The document discusses a webinar on the immigrant health paradox, focusing on how foreign-born Hispanics generally exhibit better health outcomes than U.S.-born individuals despite socio-economic disadvantages. It highlights the role of acculturation in influencing health behaviors, specifically relating to diabetes prevalence among differing Hispanic groups in California. Data analysis reveals that longer residency in the U.S. increases the likelihood of diabetes, supporting the immigrant health paradox and emphasizing the need for targeted prevention efforts.

1. Investigating the Immigrant Health
Paradox in California
Wednesday, September 10th
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11:00am – 12:00pm
Taisha Bonilla
Training & Communications Coordinator
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Jose Cuchilla
Healthy City Data Analyst
jcuchilla@advanceproj.org

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6. Webinar Agenda:
• Learn about the Immigrant Health Paradox
• Examine diabetes hospitalization rates among US and
Foreign-Born Hispanics/Latin@s
• Using the Social Determinants of Health framework, we
will explore potential contributing factors
• Live demonstration of how to access and map related
data on other communities of interest on
HealthyCity.org

7. Exploring the Association between
Acculturation and Diabetes among
US/foreign-born Hispanics
-Jose Cuchilla, Healthy City Data Analyst-
 Jose Cuchilla1
 Micere Keels, PhD2
 1 California State Polytechnic University
of Pomona
 2 The University of Chicago, Department
of Comparative Human Development

8. Social Determinants of Health
“The economic and social conditions that influence individuals and group differences in health status.”
– The World Health Organization
http://www.baltimorehia.org/social-determinants-of-health.html

9. The Immigrant Health Paradox
Despite lower levels of education and income,
immigrants are generally healthier than the US-born
population
Lower mortality (Jasso et al., 2002; Muennig and Fahs, 2002)
Lower rates of obesity (Gordon-Larsen, 2003)
Better mental health (Dey and Lucas, 2006)
Lower rates of heart and circulatory disease (Singh and Siahpush, 2001)
However, as their length of residence increases, so does the prevalence
of poor health behaviors and chronic conditions (Kaplan, 2004)

10. The Acculturation Hypothesis
Acculturation
The acquisition and integration of dominant cultural norms by
members of a non-dominant group (Gordon-Larsen, 2003).
Over time, immigrants integrate American behavioral norms and
lifestyles (Gordon-Larsen, 2003).
Immigrant dietary patterns
More fruits and vegetables (Satia-Abouta, 2002)
Less processed foods (Akresh, 2007)
Americanization
Eat less fruits & vegetable (Neuhouser, 2004)
Eat more red meat & processed foods (Ayala, 2008)
Less exercise (Lanza, 2005)
Increase smoking & drinking (Detjen et al., 2007)

11. Research on acculturation and Type-2 diabetes
Limited research exists on the association of length of
residence and type 2 diabetes outcomes
Research that does exist has two limitations…
1) Regional sample
2) Self-reported data to measure diabetes

12. A quantitative analysis of diabetes prevalence in
Hispanics
2001- 2010 NHANES (CDC)
Nationally representative sample
US/foreign-born Mexican Americans ages 20-65
Tested for diabetes (n= 2417)
Fasting blood glucose test
Nativity (US-born/foreign-born)
Acculturation (Length of time [years] in the US)
STATA
T-test
Logistic Regression
Model 1: Basic Differences
Model 2: Control

13. Research Question and Hypothesis
RQ: Does nativity and acculturation affect diabetes health outcomes
among Hispanics?
H1: Hispanics born in the US will be more likely to suffer from diabetes than
foreign born Hispanics.
H2: The longer foreign born Hispanics are in the US, the more likely they
are to have diabetes.

14. Native-born Mexican Americans had a higher rate
of diabetes
Table 1: Descriptive Characteristics
Variable
Full Sample
(n= 5416)
Native
(n= 2035)
Foreign
(n=3381)
Diabetes (%) 10.63 12.57 9.49
Undiagnosed Diabetes (%) 33.20 30.09 35.66
Female (%) 52.25 56.16 49.83
Length in US (%)
<5 years 18.66
5 - <15 years 32.54
15 - <30 years 33.15
30+ years 15.66
Citizenship (%) 22.61
Education (%)
<9th grade 33.90 9.30 48.70
9th grade - H.S. 41.26 47.72 37.41
Some College 18.26 31.55 10.27
College Degree 6.57 11.42 3.61
Married (%) 60.75 53.79 64.82
No Insurance (%) 47.62 27.25 59.85
Significant values (t-test: p<0.05) indicated in red.

15. Foreign-born Mexican Americans were less likely
to have diabetes
Table 2: Logistic regression results for nativity
Diabetes Model 1* Model 2**
Variable
Odds Ratio
(Std. Err.)
P-value
Odds Ratio
(Std. Err.)
P-value
All Mexican Americans
Native born reference category
Foreign born 0.73 0.018 0.50 <0.001
(0.10) (0.09)
*Model 1: Includes only nativity or length in US.
**Model 2: Adds controls for education, poverty, marital status, smoker, insurance, age, and gender.

16. Foreign-born Mexican Americans who have been
in the US longer were more likely to have diabetes
Table 2: Logistic regression results for length of time among foreign-born
Hispanics
Diabetes Model 1* Model 2**
Variable
Odds Ratio
(Std. Err.)
P-value
Odds Ratio
(Std. Err.)
P-value
Foreign Born Mexican Americans
< 5 years in US reference category
5 - <15 years in US 1.78 0.109 1.87 0.113
(0.63) (0.74)
15-<30 years in US 2.64 0.005 3.11 0.003
(0.90) (1.21)
30+ years in US 5.06 <0.001 6.67 <0.001
(1.78) (2.82)
*Model 1: Includes only nativity or length in US. **Model 2: Adds controls for education, poverty, marital status, smoker, insurance, age, and gender.

17. Nativity and acculturation highlight important risk
factors for diabetes
Nativity & length of time in the US
• Study supports the immigrant health paradox
• Supports the acculturation hypothesis
• Identifying length of residence as a risk factor is useful
for targeting populations for diabetes prevention
“Obesogenic” environments (Powell, 2010)
• Low income communities (Walker, 2010)
• Less supermarkets (Weinberg, 1995)
• Longer distance (Rose and Richards, 2004)

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