International migration and infant health in Mexico

Urban Violence, Migration and Alcohol, Tobacco, and Marijuana Use among Transnational Students in Northern Mexico

This article reports on the findings of a study of the relationship between transnational experiences in the United States (US) and the use of alcohol, tobacco, and marijuana among 7th grade students (n = 1418). The study was guided by a cross-national framework for research on immigrant health and assessed the accumulation of risk factors for transnational adolescents. Data came from a survey conducted in 2017 in Nogales, Mexico. In this study, the last 30-day prevalence of use of alcohol, tobacco, and marijuana among students was 21.7%, 8.3%, and 2.4%, respectively. Most students were born in Nogales (69.6%), while 10.5% were born in the US, 7.5% attended school in the US, and 3.6% engaged in health-related risk behaviors while living in or visiting the US. Students with transnational experiences, such as attending school in the US, reported the highest 30-day prevalence of tobacco (13.3%) and marijuana (9.5%) use. After adjusting for family, school, access to substances and neighborhood violence variables, students who engaged in health-related risk behavior in the US had significantly increased odds of alcohol and marijuana use while later attending school in Mexico. The article discusses the findings from a prevention science perspective and provides implications for policy, practice, and future research on the Mexico-US border region.

The effects of spousal migration on perinatal healthcare utilization

Over the last three decades, out-migration has become a stable source of income for more than 12 million Bangladeshis. Of those migrants, 90% are men. Due to patriarchal cultural norms in Bangladeshi society, the migration of a male spouse may have significant consequences for the social well-being and health of left-behind women. In this study, we examine the impact of external (out of country) and internal (rural to urban) spousal migration on the perinatal healthcare utilization of left-behind women. We used data from the 2012 Matlab Health and Socioeconomic Survey (MHSS2) to examine use of antenatal care, presence of a medically qualified attendant at birth, and delivery at a healthcare facility for live births that occurred between 2007 and 2014 for currently married women aged 15-45 (N = 1,458 births among 1,180 women). Adjusted regression models indicated that for births occurring to women with a migrant spouse, odds of receiving antenatal care were significantly higher (OR: 4.1 for births to women with a domestic urban migrant spouse and 4.6 for births to women with an international migrant spouse, p < 0.01). Spousal migration was not linked to having a medically qualified attendant at birth or delivery at a clinic or hospital. Results suggest that spousal migration may be beneficial for receiving health care during a pregnancy, but not for the type of attendant or place of delivery at birth.

Migration and the Health of Non-migrant Family: Findings from the Jamaica Return(ed) Migrants Study

Research on the association between migration and health among nonmigrant family in Jamaica is limited. Data from the 2012 Jamaica Return(ed) Migrants Study (N = 621) and weighted regression models were used to investigate the association between migration and health among left-behind women (n = 323) and men (n = 298) in Jamaica. Compared to women whose children lived in Jamaica, women who had a child abroad reported lower odds of good mental health (OR = 0.46, 95% CI 0.21, 0.97). Men in this situation were less satisfied with their lives (b = - 2.370, p = 0.031). Women reported better physical (b = - 2.113, p = 0.010) and mental (b = - 3.119, p = 0.039) health scores when a parent, but not a grandparent, lived abroad. Men with a migrant spouse/partner reported significantly more physical illness symptoms than men whose spouse/partner lived in Jamaica (b = 3.215, p = 0.013). Migration exerts disparate health impacts on left-behind family and may disrupt social relationships.

Transnational social networks, health, and care: a systematic narrative literature review

