Immigrants and Host Country. What is the cost of acculturation? M Maldonado

Immigrants and Host Immigrants and Host Country. What is the cost of Country. What is the cost of

acculturation?acculturation?

M MaldonadoM Maldonado

ImmigrantsImmigrants

Traditional belief is that immigrants are at Traditional belief is that immigrants are at higher risk of mental health problemshigher risk of mental health problems

This is thought to be due to the effects of This is thought to be due to the effects of migration, economic deprivation and loss migration, economic deprivation and loss (Escobar et al, 2000)(Escobar et al, 2000)

At times, they have been thought to be At times, they have been thought to be “defective” or backwards.“defective” or backwards.

Industrialized countries are increasingly Industrialized countries are increasingly “multicultural”“multicultural”


Have higher risk factors than host Have higher risk factors than host population:population:

PovertyPoverty Lack of access to health care, Lack of access to health care,

insuranceinsurance Fewer visits to health care Fewer visits to health care

professionalsprofessionals


In the US Latinos are increasing in In the US Latinos are increasing in number steadilynumber steadily

By 2050 they will be 25% of the US By 2050 they will be 25% of the US populationpopulation

The majority of Hispanics in the US The majority of Hispanics in the US are of Mexican originare of Mexican origin

In some states they reach 25 to 30% In some states they reach 25 to 30% of the populationof the population


Degree of “acculturation” Degree of “acculturation” Embracing new values, new Embracing new values, new

language, new costumes and ways of language, new costumes and ways of behavingbehaving

For Mexican immigrant women, more For Mexican immigrant women, more “acculturation” means worse “acculturation” means worse outcomes in terms of health and outcomes in terms of health and mental health ( substance use, mental health ( substance use, alcohol abuse, etc.)alcohol abuse, etc.)

Acculturartion measuresAcculturartion measures

Language used at home, e.g. Spanish Language used at home, e.g. Spanish or Englishor English

Language familiarity and preferenceLanguage familiarity and preference Child rearing preferencesChild rearing preferences Electronic media interestElectronic media interest Ethnic pride and idetityEthnic pride and idetity Food, music, generational proximityFood, music, generational proximity

Acculturation measuresAcculturation measures

CoworkersCoworkers Ethnicity of neighbors and close Ethnicity of neighbors and close

friendsfriends Cultural heritage and celebrationsCultural heritage and celebrations MusicMusic Childhood cultural characteristicsChildhood cultural characteristics Cultural exposure. Bicultural Cultural exposure. Bicultural

involvementinvolvement

AcculturationAcculturation

Measuring degree of acculturation in Measuring degree of acculturation in Latinos Latinos (Burnam et al. 1987)(Burnam et al. 1987)

Epidemiological Catchment Area study , of Epidemiological Catchment Area study , of rates of psychopathology in US. Related rates of psychopathology in US. Related to Latinos:to Latinos:

Less acculturated people, less prevalence Less acculturated people, less prevalence of alcohol and drug abuse, phobia, of alcohol and drug abuse, phobia, antisocial personalityantisocial personality

Is there a selective effect of migrators?Is there a selective effect of migrators?


Rates of mood disorder in Latino Rates of mood disorder in Latino populationpopulation

Rates lower in Mexican born people Rates lower in Mexican born people vs. US born Latino persons (Kessler vs. US born Latino persons (Kessler et al, 1994)et al, 1994)

Lower prevalence of substance abuse Lower prevalence of substance abuse in the Mexican born populationin the Mexican born population

Prevalence studies. Mexican Prevalence studies. Mexican American prevalence survey (Vega American prevalence survey (Vega

et al, 1998) et al, 1998) 3000 adults in California3000 adults in California CIDI instrument CIDI instrument (Composite Int. Diag.Interv.)(Composite Int. Diag.Interv.)

