Does Selective Migration Explain the Hispanic Paradox? A Comparative Analysis of Mexicans in the U.S. and Mexico

Latino immigrants, particularly Mexican, have some health advantages over U.S.-born Mexicans and Whites. Because of their lower socioeconomic status, this phenomenon has been called the epidemiologic “Hispanic Paradox.” While cultural theories have dominated explanations for the Paradox, the role of selective migration has been inadequately addressed. This study is among the few to combine Mexican and U.S. data to examine health selectivity in activity limitation, self-rated health, and chronic conditions among Mexican immigrants, ages 18 and over. Drawing on theories of selective migration, this study tested the “healthy migrant” and “salmon-bias” hypotheses by comparing the health of Mexican immigrants in the U.S. to non-migrants in Mexico, and to return migrants in Mexico. Results suggest that there are both healthy migrant and salmon-bias effects in activity limitation, but not other health aspects. In fact, consistent with prior research, immigrants are negatively selected on self-rated health. Future research should consider the complexities of migrants’ health profiles and examine selection mechanisms alongside other factors such as acculturation.     

A Transnational Approach to Understanding Indicators of Mental Health,Alcohol Use and Reproductive Health Among Indigenous Mexican Migrants

The three studies presented in this Special Topics in Immigrant Health report findings from a novel transnational, mixed-methods study with indigenous Mayans in Yucatán, Mexico, and their satellite communities in Southern California. Indigenous migrants comprise the largest proportion of recent, first-time migrants from Mexico to the United States and are among the migrant populations most vulnerable to discrimination (e.g. work place) and health disparities. The studies presented focus on three topics: perceived discrimination and mental health among indigenous migrants and non-migrants, risky alcohol use behaviors associated with migration to the U.S. and within Mexico, and gendered power dynamics related to sexual health care access and utilization. This transnational research sheds new light on health issues and gender differences affecting indigenous Mexican migrant men, women and their families. Findings can serve to inform intervention research to improve migrant health in the U.S. and Mexico as well as transnational collaboration between countries.     

Healthier before they migrate,less healthy when they return? The health of returned migrants in Mexico

Over the course of the 20th century, Mexico-U.S. migration has emerged as an important facet of both countries, with far reaching economic and social impacts. The health of Mexican immigrants in the U.S. has been well studied, but relatively less is known about the health of returned migrants to Mexico. The objectives of this paper are twofold. Relying on health data pertaining to two stages of the life course, early life health (pre-migration) and adult health (post-migration) from the Mexican Migration Project gathered between 2007 and 2009, we aim to assess disparities in adult health status between male returned migrants and male non-migrants in Mexico, accounting for their potentially different early life health profiles. While we find evidence that returned migrants had more favorable early life health, the results for adult health are more complex. Returned migrants have a higher prevalence of heart disease, emotional/psychiatric disorders, obesity, and smoking than non-migrants but no differences are found in self-rated health, diabetes, or hypertension.     

Health selection among migrants from Mexico to the U.S.: childhood predictors of adult physical and mental health

Objectives

We tested whether positive selection on childhood predictors of adult mental and physical health contributed to health advantages of Mexican-born immigrants to the United States relative to U.S.-born Mexican Americans.

Methods

We combined data from surveys conducted during 2000–2003 in Mexico and the U.S. with the same structured interview. We examined retrospective reports of childhood (i.e., <16 years of age) predictors of adult health—education, height, childhood physical illness, childhood mental health, early substance use, and childhood adversities—as predictors of migration from Mexico to the U.S. at ≥16 years of age. We estimated overall selection by comparing migrants to all non-migrants. We also examined selection at the family (members of families of migrants vs. members of families without a migrant) and individual (migrants vs. non-migrants within families of migrants) levels.

Results

Distinguishing between family and individual selection revealed evidence of positive health selection that is obscured in the overall selection model. In particular, respondents in families with migrants were more likely to have ≥12 years of education (odds ratio [OR] = 1.60) and be in the tallest height quartile (OR=1.72) than respondents in families without migrants. At both the family and individual levels, migrants are disadvantaged on mental health profiles, including a higher prevalence of conduct problems, phobic fears, and early substance use.