While transnational social ties and exchanges are a core concern within migration studies, health researchers have often overlooked their importance. Continuous and circular exchanges of information within transnational networks, also defined as social remittances, facilitate the diffusion of innovations, potentially driving contemporary social and cultural change. Influences on health, wellbeing, and care-seeking are important, but under-researched, dimensions for consideration. We undertook a systematic narrative evidence synthesis to describe the current state of knowledge in this area and to identify gaps and future directions for health researchers to take. Between April 2017 and May 2019, an iterative series of searches in Medline, Embase, PsycINFO and PubMed, plus backward and forward citation searches identified 1173 potential papers. Screening resulted in 36 included papers, eighteen focused on migrant populations and eighteen on those who remain behind. The top three health topics were health-seeking strategies, sexual and reproductive health issues, and healthcare support. And, while not always explicitly identified, mental health and wellbeing was a further prominent, cross-cutting theme. Articles on migrant populations were all conducted in the global North and 13 out of 18 used qualitative methods. Five main themes were identified: therapeutic effect of the continuing social relationships, disrupted social relationships, hybridisation of healthcare, facilitation of connections to healthcare providers, and factors encouraging or undermining transnational social exchanges. Papers concerned with those who remain behind were mainly focused on the global South and used a mix of qualitative and quantitative approaches. Four main themes were identified: transnational transfer of health-related advice, norms, and support; associations between migrant linkages and health behaviours/outcomes; transnational collective transfer of health knowledge; and power and resistance in exchanges. Findings suggest that transnational social exchanges can both support and undermine the health of migrants and those who remain behind. This review confirms that the volume and quality of research in this area must be increased so that health policy and practice can be informed by a better understanding of these important influences on the health of both migrants and those who remain behind.

Utilisation of sexual and reproductive health services among street children and young adults in Kampala, Uganda: does migration matter?

BACKGROUND

While the nexus of migration and health outcomes is well acknowledged, the effect of rural-urban migration on the use of sexual and reproductive health (SRH) services has received less attention. We assessed the effect of rural-urban migration on the use of SRH services, while controlling for confounding, and whether there is a difference in the use of SRH services among migrant and non-migrant street children and young adults.

METHODS

Data were collected from 513 street children and young adults aged 12-24 years, using venue-based time-space sampling (VBTS). We performed multivariate logistic regression analysis using Stata 16.0 to identify factors associated with SRH services use, with rural-urban migration status as the main predictor. Participants were further classified as new migrants (≤ 2 years of stay in city), established migrants (> 2 years of stay in city) or non-migrants (lifelong native street children) with no rural-urban migration history.

RESULTS

Overall, 18.13% of the street children and young adults had used contraception/family planning, 58.67% had tested for human immunodeficiency virus (HIV) and knew their status and 34.70% had been screened for sexually transmitted infections (STIs). Non-migrants were 2.70 times more likely to use SRH services (HIV testing, STI screening and family planning) compared to the migrants (aOR = 2.70, 95% CI 1.23-5.97). Other factors associated with SRH services use among street children and young adults include age (aOR = 4.70, 95% CI 2.87-7.68), schooling status (aOR = 0.33, 95% CI 0.15-0.76), knowledge of place of care (aOR = 2.71, 95% CI 1.64-4.46) and access to SRH information (aOR = 3.23, 95% CI 2.00-5.24).

CONCLUSIONS

SRH services utilisation among migrant street children and young adults is low compared to their non-migrant counterparts and is independently associated with migration status, age, schooling status, knowledge of place of care and access to SRH information. Our findings call for the need to design and implement multi-dimensional interventions to increase the use of SRH services among street children and young adults, while taking into consideration their migration patterns.

Men's migration and women's mortality in rural Mozambique

Labor migration is widespread and growing across the world. As migration grows, the economic outcomes of migration increasingly diversify, and so do its consequences for the well-being and health of both migrants and non-migrating household members. A considerable body of scholarship has examined the effects of migration on the physical and mental health of 'left-behind' household members. The impact of migration on mortality, particularly of non-migrating marital partners, is less well understood. Addressing this gap, we use data from a longitudinal survey of married women conducted over twelve years in rural Mozambique to examine the association between men's labor out-migration and their non-migrating wives' mortality. The analyses detect no significant differences when comparing non-migrants' wives to migrants' wives in the aggregate but point to instructive variation among migrants' wives according to the economic success of migration, as measured by the effects of migration on the household's material well-being. Specifically, women married to less successful migrants had higher mortality risks over the project span than women married to more successful migrants, regardless of other individual and household-level factors. Importantly for this setting with high HIV prevalence, the advantage of wives of more successful migrants is significant for HIV/AIDS-unrelated deaths but not for HIV/AIDS-related deaths. We situate these findings within the cross-national scholarship on migration and health.

Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis

BACKGROUND

Globally, a growing number of children and adolescents are left behind when parents migrate. We investigated the effect of parental migration on the health of left behind-children and adolescents in low-income and middle-income countries (LMICs).

