Scholar 

  • De Trinidad Young, M.-E., & Madrigal, D. S. (2017). Documenting legal status: A systematic review of measurement of undocumented status in health research. Public Health Reviews, 38(article 26), 1–25. https://doi.org/10.1186/s40985-017-0073-4

    Google Scholar 

  • De Trinidad Young, M.-E., & Pebley, A. R. (2017). Legal status, time in the USA, and the well-being of Latinos in Los Angeles. Journal of Urban Health, 94, 764–775.

    Article  Google Scholar 

  • Donham, K. J., & Thelin, A. (2016). Special risk populations in agricultural communities. In K. J. Donham & A. Thelin (Eds.), Agricultural medicine: Rural occupational and environmental health, safety, and prevention (2nd ed., pp. 43–94). Hoboken, NJ: Wiley & Sons.

    Chapter  Google Scholar 

  • Dreby, J. (2015). Everyday illegal: When policies undermine immigrant families. Oakland: University of California Press.

    Google Scholar 

  • Durand, J., Massey, D. S., & Zenteno, R. M. (2001). Mexican immigration to the United States: Continuities and changes. Latin American Research Review, 36(1), 107–127.

  • Flynn, M. A., Eggerth, D. E., & Jacobson, C. J. (2015). Undocumented status as a social determinant of occupational safety and health: The workers’ perspective. American Journal of Industrial Medicine, 58, 1127–1137.

    Article  Google Scholar 

  • Gonzales, R. G., & Chavez, L. R. (2012). Awakening to a nightmare. Current Anthropology, 53, 255–281.

    Article  Google Scholar 

  • Gonzales, R. G., Suárez-Orozco, C., & Dedios-Sanguineti, M. C. (2013). No place to belong. American Behavioral Scientist, 57, 1174–1199.

    Article  Google Scholar 

  • Government Accountability Office (GAO). (2006). Estimating the undocumented population: A “grouped answers” approach to surveying foreign-born respondents (GAO Report No. GAO-06-775). Washington, DC: U.S. Government Accountability Office. Retrieved from http://www.gao.gov/products/GAO-06-775

  • Guarnaccia, P. J., Angel, J. L., & Angel, R. (1992). The impacts of farm work on health: Analyses of the Hispanic Health and Nutrition Examination Survey. International Migration Review, 26, 111–132.

    Article  Google Scholar 

  • Hagan, J. M., Rodriguez, N., & Castro, B. (2011). Social effects of mass deportations by the United States government, 2000–10. Ethnic and Racial Studies, 34, 1374–1391.

    Article  Google Scholar 

  • Hall, M., & Greenman, E. (2015). The occupational cost of being illegal in the United States: Legal status, job hazards, and compensating differentials. International Migration Review, 49, 406–442.

    Article  Google Scholar 

  • Hall, M., Greenman, E., & Farkas, G. (2010). Legal status and wage disparities for Mexican immigrants. Social Forces, 89, 491–513.

    Article  Google Scholar 

  • Holmes, S. M. (2013). Fresh fruit, broken bodies: Migrant farmworkers in the United States. Berkeley: University of California Press.

    Google Scholar 

  • Iten, A. E., Jacobs, E. A., Lahiff, M., & Fernández, A. (2014). Undocumented immigration status and diabetes care among Mexican immigrants in two immigration “sanctuary” areas. Journal of Immigrant and Minority Health, 16, 229–238.

    Article  Google Scholar 

  • Krogstad, J. M., Passel, J. S., & Cohn, D. (2017). 5 facts about illegal immigration in the U.S. (FactTank report). Washington, DC: Pew Research Center.. Retrieved from http://pewrsr.ch/2pqs0RS

  • Lee, S.-J., Tak, S., Alterman, T., & Calvert, G. M. (2014). Prevalence of musculoskeletal symptoms among agricultural workers in the United States: An analysis of the National Health Interview Survey, 2004–2008. Journal of Agromedicine, 19, 268–280.

    Article  Google Scholar 

  • Leigh, J. P., McCurdy, S. A., & Schenker, M. B. (2001). Costs of occupational injuries in agriculture. Public Health Reports, 116, 235–248.

    Article  Google Scholar 

  • Li, L., Kleinman, K., & Gillman, M. W. (2014). A comparison of confounding adjustment methods with an application to early life determinants of childhood obesity. Journal of Developmental Origins of Health and Disease, 5, 435–447.

    Article  Google Scholar 

  • Liebman, A. K., Juarez-Carrillo, P. M., Reyes, I. A. C., & Keifer, M. C. (2016). Immigrant dairy workers’ perceptions of health and safety on the farm in America’s Heartland. American Journal of Industrial Medicine, 59, 227–235.