Conclusions

Positive health selection may contribute to physical health advantages among Mexican immigrants in the U.S. relative to their U.S.-born descendants. Mental health advantages likely reflect a lower prevalence of psychiatric disorders in Mexico, rather than protective factors that distinguish migrants.Mexican-born immigrants in the United States are in better health than U.S.-born Mexican Americans with respect to a broad range of physical and mental health conditions, including overweight and obesity,¹ asthma,² cardiovascular risk factor profiles,^3,4 substance use,⁵ and psychiatric disorders.^6,7 One proposed explanation for these findings is positive health selection⁸ (i.e., that compared with the non-migrating population of Mexico, migrants are predisposed pre-migration to better health), an advantage that is lost due to environmental influences on the second generation. Understanding the contribution of pre-migration factors to intergenerational differences in health in the Mexican-origin population in the U.S. is limited by the lack of information on pre-migration health of migrants, relative to the non-migrant population of Mexico.Ecological comparisons based on population averages estimated separately in the U.S. and Mexico provide indirect evidence of better health among migrants with respect to life expectancy,⁹ height,¹⁰ and educational attainment.¹¹ However, because many migrants arrive in the U.S. as children, ecological comparisons reflect differences that might have risen after arrival in the U.S. Rubalcava et al.,¹² in the only prospective study of migrant health selection, followed a nationally representative sample of the Mexican population assessed in 2001 and identified individuals who migrated to the U.S. during the following three years. Baseline assessments included height, body mass index (BMI), blood pressure, hemoglobin, and self-rated health. In that study, migrants had been in slightly better-than-average health prior to migration with respect to some indicators of physical health (e.g., blood pressure and height).Two recent studies have examined selection on mental health by combining data from surveys in Mexico and the U.S. collected retrospectively with the same structured interview. Both studies used information on age at migration to identify mental health problems that began prior to migration. Breslau et al.¹³ found that anxiety disorders were associated with a higher likelihood of subsequent migration, suggesting negative selection (i.e., worse mental health among migrants prior to migration than non-migrants). However, the migrant sample in that study was small (n=75) and limited to proficient English speakers. Borges et al.,¹⁴ using a larger sample of migrants interviewed in both English and Spanish, found no association between suicidality and subsequent likelihood to migrate to the U.S.This study used a large epidemiologic dataset from surveys in Mexico and the U.S. to examine whether childhood predictors of adult health prior to age 16 were associated with migration to the U.S. at ≥16 years of age. We examined a broader range of mental health conditions than previous studies have done and covered, for the first time, early substance use and childhood family adversities, both of which are predictive of poor physical and mental health in adulthood.^15–17 In addition, data from the Mexican survey identify those respondents who had previously been to the U.S. as labor migrants and those with an immediate family member living in the U.S. These data allowed for two additional methodological innovations.First, we identified and grouped return migrants (i.e., people living in Mexico who have previously lived in the U.S.) with other migrants. Previous studies have misclassified return migrants as non-migrants. Second, in addition to estimating overall selection (i.e., differences between all migrants and all non-migrants), we also distinguished between selection at the family level (i.e., differences between families with and without migrants) and selection at the individual level (i.e., differences within families of migrants between those who migrate and those who remain in Mexico). Previous studies have not distinguished these two levels at which selection might occur, despite sociological evidence suggesting that migration is influenced by familial as well as individual factors.¹⁸ Health selection might occur at the family level because migrants tend to come from families with sufficient material and social resources to facilitate migration,¹⁸ including ties to cross-national migrant networks.^19,20 Families with more resources are also likely to enjoy better health. Selection at the individual level would occur if decisions about migration take into account individual characteristics related to health. For instance, among family members, those less likely to succeed in the local vs. U.S. labor market due to lower educational attainment²¹ may be more likely to migrate.Estimation of each of these two levels of selection was possible in this study because the sampling design in the U.S. and the Mexico surveys involved random selection of households and random selection of one respondent within each household. Because of this design, the sample included subsamples of respondents who were representative of the relevant comparison groups. We estimated family-level selection by comparing respondents from families without a migrant with respondents from families with a migrant (migrants in the U.S., return migrants in Mexico, and non-migrants in Mexico with a family member in the U.S.). We estimated individual-level selection within the subsample of respondents from families of migrants by comparing respondents who were themselves migrants (migrants in the U.S. and return migrants in Mexico) with respondents from families of migrants who were not migrants (non-migrants in Mexico with a family member in the U.S.). Countervailing migrant selection processes at the family and individual levels may be obscured when only overall selection is examined.     