METHODS

For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, the Cochrane Library, Web of Science, PsychINFO, Global Index Medicus, Scopus, and Popline from inception to April 27, 2017, without language restrictions, for observational studies investigating the effects of parental migration on nutrition, mental health, unintentional injuries, infectious disease, substance use, unprotected sex, early pregnancy, and abuse in left-behind children (aged 0-19 years) in LMICs. We excluded studies in which less than 50% of participants were aged 0-19 years, the mean or median age of participants was more than 19 years, fewer than 50% of parents had migrated for more than 6 months, or the mean or median duration of migration was less than 6 months. We screened studies using systematic review software and extracted summary estimates from published reports independently. The main outcomes were risk and prevalence of health outcomes, including nutrition (stunting, wasting, underweight, overweight and obesity, low birthweight, and anaemia), mental health (depressive disorder, anxiety disorder, conduct disorders, self-harm, and suicide), unintentional injuries, substance use, abuse, and infectious disease. We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs) using random-effects models. This study is registered with PROSPERO, number CRD42017064871.

FINDINGS

Our search identified 10 284 records, of which 111 studies were included for analysis, including a total of 264 967 children (n=106 167 left-behind children and adolescents; n=158 800 children and adolescents of non-migrant parents). 91 studies were done in China and focused on effects of internal labour migration. Compared with children of non-migrants, left-behind children had increased risk of depression and higher depression scores (RR 1·52 [95% CI 1·27-1·82]; SMD 0·16 [0·10-0·21]), anxiety (RR 1·85 [1·36-2·53]; SMD 0·18 [0·11-0·26]), suicidal ideation (RR 1·70 [1·28-2·26]), conduct disorder (SMD 0·16 [0·04-0·28]), substance use (RR 1·24 [1·00-1·52]), wasting (RR 1·13 [1·02-1·24]) and stunting (RR 1·12 [1·00-1·26]). No differences were identified between left-behind children and children of non-migrants for other nutrition outcomes, unintentional injury, abuse, or diarrhoea. No studies reported outcomes for other infectious diseases, self-harm, unprotected sex, or early pregnancy. Study quality varied across the included studies, with 43% of studies at high or unclear risk of bias across five or more domains.

INTERPRETATION

Parental migration is detrimental to the health of left-behind children and adolescents, with no evidence of any benefit. Policy makers and health-care professionals need to take action to improve the health of these young people.

FUNDING

Wellcome Trust.

Migration and child health in Moldova and Georgia

There is scarce empirical evidence on the relation between migration and child health in Moldova and Georgia-two post-Soviet countries with large out-migration flows in the region. This study uses nationally representative data collected in 2011-2012 in Moldova (N = 1601) and Georgia (N = 1193) to investigate how children's health associates with five transnational characteristics: migrant and return-migrant household types, parental migration and parental divorce, maternal and/or paternal migration and caregiver's identity, the duration of migration, and remittances. Findings show that, regardless of the transnational family setting, children of migrants have overall positive or no differing health compared to children in non-migrant households. However, significant gender differences are found in both countries. More often than not, Moldovan and Georgian girls are more at risk of having poorer health when living transnationally. These results add nuance to a field of research that has mainly emphasized negative outcomes for children in transnational care.

Beyond Orphanhood: Parental Nonresidence and Child Well-being in Tanzania

This article used data from the Rufiji Health and Demographic Surveillance System in Tanzania to examine the influence of parental non-residence on child survival and school entry. Using survival analysis methods, the article tested variations by parent and by cause, examining parental death, non-residence due to parental relationship status, and migration. In general, maternal non-residence was more consequential for child survival, while paternal non-residence influences school entry. This is consistent with gendered parenting patterns in the setting. There was important variation by cause and by outcome, particularly for paternal non-residence. Paternal non-residence due to non-marital birth was associated with increased risk of child death, while paternal migration was associated with improved survival. Paternal death and migration were associated with lower odds of school entry. This article moves beyond orphanhood to consider multiple causes of parental non-residence simultaneously, demonstrating that parental non-residence is not uniformly deleterious for children.

Cross-border Ties as Sources of Risk and Resilience: Do Cross-border Ties Moderate the Relationship between Migration-related Stress and Psychological Distress for Latino Migrants in the United States?