    Article  Google Scholar 

  • Lindstrom, D. P., & López Ramírez, A. (2010). Pioneers and followers: Migrant selectivity and the development of U.S. migration streams in Latin America. Annals of the American Academy of Political and Social Science, 630, 53–77.

    Article  Google Scholar 

  • Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35(Extra Issue), 80–94.

    Article  Google Scholar 

  • López, G., Bialik, K., & Radford, J. (2018). Key findings about U.S. immigrants (Fact Tank report). Washington, DC: Pew Research Center. Retrieved from http://pewrsr.ch/2qz2zvx

  • López, G., & Radford, J. (2017). 2015, foreign-born population in the United States statistical portrait: Statistical portrait of the foreign-born population in the United States (Pew Research Center Hispanic Trends report). Retrieved from http://www.pewhispanic.org/2017/05/03/statistical-portrait-of-the-foreign-born-population-in-the-united-states-2015/

  • Markides, K. S., & Coreil, J. (1986). The health of Hispanics in the southwestern United States: An epidemiologic paradox. Public Health Reports, 101, 253–265.

    Google Scholar 

  • Martin, P. (2017). Immigration and farm labor: From unauthorized to H-2A for some? (MPI issue brief). Washington, DC: Migration Policy Institute. Retrieved from https://www.migrationpolicy.org/research/immigration-and-farm-labor-unauthorized-h-2a-some

  • Martinez, O., Wu, E., Sandfort, T., Dodge, B., Carballo-Dieguez, A., Pinto, R., & Carballo-Dieguez, S. (2013). Evaluating the impact of immigration policies on health status among undocumented immigrants: A systematic review. Journal of Immigrant and Minority Health, 17, 947–970.

  • Massey, D. S., Durand, J., & Pren, K. A. (2015). Border enforcement and return migration by documented and undocumented Mexicans. Journal of Ethnic and Migration Studies, 41, 1015–1040.

    Article  Google Scholar 

  • Massey, D. S., Goldring, L., & Durand, J. (1994). Continuities in transnational migration: An analysis of nineteen Mexican communities. American Journal of Sociology, 99, 1492–1533.

    Article  Google Scholar 

  • Mills, P. K., Dodge, J., & Yang, R. (2009). Cancer in migrant and seasonal hired farm workers. Journal of Agromedicine, 14, 185–191.

    Article  Google Scholar 

  • Palloni, A., & Morenoff, J. D. (2001). Interpreting the paradoxical in the Hispanic paradox: Demographic and epidemiologic approaches. Annals of the New York Academy of Sciences, 954, 140–174.

  • Patler, C. (2017). Citizen advantage, undocumented disadvantage, or both? The comparative educational outcomes of second and 1.5-generation Latino young adults. International Migration Review. Advance online publication. https://doi.org/10.1111/imre.12347

  • Phelan, J. C., & Link, B. G. (2015). Is racism a fundamental cause of inequalities in health? Annual Review of Sociology, 41, 311–330.

    Article  Google Scholar 

  • Riosmena, F., Everett, B. G., Rogers, R. G., & Dennis, J. A. (2014). Negative acculturation and nothing more? Cumulative disadvantage and mortality during the immigrant adaptation process among Latinos in the United States. International Migration Review, 49, 443–478.

    Article  Google Scholar 

  • Riosmena, F., Kuhn, R., & Jochem, W. C. (2017). Explaining the immigrant health advantage: Self-selection and protection in health-related factors among five major national-origin immigrant groups in the United States. Demography, 54, 175–200.

    Article  Google Scholar 

  • Robins, J. (1986). A new approach to causal inference in mortality studies with a sustained exposure period—application to control of the healthy worker survivor effect. Mathematical Modelling, 7, 1393–1512.

    Article  Google Scholar 

  • Rosenbaum, P. R. (1984). The consquences of adjustment for a concomitant variable that has been affected by the treatment. Journal of the Royal Statistical Society: Series A (General), 147, 656–666.

    Article  Google Scholar 

  • Rubalcava, L. N., Teruel, G. M., Thomas, D., & Goldman, N. (2008). The healthy migrant effect: New findings from the Mexican Family Life Survey. American Journal of Public Health, 98, 78–84.

    Article  Google Scholar 

  • Snipes, S. A., Cooper, S. P., & Shipp, E. M. (2017). “The only thing I wish I could change is that they treat us like people and not like animals”: Injury and discrimination among Latino farmworkers. Journal of Agromedicine, 22, 36–46.