"Hospital utilization by Mexican migrants returning to Mexico due to health needs"

Background  

A total of 12.7 million Mexicans reside as migrants in the United States, of whom only 45% have health insurance in this country while access to health insurance by migrants in Mexico is fraught with difficulties. Health insurance has been shown to impact the use of health care in both countries. This paper quantifies hospitalizations by migrants who return from the US seeking medical care in public and private hospitals in the US-Mexico border area and in communities of origin. The proportion of bed utilization and the proportion of hospitalizations in Mexico out of the total expected by migrants in the US were estimated.     

Redressing the Limitations of the Affordable Care Act for Mexican Immigrants Through Bi-National Health Insurance: A Willingness to Pay Study in Los Angeles

The 12.4 million Mexican migrants in the United States (US) face considerable barriers to access health care, with 45 % of them being uninsured. The Affordable Care Act (ACA) does not address lack of insurance for some immigrants, and the excluded groups are a large proportion of the Mexican–American community. To redress this, innovative forms of health insurance coverage have to be explored. This study analyses factors associated with willingness to pay for cross-border, bi-national health insurance (BHI) among Mexican immigrants in the US. Surveys were administered to 1,335 Mexican migrants in the Mexican Consulate of Los Angeles to assess their health status, healthcare utilization, and willingness to purchase BHI. Logistic regression was used to identify predictors of willingness to pay for BHI. Having a job, not having health insurance in the US, and relatives in Mexico attending public health services were significant predictors of willingness to pay for BHI. In addition, individuals identified quality as the most important factor when considering BHI. In spite of the interest for BHI among 54 % of the sampled population, our study concludes that this type of coverage is unlikely to solve access to care challenges due to ACA eligibility among different Mexican immigrant populations.     

The Rural–Urban Divide: Health Services Utilization Among Older Mexicans in Mexico

Context: Mexico. Purpose: Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods: The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's “model of health services” of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Findings: Results showed that older Mexicans living in the most rural areas (populations of 2,500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Conclusions: Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health.     

Revisiting the Hispanic mortality advantage in the United States: The role of smoking

More than three decades of health disparities research in the United States has consistently found lower adult mortality risks among Hispanics than their non-Hispanic white counterparts, despite lower socioeconomic status among Hispanics. Explanations for the “Hispanic Paradox” include selective migration and cultural factors, though neither has received convincing support. This paper uses a large nationally representative survey of health and smoking behavior to examine whether smoking can explain life expectancy advantage of Hispanics over US-born non-Hispanics whites, with special attention to individuals of Mexican origin. It tests the selective migration hypothesis using data on smoking among Mexico-to-US migrants in Mexico and the United States. Both US-born and foreign-born Mexican-Americans exhibit a life expectancy advantage vis-à-vis whites. All other Hispanics only show a longevity advantage among the foreign-born, while those born in the United States are disadvantaged relative to whites. Smoking-attributable mortality explains the majority of the advantage for Mexican-Americans, with more than 60% of the gap deriving from lower rates of smoking among Mexican-Americans. There is no evidence of selective migration with respect to smoking; Mexicans who migrate to the US smoke at similar rates to Mexicans who remain in Mexico, with both groups smoking substantially less than non-Hispanic whites in the US. The results suggest that more research is needed to effectively explain the low burden of smoking among Mexican-Americans in the United States.     

Migrants in Transit: The Importance of Monitoring HIV Risk Among Migrant Flows at the Mexico–US Border