Few studies have examined the associations between health and the cross-border ties that migrants maintain with their family members in communities of origin. We draw on theory related to social ties, ethnic identity, and mental health to examine cross-border ties as potential moderators of the association between migration-related stress and psychological distress among Latino migrants. Using data from the National Latino and Asian American Survey, we find that remittance sending is associated with significantly lower levels of psychological distress for Cuban migrants, and difficulty visiting home is associated with significantly greater psychological distress for Puerto Rican migrants. There were significant associations between migration-related stressors and psychological distress, although these associations fell to nonsignificance after accounting for multiple testing. We found little evidence that cross-border ties either buffer or exacerbate the association between migration-related stressors and psychological distress. We consider the findings within the current political and historical context of cross-border ties and separation.

Does helping them benefit me? Examining the emotional cost and benefit of immigrants' pecuniary remittance behaviour in Canada

The existing literature has largely focused on how immigrants' pre/post-migration experiences affect their health in destination societies. Hence, little is known about the extent to which immigrants' choice to maintain transnational ties to their family and friends abroad influences their health. This study makes a theoretical and empirical contribution to the sociology of health literature by examining how immigrants' pecuniary remittance behaviour affects their emotional health using data from the Longitudinal Survey of Immigrants to Canada (LSIC, 2001-2005). Our weighted logistic regression analyses demonstrate that sending remittances within the first six months of arrival predisposes immigrants to emotional health problems. However, remitting after six months of arrival provides an "emotional advantage" for immigrants, but this advantage is greater for female immigrants compared to their male counterparts. The study clearly shows that immigrants' remittance behaviour has far reaching gendered implications on their emotional health, which underscores the importance of including transnational theory and gender in the conceptual toolbox for explaining immigrants' health transitions. Admittedly, insights from this study can help professional healthcare staff, and immigrant settlement and integration agency workers better understand and address the mental health needs of immigrants in order to enhance their contribution to the Canadian economy.

Cultural perceptions and negotiations surrounding sexual and reproductive health among migrant and non-migrant indigenous Mexican women from Yucatán, Mexico

Information regarding sexual and reproductive health of indigenous women from Mexican sending and US receiving communities is limited. This research aims to explore the perceptions of indigenous women from US migrant receiving and Mexican migrant sending communities regarding their sexual health experiences and reproductive health practices. From January to March 2012, two key informant interviews and 31 in-depth, semi-structured interviews were conducted among women ages 18-55 in Tunkás, Yucatán and Anaheim and Inglewood, California. Women reported challenges to obtaining routine reproductive clinical care, including access to care barriers and lack of perceived power over their own sexual health. This was further compounded by migration processes and deficiencies in health care delivery systems. Socio-cultural beliefs and gendered power dynamics influence sexual and reproductive health decisions and behaviors of migrant and non-migrant women. Findings underscore existing gender-based reproductive health norms and serve to inform future transnational research and public health education to improve the health of indigenous migrant and non-migrant women in the US and Mexico.

Transnational ties and past-year major depressive episodes among Latino immigrants

Latino immigrants live in an increasingly global world in which maintaining contact with kin in the home country is easier than ever. We examined (a) the annual distribution of remittances burden (percentage of remittances/household income) and visits to the home country, (b) the association of these transnational ties with a past-year major depressive episode (MDE), and (c) moderation by Latino subethnicity or gender. We conducted weighted logistic regression analyses with the Latino immigrant subsample (N = 1,614) of the National Latino and Asian American Study. Mexican and Other Latino immigrants had greater remittances burden than Puerto Rican migrants. Cuban immigrants made the fewest visits back home. After adjustment for sociodemographics and premigration psychiatric history, remittances burden decreased odds of MDE (odds ratio [OR] = 0.80, 95% confidence interval [CI] [0.67, .0.98]), whereas visits back home increased odds of MDE (OR = 1.04, 95% CI [1.01, 1.06]). Latino subethnicity was not a significant moderator. Visits back home were more strongly linked to depression among women than men. The distribution of transnational ties differs by Latino subgroup, although its association with depression is similar across groups. Monetary giving through remittances might promote a greater sense of self-efficacy, and caregiving for relatives back home that positively affect mental health. Visits back home, especially for women, might signal social stress from strained relationships with kin, spouses, or children left behind, or increased caregiving demands that negatively affect mental health. Clinical practice with immigrants should routinely assess the social resources and strains that fall outside national borders.