    Article  Google Scholar 

  • Stoecklin-Marois, M. T., Hennessy-Burt, T. E., & Schenker, M. B. (2011). Engaging a hard-to-reach population in research: Sampling and recruitment of hired farm workers in the MICASA study. Journal of Agricultural Safety and Health, 17, 291–302.

    Article  Google Scholar 

  • Swanberg, J. E., Clouser, J. M., & Westneat, S. (2012). Work organization and occupational health: Perspectives from Latinos employed on crop and horse breeding farms. American Journal of Industrial Medicine, 55, 714–728.

    Article  Google Scholar 

  • Thoemmes, F., & Ong, A. D. (2016). A primer on inverse probability of treatment weighting and marginal structural models. Emerging Adulthood, 4, 40–59.

    Article  Google Scholar 

  • Tonozzi, T. R., & Layne, L. A. (2016). Hired crop worker injuries on farms in the United States: A comparison of two survey periods from the National Agricultural Workers Survey. American Journal of Industrial Medicine, 59, 408–423.

    Article  Google Scholar 

  • Torres, J. M., & Young, M. E. D. (2016). A life-course perspective on legal status stratification and health. SSM–Population Health, 2, 141–148.

    Google Scholar 

  • Tran, L. H., & Perloff, J. M. (2002). Turnover in U.S. agricultural labor markets. American Journal of Agricultural Economics, 84, 427–437.

    Article  Google Scholar 

  • U.S. Department of Labor. (2009). The National Agricultural Workers Survey, Part B: Collection of information employing statistical methods, description of universe and sample. Washington, DC: U.S. Department of Labor. Retrieved from https://www.doleta.gov/pdf/NAWS StatisticalMethodsAKASupportingStatementPart B.pdf

  • U.S. Department of Labor. (2017a). National Agricultural Workers Survey. Washington, DC: U.S. Department of Labor. Retrieved from https://www.doleta.gov/naws/

  • U.S. Department of Labor (2017b). Agricultural worker tables: Demographic characteristics. Washington, DC: National Agricultural Workers Survey, U.S. Department of Labor.

    Google Scholar 

  • Villarejo, D., McCurdy, S. A., Bade, B., Samuels, S., Lighthall, D., & Williams, D., III. (2010). The health of California’s immigrant hired farmworkers. American Journal of Industrial Medicine, 53, 387–397.

  • Waters, M. C., & Pineau, M. G. (Eds.). (2016). The integration of immigrants into American society. Washington, DC: National Academies Press.

    Google Scholar 

  • Williamson, E. J., Forbes, A., & White, I. R. (2014). Variance reduction in randomised trials by inverse probability weighting using the propensity score. Statistics in Medicine, 33, 721–737.

    Article  Google Scholar 

  • Wilson, J. H. (2013). Immigration facts: Temporary foreign workers (Immigration Facts Series report). Washington, DC: Brookings. Retrieved from https://www.brookings.edu/research/immigration-facts-temporary-foreign-workers/

  • Xiao, Y., Moodie, E. E. M., & Abrahamowicz, M. (2013). Comparison of approaches to weight truncation for marginal structural Cox models. Epidemiologic Methods, 2, 1–20.

    Article  Google Scholar 

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Acknowledgments

We gratefully acknowledge support from the Western Center for Agricultural Health & Safety, which is funded by National Institute of Occupational Health and Safety Grant No. 2U54OH007550, and from the Max Planck Institute for Demographic Research. We also thank Trish Hernandez and Susan Gabbard at JBS International; Daniel Carroll at the U.S. Department of Labor; Don Villarejo and Gail Wadsworth at the California Institute for Rural Studies; Marc Schenker, Heather Riden, and Emily Sousa at the Western Center for Agricultural Health and Safety; and Angelo Lorenti.

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Authors and Affiliations

  1. Department of Sociology, University of California, Davis, 1282 SSH, One Shields Avenue, Davis, CA, 95616, USA

    Erin R. Hamilton & Robin Savinar

  2. School of Geography and Sustainable Development, Irvine Building, University of St Andrews, North Street, St Andrews, Fife, Scotland, KY16 9AL, UK

    Jo Mhairi Hale

  3. Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, 18057, Rostock, Germany

    Jo Mhairi Hale

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  1. Erin R. Hamilton
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Hamilton, E.R., Hale, J.M. & Savinar, R. Immigrant Legal Status and Health: Legal Status Disparities in Chronic Conditions and Musculoskeletal Pain Among Mexican-Born Farm Workers in the United States. Demography 56, 1–24 (2019). https://doi.org/10.1007/s13524-018-0746-8

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