We conducted a probability-based survey of migrant flows traveling across the Mexico–US border, and we estimated HIV infection rates, risk behaviors, and contextual factors for migrants representing 5 distinct migration phases. Our results suggest that the influence of migration is not uniform across genders or risk factors. By considering the predeparture, transit, and interception phases of the migration process, our findings complement previous studies on HIV among Mexican migrants conducted at the destination and return phases. Monitoring HIV risk among this vulnerable transnational population is critical for better understanding patterns of risk at different points of the migration process and for informing the development of protection policies and programs.Previous research indicates that Mexican labor migrants in the United States are at increased risk for HIV infection1–3 and may be a bridge population for increasing rates of HIV/AIDS in rural Mexico.4–6 The behavioral ecological model posits that health behaviors are influenced by a hierarchy of factors, including individual characteristics, features of the proximal context, and broader structural factors.7 The proximal context involves the physical and social conditions in which individuals live, work, learn, and play. The broader environment comprises political, social, and economic structures and cultural factors. Bidirectional influences exist across factors at the individual, contextual, and structural level, with interventions at the structural level having the most far-reaching public health impact.7 Mexican migrants tend to be male and young, have low levels of educational attainment, and report limited HIV prevention knowledge and condom use.8,9 Increased risk for HIV in migrants may result from the interplay between these individual characteristics and the broader contextual and structural factors in migration between Mexico and the United States.10Migration is a complex and multistage process involving 5 phases: predeparture, transit, destination, interception, and return.11 Different constellations of contextual and structural factors may influence risk behaviors for HIV infection among migrants at each of these stages. Research on HIV risk among migrants must cover the different phases involved in the migration process and identify risks as well as prevention and treatment opportunities associated with each of them.12 Much of our knowledge regarding HIV prevalence and behavioral risk factors among Mexican migrants has emanated from surveys conducted among receiving communities in the United States 1^,2^,13–15 and sending communities in Mexico.16^,17 These studies have covered the destination and return phases of migration.Mexican migrants in the United States (i.e., the destination) are exposed to contexts that may heighten their HIV risk. HIV prevalence rates are higher in the United States than in Mexico,18 increasing the probability of coming into contact with the virus. Furthermore, many migrants live in environments characterized by unbalanced gender composition (i.e., male overrepresentation) and limited family- and community-based social behavioral controls.19 They experience loneliness, geographic isolation, social exclusion,20 fear,21 poor living and working conditions, and limited access to health care, including access to HIV testing and other prevention services.2^,16^,19^,21–24 All these factors coalesce to increase the probability of risk behaviors for HIV, such as alcohol and drug use, sex with sex workers, and unprotected sex practices.9,10 Surveys in Mexican sending communities have documented higher rates of behavioral risk factors, such as a higher number of sexual partners and illicit drug use, but also increased rates of condom use, knowledge of HIV transmission, and HIV testing among return migrants, compared to nonmigrants in the same communities.16,25Little research has examined HIV risk among Mexican migrants during the predeparture, transit, and interception phases of the migration process. The same factors that may push migrants away from their sending communities, such as poverty,26 violence,27 and gender power unbalances,28,29 are also structural factors that may increase their HIV risk even before they leave these communities.30 The transit phase is defined as the period when migrants are between their place of origin and their destination.11 For most Mexican migrants, the northern border of Mexico is an intermediate point in their trajectory between the 2 countries. Northbound unauthorized and deported migrants may spend time in this transit location making arrangements to enter or reenter the United States. This region has been described as at heightened risk for infectious diseases such as HIV to occur and is characterized by “an economically disadvantaged population” and “a nexus for drug use, prostitution, and mobility.”^31(p428)Research with injecting drug users and sex workers in Mexican border cities has provided critical evidence of migration as a structural risk factor for HIV infection and substance use as well as the prevention needs of these high-risk groups.14,32 These studies have offered some insights into the potential risks among migrants in this intermediate migration context. Finally, migrants apprehended while trying to enter or after reaching the destination communities (i.e., interception phase) are at a particularly critical stage. Detention in immigration centers or prisons can have detrimental effects on migrants’ health.11 Interception may also be a marker of higher social vulnerability, as migrants who have less economic and social resources are more likely to experience this migration phase. A recent survey found higher rates of HIV infection and behavioral risk factors among deported Mexican migrants in Tijuana, Mexico, than among the US and Mexico populations.33 In general, knowledge concerning HIV risk among migrants at the 5 migration phases is fragmented, and the heterogeneity of sampling and data collection methodologies that previous studies have used creates challenges for comparing data on the different phases.There are an estimated 12 million Mexican migrants in the United States.34 Although not all migrants go through all 5 migration phases (some may never be intercepted, some may settle permanently in the region of destination and never return), many Mexican migrants go through 2 or more of these phases in their lifetime. Data on Mexican migration patterns indicate that circular migration (i.e., traveling back and forth between Mexico and the United States) is relatively common among Mexican migrants.34,35 About 29% of Mexican migrants are estimated to engage in circular migration,36 and 50% of undocumented migrants leave the United States within the first year of immigration.37 Proximity, social and political conditions, transportation costs, and cultural identity make Mexicans more likely to return to their home country than are migrants from other countries. Although the strengthening and stricter enforcement of border policies has lowered this trend in recent years, the incentives to emigrate out of Mexico have also increased.38 These circular migration patterns between Mexico and the United States result in sizable migrant flows traveling across the Mexican border.It is estimated that each year more than 600 000 Mexican migrants arrive in the United States, approximately 400 000 Mexican migrants return from the United States, and approximately 400 000 Mexican migrants are deported to Mexico.39,40 The same individual may arrive, return, or be deported more than once. In 2012, the net rate of Mexicans departing Mexico (mostly to the United States) and entering Mexico (most of whom are return migrants) was 41.9 and 14.3 per 1000, respectively.41 An estimated 300 000 Mexican migrants were admitted to a detention facility and repatriated by US immigration authorities,42 and an additional 266 000 unauthorized Mexican migrants were apprehended at the Mexican border.40 The volume and mix of migrants traveling across the Mexico–US border makes this region an important setting for binational monitoring of the mobile populations’ health. Such monitoring can further our understanding of HIV infection levels and of behavioral and environmental factors that contribute to HIV infection among Mexican migrants representing different phases and contexts of the migration process. Ongoing surveillance of this region can also reveal changes in HIV infection and behavioral risk factors among migrants on the move and inform the need for interventions to reduce HIV risk among Mexican migrants in sending, receiving, and intermediate communities.We estimated and compared the levels of HIV infection, risk behaviors, and contextual factors associated with different migration phases, using data from a survey of migrant flows who traveled across the Mexico–US border region and represented the different phases and geographic contexts of migration between Mexico and the United States.     