The mixed effects of migration: community-level migration and birthweight in Mexico

Research on the relationship between migration and infant health in Mexico finds that migration has mixed impacts on the risk of low birthweight (LBW). Whereas the departure and absence of household and community members are harmful, remittances are beneficial. We extend this work by considering a different measure of infant health in addition to LBW: macrosomia (i.e., heavy birthweight), which is associated with infant, child, and maternal morbidities but has a different social risk profile from LBW. We link the 2008 and 2009 Mexican birth certificates with community data from the 2000 Mexican census to analyze the association between various dimensions of community-level migration (i.e., rates of out-migration, receipt of remittances, and return migration) and the risk of LBW and macrosomia. We examine this association using two sets of models which differ in the extent to which they account for endogeneity. We find that the health impacts of migration differ depending not only on the dimension of migration, but also on the measure of health, and that they are robust to potential sources of endogeneity. Whereas community remittances and return migration are associated with lower risk of LBW, they are associated with increased risk of macrosomia. By contrast, out-migration is associated with increased risk of LBW and lower risk of macrosomia. Our analysis of endogeneity suggests that bias resulting from unmeasured differences between communities with different levels of migration may result in an underestimate of the impacts of community migration on birthweight.

Positive youth development in rural China: the role of parental migration

This study examined how parental rural-to-urban migration may affect left-behind children's development in rural China. We used two-wave data collected on 864 rural youth age 10-17 years in the Guangxi Province, China in 2010. We tested psychometric properties of a positive youth development (PYD) model theorized and corroborated in the US, compared a range of developmental outcomes among rural youth by their parental migration status, and explored the mediating role of family economic and social resources in observed associations between developmental outcomes and parental migration. The results showed the PYD model had some international validity although modifications would be needed to make it more suitable to Chinese settings. Little difference in the PYD outcomes was detected by parental migration status. On other outcomes (i.e., self-rated health, school grades, educational aspirations, problem behavior), positive influences of parental migration were observed. Increased income but not social resources in migrant families helped explain some of these patterns. The take-home message from this study is that parental migration is not necessarily an injurious situation for youth development. To advance our knowledge about the developmental significance of parental migration for rural Chinese youth, we urgently need large-scale representative surveys to collect comprehensive and longitudinal information about rural children's developmental trajectories and their multilevel social contexts to identify key resources of PYD in order to better help migrant and non-migrant families nurture thriving youth in rural China.

The impact of outmigration of men on fertility and marriage in the migrant-sending states of Mexico, 1995-2000

Using the 2000 Mexican Census, we examined whether the level of migration was associated with total fertility and the proportion of women married in 314 municipalities from seven traditional sending states. Across these municipalities, we observe lower fertility in higher-migration areas. Municipalities in the quartile with the highest levels of migration have total fertility more than half a child lower than municipalities in the lowest migration quartile. However, there are no differences in marital fertility by level of migration, indicating that lower proportions of women married account for lower total fertility in high-migration municipalities. In municipal-level regression models, lower sex ratios are associated with a lower proportion of women married, while there is an inverse association between education and marriage. The level of migration also has an independent association with marriage, suggesting that there may be changing ideas surrounding family formation in high-migration areas.

U.S. Migration, Translocality, and the Acceleration of the Nutrition Transition in Mexico

Migrant flows are generally accompanied by extensive social, economic, and cultural links between origins and destinations, transforming the former's community life, livelihoods, and local practices. Previous studies have found a positive association between these translocal ties and better child health and nutrition. We contend that focusing on children only provides a partial view of a larger process affecting community health, accelerating the nutrition transition in particular. We use a Mexican nationally-representative survey with socioeconomic, anthropometric, and biomarker measures, matched to municipal-level migration intensity and marginalization measures from the Mexican 2000 Census to study the association between adult body mass and community migration intensity. Our findings from multi-level models suggest a significant and positive relationship between community-level migration intensity and the individual risk of being overweight and obese, with significant differences by gender and with remittance intensity playing a preponderant role.

Report on Honduras: ripples in the pond--the financial crisis and remittances to chronically ill patients in Honduras

The U.S. financial crisis has affected employment opportunities for Latino immigrants, and this could affect their ability to send financial assistance, or "remittances", to chronically ill family members in their home country. In a cross-sectional survey of 624 chronically ill adults conducted in Honduras between June and August 2009, respondents reported their receipt of remittances, health service use, and cost-related access barriers. Fifty-four percent of respondents reported relatives living outside the country, and of this group, 66 percent (37% of the overall sample) received remittances. Seventy-four percent of respondents receiving remittances reported a decrease over the prior year, mostly due to job losses among their relatives abroad. Respondents reporting reductions in remittances received significantly less per month, on average, than those without a reduction (US $170 vs. $234; p = 0.01). In multivariate models, respondents experiencing a reduction in remittances used fewer health services and medications due to cost concerns. Remittance payments from relatives resident in the United States are a major source of income for chronically ill individuals in Latin America. Most recipients of remittances reported a reduction during the financial downturn that affected their access to care.