Rates of psychopathology are twice Rates of psychopathology are twice for US born individualsfor US born individuals

For women rates of alcohol and drug For women rates of alcohol and drug abuse are 7x for US born womenabuse are 7x for US born women

Healthy immigrant effect in womenHealthy immigrant effect in women

In US Latino women who adhere to their In US Latino women who adhere to their traditional culture have more “positive traditional culture have more “positive health behaviors” health behaviors” (Ventura et al, 1997)(Ventura et al, 1997)

Less use of drugs and alcoholLess use of drugs and alcohol Less complications during childbirthLess complications during childbirth Better perinatal health outcomes Better perinatal health outcomes

compared with more acculturated Latino compared with more acculturated Latino women, diabetes, hypertensionwomen, diabetes, hypertension

Effect for immigrant womenEffect for immigrant women

Less acculturation (foreign born) Less acculturation (foreign born) means:means:

Lower rate of “small for gestational Lower rate of “small for gestational age babies” (3% Mexican born vs. age babies” (3% Mexican born vs. 14% for US born women) 14% for US born women)

Lower rates of prematurityLower rates of prematurity Lower infant mortality for foreign Lower infant mortality for foreign

born than US born women (Collins et born than US born women (Collins et al, 2001)al, 2001)

Latinos in California. Latinos in California.

3000 adults in California3000 adults in California CIDI instrument CIDI instrument (Composite Int. Diag.Interv.)(Composite Int. Diag.Interv.)

Rates of psychopathology are twice Rates of psychopathology are twice for US born individualsfor US born individuals

For women rates of alcohol and drug For women rates of alcohol and drug abuse are 7x for US born women vs. abuse are 7x for US born women vs. those born in Mexicothose born in Mexico


Adoption of “new ways” , language, Adoption of “new ways” , language, beliefs, practices, while abandoning beliefs, practices, while abandoning the old or traditional ones.the old or traditional ones.

Is acculturation adaptive? Is Is acculturation adaptive? Is acculturation beneficial for the health acculturation beneficial for the health of pregnant women?of pregnant women?

Women and pregnancyWomen and pregnancy

In US Latino women who adhere to their In US Latino women who adhere to their traditional culture have more “positive traditional culture have more “positive health behaviors” health behaviors” (Ventura et al, 1997)(Ventura et al, 1997)

Less use of drugs and alcoholLess use of drugs and alcohol Less complications during childbirthLess complications during childbirth Better perinatal health outcomes Better perinatal health outcomes

compared with more acculturated Latino compared with more acculturated Latino women, diabetes, hypertensionwomen, diabetes, hypertension

Pregnancy and domestic violence. Pregnancy and domestic violence. Pregnant Latina Women Pregnant Latina Women (Matson (Matson

and Rodriguez, 1999)and Rodriguez, 1999) 150 women, immigrant and US Born, 150 women, immigrant and US Born,

rural and urbanrural and urban Highest rate of domestic violence in Highest rate of domestic violence in

US born rural Latina (highest level of US born rural Latina (highest level of acculturation)acculturation)

Latina womenLatina women

More acculturated young Latina More acculturated young Latina womenwomen

Start intercourse earlier in ageStart intercourse earlier in age

Higher rate of non-marital births Higher rate of non-marital births (Loue, (Loue, 19871987

US Mexico border study of US Mexico border study of adolescents adolescents (Pumariega et al, 1992)(Pumariega et al, 1992)

4000 adolescents, 11 to 18 years old4000 adolescents, 11 to 18 years old Rates of depression and distress Rates of depression and distress

(Panamerican Youth Inventory and Center for Epidemiologic (Panamerican Youth Inventory and Center for Epidemiologic Studies Depressive Scale)Studies Depressive Scale)

Rate of drug abuse was 4x higher in Rate of drug abuse was 4x higher in US born adolescents (21% vs 5%)US born adolescents (21% vs 5%)

Higher levels of distress and suicidal Higher levels of distress and suicidal ideation in US born teenagers.ideation in US born teenagers.