Deported Mexican migrants: health status and access to care

OBJECTIVE

To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants.

METHODS

Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups.

RESULTS

As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95).

CONCLUSIONS

According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required.     

Acculturation and Cross-Border Utilization of Health Services

Health services from Mexico constitute an important source of care for U.S. residents living along the U.S.-Mexico border. Data from The Cross-Border Utilization of Health Care Survey (n = 966) were used to estimate logit models that related acculturation, as measured by generational status, to the use of medication, physician, dental, and inpatient services from Mexico by U.S. residents in the Texas border region. Relative to first-generation Mexican immigrants, later-generation Mexican-Americans were progressively less likely to go to Mexico for health services. This finding holds with or without adjusting for the effects of selected demographic and socioeconomic variables. Addressing unmet needs in medical care in the southwestern U.S. border area should go beyond a simple expansion of health insurance coverage--it is also important to deliver health services that are sensitive to generational differences within the population in terms of linguistic and cultural barriers to health care access.     

Utilization and purchase of medical care services in Mexico by residents in the United States of America, 1998-1999.

OBJECTIVES: We assessed self-reported frequency of purchase of medications and medical care services in Mexico by southern New Mexico (United States, [U.S.]) residents in relation to their medical insurance coverage. METHODS: We analyzed data obtained in 1998 and 1999 from a health interview survey of residents in a six-county region of southern New Mexico, using prevalence and logistic regression methods for complex survey data. RESULTS: About 22% of southern New Mexico residents had purchased medications and 11% had sought medical care in Mexico at least once during the year preceding the survey. When we adjusted for the effects of other variables, persons able to pay for services out of pocket and those who were uninsured were more likely than persons who were fully covered to purchase medications or medical care in Mexico. CONCLUSIONS: Large numbers of people residing near the border in New Mexico traveled south to Mexico to purchase medications and medical care. Lack of medical insurance was associated with higher frequencies of these purchases. There seems to be a need to establish relationships between U.S. private and public care plans and Mexican medical care providers to identify appropriate mechanisms for U.S. residents to purchase medical care in Mexico.     