Integrating social epidemiology into immigrant health research: a cross-national framework

Scholarship on immigrant health has steadily increased over the past two decades. This line of inquiry is often approached as a "specialty" topic involving a discrete de-contextualized population, rather than a topic that is central for understanding patterns of population health within and between sending and receiving countries. Frequently immigrant health research employs theoretical frameworks (e.g., acculturation) that emphasize cultural explanations, while less commonly utilized is the "social determinants of health" framework, which emphasizes social and structural explanations. Drawing upon literature in the fields of economics, sociology of immigration, and social epidemiology, we present a conceptual framework for understanding immigrant health from a cross-national perspective. We discuss the theoretical foundations of this framework; the methodological challenges for undertaking research on immigration and health using this framework; examples of emerging research in this area; and directions for future research. Progress in immigrant health research and population health improvements can be achieved through an enhanced understanding of population health patterns in sending and receiving societies. Immigrant health research needs to be better integrated into social epidemiology. Concurrently, immigrant health research offers conceptual, empirical, and analytic opportunities to advance social epidemiological research. Together, scholarship in immigrant health and social epidemiology can make significant contributions toward one of their mutual and ultimate goals: to improve knowledge about population health.

Exposure to international migration and its effect on childbearing in Turkey

International migration alters social norms, family structures, and population development in sending regions. Each of these factors affects fertility, making the impact of international migration on childbearing an increasingly important area of study. In many sending regions, the Demographic and Health Surveys (DHS) provide a promising, but underutilized, source of data for understanding the relationship between international migration and childbearing. Using the household and individual questionnaires in the 2003 Turkish DHS, we develop a multi-layered approach for measuring international migration. We then use these measures to examine differences in childbearing among women in migrant and non-migrant households, assessing the effects of migrant selection and migration-related roles and attitudes on the number of children born. After adjusting for selection characteristics, we find return female migrants and migrant wives are not significantly different from women in non-migrant households; role and attitude differences have only modest impacts on the association between women’s exposure to migration and childbearing.

Differentiated childhoods: impacts of rural labor migration on left-behind children in China

This article draws on data from research that includes 400 children who lived separately from their migrant parents in 10 rural communities in China, to explore the deep impacts of rural parents' migration on the care-giving and nurturing of children left behind. It shows that parent migration has brought about multiple impacts, mostly negative, on the lives of children, such as increased workloads, little study tutoring and supervision, and above all the unmet needs of parental affection. Children's basic daily care and personal safety could become problematic since surrogate caregivers, mostly elderly, are usually exhausted with livelihood maintenance. With illumination on the family dysfunction in children's development due to migration-induced family separation, this article highlights the social cost to rural families of parental migration. Urbanization in developing countries is obtained at the expense of rural migrants and their families, especially children left behind. Further attention is required to improve left-behind children's well being within split family structures and interregional migration.

New evidence on the effects of international migration on the risk of low birthweight in Mexico

The purpose of this article is to provide new empirical evidence linking migration of Mexican households to the USA with infant health outcomes. By using new data for Mexico, the Encuesta Nacional de la Dinamica Demografica 2006, this research focuses on the effect of migration on birth weight. Multivariate logistic regression methods are used to model low birth weight (LBW) as a function of a set of proximate, intermediate and socioeconomic determinants. In analyzing the channels through which migration affects birth outcomes, the findings provide no conclusive evidence for remittances as the only mechanism associated with lowering the odds of LBW. Given the limitations of the data, the study results showed new empirical evidence explaining the significance of both financial and social remittances associated with international migration and infant health outcomes in Mexico.

Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities

This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas.

Understanding racial-ethnic disparities in health: sociological contributions

This article provides an overview of the contribution of sociologists to the study of racial and ethnic inequalities in health in the United States. It argues that sociologists have made four principal contributions. First, they have challenged and problematized the biological understanding of race. Second, they have emphasized the primacy of social structure and context as determinants of racial differences in disease. Third, they have contributed to our understanding of the multiple ways in which racism affects health. Finally, sociologists have enhanced our understanding of the ways in which migration history and status can affect health. Sociological insights on racial disparities in health have important implications for the development of effective approaches to improve health and reduce health inequities.

