Revisiting the role of acculturation and selectivity in the Hispanic health paradox: An analysis of health behaviors, adult mortality and low birthweight

There is compelling evidence for the "Hispanic Health Paradox" such that Hispanics in the United States have exhibited better health and mortality outcomes than do non-Hispanic whites although the Hispanics generally have lower socioeconomic status than do non-Hispanic whites. Research on the Hispanic health paradox often suggested two standard explanations for the observed health advantage of Hispanics: health selection and cultural buffering effect. Although substantial literature has focused on these two explanations, most literature assumed that Hispanic immigrants are a homogeneous group in terms of the health selection and acculturation, suggesting the strength and direction of the two effects are constant. In this dissertation, I focus on age at migration of Hispanic immigrants as an important factor that explains heterogeneity in the health selection and cultural buffering effect. In particular, I hypothesize that immigration into the U.S. early in life will result in a weaker selection, stronger negative acculturation effect but better access to health care services than later life migration.

Results from three empirical analyses that examine health behaviors, adult mortality, and low birth-weight demonstrate that the impact of duration of U.S. residence on health outcomes among Hispanic immigrants, the adult mortality advantage among Mexican immigrants and low birth-weight among Hispanic women vary by their age at migration. Specifically, Hispanic immigrants who migrated early in life show a significant negative relationship between health and duration of U.S. residence, but those who migrated later in life do not; the adult mortality advantage is found among Mexican immigrants relative to non-Hispanic white adults, but this advantage is limited to those who migrated later in life when age at migration is considered; Hispanic women who migrated to the U.S. before adolescence show a lower LBW risk than non-Hispanic whites, but such favorable LBW risk is not observed among Hispanic women who migrated in adulthood.

These results suggest age at migration is not simply a proxy for acculturation, rather an important factor that mediates the relationships between health selection, acculturation and health outcomes. Also, the results suggest that studies that examine the health of Hispanics should consider Hispanic immigrants' age at migration to better understand the source of the favorable health of the population. Furthermore, this dissertation addresses that a pattern of divergent international migration and incorporation into the U.S. resulting from different ages at migration can determine whether and to what degree the Hispanic health paradox exists. Throughout the analyses, the current dissertation contributes to the literature on Hispanic health paradox by elucidating an important source of the favorable health and mortality among Hispanics.