Risk behaviours for HIV infection among travelling Mexican migrants: The Mexico–US border as a contextual risk factor

The Mexico–US border region is a transit point in the trajectory of Mexican migrants travelling to and from the USA and a final destination for domestic migrants from other regions in Mexico. This region also represents a high-risk environment that may increase risk for HIV among migrants and the communities they connect. We conducted a cross-sectional, population-based survey, in Tijuana, Mexico, and compared Mexican migrants with a recent stay on the Mexico–US border region (Border, n?=?553) with migrants arriving at the border from Mexican sending communities (Northbound, n?=?1077). After controlling for demographics and migration history, border migrants were more likely to perceive their risk for HIV infection as high in this region and regard this area as a liberal place for sexual behaviours compared to Northbound migrants reporting on their perceptions of the sending communities (p?p?相似文献   

Diabetes in Mexico--a serious and growing problem.

According to a recent national health survey, the prevalence of self-reported diabetes in Mexico is 1.2%, but this figure reflects the relative youth of the Mexican population. Age-specific estimates are similar to those for the United States of America, where crude prevalence is higher. Given that self-reporting usually underestimates prevalence by at least 50%, there may be as many as 1.7 million persons with diabetes in Mexico, with a prevalence of approximately 6% in the age range 30-64 years. The average age at death for Mexicans with diabetes is 57 years, compared to 69 years for the population as a whole. Diabetes is the fifth most important cause of death in the Mexican population, and the third cause in people over 45 years of age, in whom it accounts for 10% of all deaths. There is evidence for important increases in diabetes-related mortality over time. Most studies indicate high rates of complications in Mexicans with diabetes and data show that their average length of hospital stay is almost twice as long as for non-diabetic patients. The annual cost of diabetes to Mexican society may be estimated at US$ 15 million for metabolic control, US$ 85 million for additional health services and US$ 330 million for indirect costs--in total, approximately three-quarters of all government spending on health care, or approximately US$ 450 per known diabetic person per year.     

HIV infection in mobile populations: the case of Mexican migrants to the United States.

OBJECTIVE: Previous studies have indicated varying rates of HIV infection among labor migrants to the United States of America. Most of these studies have been conducted with convenience samples of farmworkers, thus presenting limited external validity. This study sought to estimate the prevalence of HIV infection and risk factors among Mexican migrants traveling through the border region of Tijuana, Baja California, Mexico, and San Diego, California, United States. This region handles 37% of the migrant flow between Mexico and the United States and represents the natural port of entry for Mexican migrants to California. METHODS: From April to December 2002 a probability survey was conducted at key migrant crossing points in Tijuana. Mexican migrants, including ones with a history of illegal migration to the United States, completed an interview on HIV risk factors (n = 1 429) and an oral HIV antibody test (n = 1,041). RESULTS: Despite reporting risk factors for HIV infection, none of the migrants tested positive for HIV. CONCLUSIONS: Our findings contrast with previous estimates of HIV among labor migrants in the United States that were based on nonprobability samples. Our findings also underline the need for early HIV prevention interventions targeting this population of Mexican migrants.     

Measuring Tijuana residents' choice of Mexican or U.S. health care services

There is growing concern that the indigent health care burden in the southwestern United States may be caused partly by Mexican residents who cross the border to use U.S. health services. This article describes the first attempt to measure the extent of this use by border residents. It also compares factors associated with their use of health care services in both the United States and Mexico. Data were obtained from a household survey conducted in Tijuana, Mexico, near the California border, using a random, stratified analytic sample of 660 households that included a total of 2,954 persons. The dependent variables--extent and volume of contacts with health professionals--were examined according to sociodemographic characteristics, insurance coverage, payment modality, type of visit, and health care setting. The results indicate that 40.3 percent of the Tijuana population used health services exclusively in Mexico during a 6-month period, compared with only 2.5 percent who used services in the United States. Of the Mexican users of U.S. services, the largest proportion appeared to be older people, lawful permanent residents or citizens of the United States who are living in Mexico, and persons from high- or middle-income sectors. In addition to the low level of use of U.S. health services, the findings show that more than 84 percent of the visits were to providers in the private sector and, for 59 percent of the visits, a fee for services was implied. Overall, this border population does not seem to be a drain on the U.S. public health system.(ABSTRACT TRUNCATED AT 250 WORDS)     

Giving birth across the border: the San Diego-Tijuana connection.