Birth weight among singletons born to foreign-born mothers in Taiwan: a population-based birth register study

BACKGROUND

We compared the birth weight of newborns born to foreign-born mothers (FBMs) and Taiwan-born mothers (TBMs), using data from the 2005-2006 Taiwan Birth Registry of singleton live births.

METHODS

The Wilcox-Russell method, data restriction, and multiple linear regression were used to analyze the data. The rates of low birth weight (<2500 g) with 95% confidence intervals were computed for TBMs, and for each of the nationalities of FBMs.

RESULTS

The mean birth weight of newborns of FBMs was 3157 g, which was higher than that of newborns of TBMs (3109 g). On analysis using the Wilcox-Russell method, both the rate and residual proportion of low-birth-weight (LBW) births were lower among newborns of FBMs (4.1% and 1.1%, respectively) than among newborns of TBMs (5.9% and 1.7%, respectively). After adjusting for sex, mode of delivery, maternal age, smoking status, predisposing maternal risk factors, and condition during pregnancy, the newborns of FBMs weighed 72.9 g (95% CI, 68.8 g to 77.0 g) more than the newborns of TBMs. When data were restricted to mothers without any adverse conditions and adjusted for maternal age, the differences in birth weight between the 2 groups remained unchanged. The rates of LBW deliveries among FBMs in Taiwan were significantly lower than those in their respective countries of origin.

CONCLUSIONS

In Taiwan, newborns of FBMs had a higher birth weight than those of TBMs, even after accounting for potential confounding factors, and had lower rates of LBW deliveries than did mothers in their respective countries of origin.

Testing the "epidemiologic paradox" of birth outcomes among Asian immigrant women in Hsin-Chu County, Taiwan

BACKGROUND/PURPOSE

Taiwan saw an increase in immigration during the last decade. This retrospective study investigated whether immigrant status confers a protective effect on birth outcomes and whether this effect varies across racial/ethnic subgroups in Hsin-Chu County, Taiwan.

METHODS

A total of 30,770 singleton birth certificates from January 1, 2002 to July 31, 2007 were analyzed using ANOVA and logistic regression. Outcomes included low birth weight (LBW, < 2500 g), high birth weight (HBW, > 4000 g), preterm birth (< 37 weeks) and stillbirth. Covariates included maternal age, year of delivery, mode of delivery, medical care institution, infant sex and congenital birth defects. Five models were designed for various analyses. The reference categories included non-immigrant, non-aboriginal Taiwanese and non-Chinese-speaking immigrants.

RESULTS

Preterm rate ranged from 6.3% among mainland Chinese to 13.5% among aboriginal Taiwanese. LBW rate ranged from 4.3% among mainland Chinese to 17.3% among aboriginal Taiwanese. HBW rate ranged from 1.2% among aboriginal Taiwanese to 3.4% among mainland Chinese. Stillbirth rate ranged from 0.2% among Indonesians to 0.7% among aboriginal Taiwanese. Adjusted odds ratio (OR) was lower among mainland Chinese (preterm OR, 0.77; LBW OR, 0.62) but higher among aboriginal Taiwanese (preterm OR, 1.79; LBW OR, 2.68; stillbirth OR, 2.92). HBW rate was significantly higher (OR, 1.84) among mainland Chinese. Chinese-speaking immigrants showed significant differences in LBW (OR, 0.57) and HBW (OR, 1.62) compared with non-Chinese-speaking immigrants.

CONCLUSION

An epidemiologic paradox and heterogeneity of birth outcomes were observed among immigrants in this study. However, aboriginal Taiwanese constituted the subgroup with the highest risk. Further research is needed to identify the determinants of birth outcomes.

Individual, Household, and Community U.S. Migration Experience and Infant Mortality in Rural and Urban Mexico

This study explores rural and urban differences in the relationship between U.S. migration experience measured at the individual, household, and community levels and individual-level infant mortality outcomes in a national sample of recent births in Mexico. Using 2000 Mexican Census data and multi-level regression models, we find that women's own U.S. migration experience is associated with lower odds of infant mortality in both rural and urban Mexico, possibly reflecting a process of healthy migrant selectivity. Household migration has mixed blessings for infant health in rural places: remittances are beneficial for infant survival, but recent out-migration is disruptive. Recent community-level migration experience is not significantly associated with infant mortality overall, although in rural places, there is some evidence that higher levels of community migration are associated with lower infant mortality. Household- and community-level migration have no relationship with infant mortality in urban places. Thus, international migration is associated with infant outcomes in Mexico in fairly complex ways, and the relationships are expressed most profoundly in rural areas of Mexico.