Other studies: less risk of suicideOther studies: less risk of suicide

US Mexico border studyUS Mexico border study

Risk factors: More time watching Risk factors: More time watching televisiontelevision

Less time spent in family activitiesLess time spent in family activities Less involvement with friendsLess involvement with friends Less involvement in sportsLess involvement in sports

U. Of California Irvine . Disorders in U. Of California Irvine . Disorders in primary care (Escobar et al, 1998)primary care (Escobar et al, 1998)

1500 adolescents several groups1500 adolescents several groups Mexican and Central American born :Mexican and Central American born : Lower levels of posttraumatic Lower levels of posttraumatic

disorder, depression, panic disorderdisorder, depression, panic disorder Better levels of physical functioningBetter levels of physical functioning Higher rates of “somatization”Higher rates of “somatization”

Acculturation. Turkish children in Acculturation. Turkish children in GermanyGermany

Less acculturation meant:Less acculturation meant: Lower rates of asthmaLower rates of asthma Lower rates of allergic sensitizationLower rates of allergic sensitization Lower rates of atopyLower rates of atopy (Gruber et al, 2002)(Gruber et al, 2002)

Acculturation and dietAcculturation and diet

Less acculturated Latinos in USLess acculturated Latinos in US ““healthier diet” healthier diet” Less consumption of fat, saturated Less consumption of fat, saturated

fat, sodium ,more consumption of fat, sodium ,more consumption of fiber and vitaminesfiber and vitamines

More consumption of vegetablesMore consumption of vegetables Regular eating of breakfastRegular eating of breakfast

Acculturation and “heatlh Acculturation and “heatlh behaviors”behaviors”

Less acculturation of Latinos in USLess acculturation of Latinos in US Higher use of seat beltHigher use of seat belt Higher level of immunization of Higher level of immunization of

childrenchildren

TRANSCULTURATION

ISOLATION ANDENTRENCHMENT

asimilationasimilation

Not talking to the child or about the Not talking to the child or about the childchildUsing objects to prevent negative Using objects to prevent negative influences ( evil eye, witchcraft, influences ( evil eye, witchcraft, penetration by spirits, effects of penetration by spirits, effects of envy)envy)Massages and baths to the motherMassages and baths to the motherAvoidance of calling attention to Avoidance of calling attention to pregnancypregnancyNeed to be “mothered” herself.Need to be “mothered” herself.

Pregnancy and culturePregnancy and culture

Feeding the infantFeeding the infant

Breastfeed? Where? How? Breastfeed? Where? How? When should consistent foods be When should consistent foods be

introduced?introduced? How to make food soft and pureed?How to make food soft and pureed? What should be offered and when?What should be offered and when? Should the baby eat at night?Should the baby eat at night? How long to give the bottle?How long to give the bottle? What variety of foods?What variety of foods?

Feeding the infantFeeding the infant

Baby should sleep alone?Baby should sleep alone? Baby should sleep with mother?Baby should sleep with mother? What to do if the baby wakes up?What to do if the baby wakes up? What to do if the baby cries?What to do if the baby cries? Hammock, box, crib, mother’s bed, Hammock, box, crib, mother’s bed,

side bed, “motorcycle bed”side bed, “motorcycle bed” Should baby be swaddled?Should baby be swaddled?

Possible protective effectsPossible protective effects

Role of “familismo”: social support Role of “familismo”: social support and collective loyaltyand collective loyalty

Extensive social networksExtensive social networks Culturally based respect for parents Culturally based respect for parents

and for parenting role?and for parenting role? Greater social support and controlGreater social support and control

Protective effects?Protective effects?

Support network of extended family , Support network of extended family , traditional roles, use of cultural traditional roles, use of cultural markers and language (Escobar et markers and language (Escobar et al, 2000)al, 2000)

Social control exerted over health Social control exerted over health related behaviors such as drug and related behaviors such as drug and alcohol usealcohol use

Less isolation during pregnancy and Less isolation during pregnancy and deliverydelivery

Documents

Immigrants and Host Country. What is the cost of acculturation? M Maldonado