Large immigration flows of young Mexican women to the U.S.-Mexico border are increasing the demand for maternity services in the Southwest. To date no attempt has been made to determine how U.S. births are distributed among stable, permanent residents and transient migrants, such as border residents of Mexico who enter the U.S. temporarily, yet long enough to use health services. This exploratory study examines factors associated with childbirth in California by border residents of Tijuana, Mexico. Data on 184 women, 15-44 years old, who gave birth between 1982-87, were examined using a household survey and focus group discussions. The findings indicate that 10.4% of the sample crossed the border to give birth in the United States. Socio-economic and legal status, spoken English proficiency, history of U.S. residency, annual visits across the border, single parenthood and primiparity were factors significantly associated with childbirth in the United States. These factors, in addition to social class differentials in attitudes towards U.S. obstetrical care and citizenship-by-birth need to be examined in future studies of cross-border utilization of services. The findings also demonstrate that most U.S. deliveries were in the private sector and paid for out of pocket, representing a very low public health burden. Changes in Medicaid legislation, which have extended maternity care coverage to the undocumented, may encourage deliveries in the public sector. These effects, coupled with the bridging effects that newly legalized immigrant networks exert on friends and relatives, familiarizing them with U.S. health care resources, will require monitoring to determine changes in demand for U.S. maternity care by this population.     

Substance Use and Cumulative Exposure to American Society: Findings From Both Sides of the US–Mexico Border Region

Objectives. We investigated whether Mexican immigration to the United States exerts transnational effects on substance use in Mexico and the United States.Methods. We performed a cross-sectional survey of 2336 Mexican Americans and 2460 Mexicans in 3 Texas border metropolitan areas and their sister cities in Mexico (the US–Mexico Study on Alcohol and Related Conditions, 2011–2013). We collected prevalence and risk factors for alcohol and drug use; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol-use disorders; and 2 symptoms (hazardous use and quit or control) of drug use disorder across a continuum of migration experiences in the Mexican and Mexican American populations.Results. Compared with Mexicans with no migrant experience, the adjusted odds ratios for this continuum of migration experiences ranged from 1.10 to 8.85 for 12-month drug use, 1.09 to 5.07 for 12-month alcohol use disorder, and 1.13 to 9.95 for 12-month drug-use disorder. Odds ratios increased with longer exposure to US society. These findings are consistent with those of 3 previous studies.Conclusions. People of Mexican origin have increased prevalence of substance use and disorders with cumulative exposure to US society.During the past 25 years, epidemiological research in the United States has consistently found that alcohol and drug use and disorders of use among Mexican immigrants and Mexican Americans tend to be associated with increasing immersion into US society.1–8 More recently, transnational effects of migration on substance use in both the United States and Mexico have become apparent. First, in a comparable Mexican population without any migration experience as a reference group, it was found that Mexican immigrants in the United States and US-born persons of Mexican origin exhibited increased risk of alcohol and drug use.9,10 Second, it was also shown that, in Mexico, substance use of return migrants and families of migrants was also affected by this immigration flow.11,12 These findings suggest a transnational pattern whereby Mexican immigrants increase their use of substances while in the United States by means of early age at immigration and years living in the United States,13–15 and transmit, directly and indirectly, substance use behaviors back into Mexico. This conceptualization is intriguing, but the data provided so far are limited to studies either in the United States or in Mexico. The only previous binational study9 collected data from a wide range of communities in Mexico and the United States and evidence with greater geographic detail is needed to corroborate and extend our understanding.The border regions of Mexico and the United States are particularly important as settings in which the cultures of the 2 countries come into contact and as transit points for migrants moving in both directions. The border region is also filled with contrasts. The US counties are much richer than the Mexican municipalities, but some of the US counties in the border area are among the poorest in the United States. At the same time, some of the Mexican border municipalities are among the richest when compared with national Mexican averages. Research in this region has documented the impact that US nativity, age at immigration, and years living in the United States have in increasing alcohol and drug use and disorders among those of Mexican ancestry living in the US borderland.8,16–18 On the Mexican side of the border, research generally documented higher prevalence rates for substance use and disorders of use when compared with cities off the border or against national averages.19Previous research nevertheless lacks a binational approach—with a common framework and risk factors. Our project, the first simultaneous study that includes the dynamic experiences of contemporary Mexican immigration on both sides of the border, has started to shed new insights on the alleged differences of alcohol and drug use and disorders of use in the US–Mexico border area.20,21 Our main hypothesis is that with early age of immigration, and increasing time and contact with the US culture, alcohol use, drug use, alcohol use disorders (AUDs) and symptoms of drug use disorder (DUD) will increase along a continuum of immigration experiences in this transnational population. Our main goal is to report the prevalence of, and risk factors for, the occurrence of alcohol use, drug use, AUD, and symptoms of DUD for this population of Mexican ancestry. A second goal is to put these new results in the context of previous findings and to examine the consistency of risk estimates for substance use across the full spectrum of the Mexican immigrant groups.     