Tapping healthcare resource by older Mexicans with diabetes: how migration to the United States facilitates access

This study employs semi-structured interviews conducted in two small migrant towns in Michoacán, Mexico to determine how older Mexicans with diabetes access healthcare and treatment. Barriers in access to healthcare services are identified as well as how family members and migration are utilized to offset these limitations. Results indicate that former migrants who were economically successful in the USA have greater options in the type of services they are able to use. In addition, residents with diabetes who have family members living in the USA receive remittances in the form of money and medical supplies that aid in the treatment of their illness. Implications for policy are discussed.

The other side of the healthy immigrant paradox: Chinese sojourners in Ireland and Britain who return to China due to personal and familial health crises

Based on participant observation and interviews conducted between 2003 and 2006, this paper examines the experiences of three young adult Chinese sojourners in Ireland and the United Kingdom who return to the People's Republic of China for permanent residence because of personal or familial health crises. Their experiences illustrate the plight of failed sojourners who are part of the little-studied other side of the "healthy immigrant paradox." The experiences of the sojourners in this case study illustrate factors that tend to prevent less healthy or resourceful sojourner families from even entering the immigrant category, which has been shown to be paradoxically healthier than nonimmigrant native categories in epidemiological studies. This paper's approach demonstrates how ethnography can contribute to the study of public health by shedding light on the experiences of marginal individuals who fall between the cracks of epidemiological studies.

Contextualizing immigrant access to health resources

A vast majority of our understanding of immigrant health centers around traits of individuals and groups. While useful, current approaches to research on immigrant health decontextualize the experience of immigrants in the United States. This paper uses a historical case study of the Chinese community in San Francisco to develop a contextual framework to understand the levels of influence that impact the availability of health resources in immigrant communities. International, transnational, transcommunity, and enclave contexts have shaped health care access for Chinese immigrants in San Francisco. The conceptual framework provides a basis for future research, programmatic, and policy work that integrates individual and contextual factors in assessing and improving immigrant access to health resources.

Lower early neonatal mortality among singletons in transnational marriage families: Taiwan Birth Registry

The nativity composition of the Taiwan population has changed substantially since 1980, which resulted in one in six children being born to foreign-born mothers in 2004. The purpose of this study was to compare the early neonatal mortality rates among babies of foreign-born and Taiwan-born mothers. Data was obtained from the Taiwan Birth Registry Database in 2004 by the Bureau of Health Promotion, Department of Health, Taiwan. Multivariate analysis was used to examine the influence of the different maternal nationalities on early neonatal mortality after adjusting for important maternal and infant variables. Infants born to foreign-born mothers had a lower early neonatal mortality rate (5.6 per thousand) compared to those born to Taiwan-born mothers (9.4 per thousand). Even after adjusting for important maternal and infant variables, newborns of foreign-born mothers still had a lower risk of early neonatal death compared to newborns of Taiwan-born mothers (odds ratio = 0.68, 95% CI = 0.57-0.80). Foreign-born status may serve as an important index of differentiation in early neonatal mortality among the current Taiwan population. Selection, economic and non-economic aspects may explain the paradox of favorable early neonatal mortality outcomes.

The differential effect of foreign-born status on preterm birth: a Taiwan population-based birth registry study

Whether foreign-born status confers a protective effect on preterm birth in Taiwan was investigated using singleton live birth data from the 2004 Taiwan Birth Registry (n = 211,946). Newborns of foreign-born mothers (FBMs) comprised 13.7% of the population. The preterm birth rate of newborns of FBMs (5.9%) was significantly lower than that of newborns of Taiwan-born mothers (TBMs) (8.0%) (P < 0.0001). After having adjusted for predisposing maternal factors or adverse pregnancy conditions, newborns of FBMs still had a lower risk in preterm birth than that of TBMs, with an odds ratio of 0.74 and 95% confidence interval between 0.71 and 0.79. Selection was hypothesised to explain the low preterm birth rate in FBMs.