A Transnational Study of Migration and Smoking Behavior in the Mexican-Origin Population

Objectives. We examined migration-related changes in smoking behavior in the transnational Mexican-origin population.Methods. We combined epidemiological surveys from Mexico (Mexican National Comorbidity Survey) and the United States (Collaborative Psychiatric Epidemiology Surveys). We compared 4 groups with increasing US contact with respect to smoking initiation, persistence, and daily cigarette consumption: Mexicans with no migrant in their family, Mexicans with a migrant in their family or previous migration experience, migrants, and US-born Mexican Americans.Results. Compared with Mexicans with a migrant in their family or previous migration experience, migrants were less likely to initiate smoking (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.38, 0.83) and less likely to be persistent smokers (OR = 0.41; 95% CI = 0.26, 0.63). Among daily smokers, the US-born smoked more cigarettes per day than did Mexicans with a migrant in their family or previous migration experience for men (7.8 vs 6.5) and women (8.6 vs 4.3).Conclusions. Evidence suggests that smoking is suppressed among migrants relative to the broader transnational Mexican-origin population. The pattern of low daily cigarette consumption among US-born Mexican Americans, noted in previous research, represents an increase relative to smokers in Mexico.Epidemiological studies have found large differences in smoking between Latinos and non-Hispanic Whites in the United States. Latinos are less likely than non-Hispanic Whites to initiate smoking. For instance, in the 2003 Tobacco Use Supplement to the Current Population Survey (CPS), a large nationally representative sample, the lifetime prevalence of smoking was 25% among Latinos and 44% among non-Hispanic Whites.1 Among smokers, Latinos are more likely to be nondaily smokers2–4 and smoke fewer cigarettes per day3 than non-Hispanic Whites. The 2003 CPS found that 36% of Latino smokers were nondaily smokers, compared with 17% of non-Hispanic White smokers and that among daily smokers 63% of Latinos smoked 10 or fewer cigarettes per day, compared with only 29% of non-Hispanic Whites.3 A recent study suggests that differences in smoking account for close to three quarters of the advantage in life expectancy at age 50 years that Latinos have relative to non-Hispanic Whites.5The immigrant origins of a large portion of the Latino population may be one factor contributing to these differences. Immigrant Latinos are less likely to be current smokers than are US-born Latinos,6–9 leading some to suggest that there may be positive selection among immigrants. However, our previous study found that in the years before arrival in the United State, migrants were more likely to have smoked than the general Mexican population.10 In addition, the increase in smoking in 2nd and higher generations of Latinos suggests that the distinctive patterns among immigrants become less common with assimilation and, therefore, that the differences in lifetime smoking patterns may narrow or disappear as the US-born portion of the Latino population grows.11 However, no information is available on the extent to which the distinctive patterns of smoking among Latinos reflect continuity with the source population in the countries of origin of Latino immigrants or environmental influences on migrants and their US-born descendants that occur in the context of assimilation.We examined the trajectory of smoking behaviors related to migration and assimilation to the United States across the transnational Mexican-origin population of Mexico and the United States. Mexican Americans constitute more than 60% of the US Latino population, and about 40% of Mexican Americans were born in Mexico.12 Immigrants from Mexico are by far the largest group of immigrants in the United States, constituting about 30% of the total foreign-born population.12 Combining population-based surveys from both countries, we examined differences in initiation and cessation of smoking and in cigarette consumption among daily smokers across a series of groups with increasing contact with the United States, from Mexicans with no familial connection to migration at one extreme, through US-born Mexican Americans at the other.