Stewart J. Landers, JD, MCP. Stella M. Yu, ScD, MPH. ASSOCIATE EDITOR ... Lynne S. Wilcox, MD, MPH (2009). Christie Zunker, MA (2008). STAFF. Georges ...
AMERICAN JOURNAL OF PUBLIC HEALTH EDITOR-IN-CHIEF DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS
EDITOR’S CHOICE Personal and Ecological Contexts for Understanding the Health of Immigrants Several articles in this ‘‘Health Without Borders’’ theme issue highlight the many factors that influence the health of diverse immigrant populations. These studies underscore the complexity of immigrant health and its diversity. The human capital that immigrants bring (education, marketable job skills, social skills) can facilitate their successful adaptation to the United States, although what constitutes valued human capital is greatly determined by the culture of the new host society. Ecologically, this advantage is compounded by the social capital (social networks and contacts with ethnic enclaves) in the new society that is available to immigrants. Unfortunately, most immigrants today have a sociodemographic profile of personal and social disadvantage—this includes an immigrant’s indigenous background, low education, low English-speaking skills, low marketable or technical skills, and relocation far from culturally supportive ethnic enclaves. Although available for only some immigrants, the context of advantage can facilitate successful adaptation and cultural integration. Ironically, it can nonetheless fail to confer healthy outcomes. As a result, some immigrants exhibit low acculturation levels and incomes, yet experience psychological well-being, somatic health, and a good quality of life. These apparent contradictions have prompted an immigrant paradox hypothesis, a variant of the Hispanic–Latino paradox. Among Latinos, greater acculturation is associated with healthier diets and more exercise behavior, although it is also associated with higher rates of cigarette, alcohol, and illegal drug use. Among African American populations, being Black from the Caribbean is culturally different from being a mainland African American. For example, some Caribbean Black women report greater challenges in encouraging condom use in their sexual partners, where these challenges may be driven by very traditional native culture gender norms and expectations. In population-based analyses, despite the predictive
power of language, ethnic identification, and level of acculturation on health outcomes, the explanatory power of these factors may still be low, as these factors may constitute proxy indicators of the complex underlying processes that more directly influence health outcomes. On another public health front, access to health services is a major public health concern, especially among immigrant populations. Among border residents, access to health services involves complex risks and benefits, given that borderlanders (persons living near national borders) are exposed continuously to binational systems of health care. Among immigrant children and elders, limited access to health services has been provided by certain state policies and programs. Nonetheless, an immigrant family must still work diligently at acculturative integration into American society in hopes of providing their children with adequate health care and a better future. Unfortunately, for many adult immigrants, efforts at acculturation only lead to low-paying jobs that lack health benefits, impose unsafe working conditions, have limited access to health services and limited socioeconomic mobility, and, at times, lead to disillusionment. For immigrant populations, the variables of socioeconomic mobility, acculturation, and access to health care constitute imperfect predicators of their health outcomes and quality of life. In summary, the complex intersections of multiple personal and ecological factors present significant challenges to a more complete understanding of immigrant health. A greater understanding of these complex processes can improve the effectiveness of our health promotion interventions as offered to diverse immigrant populations. j
November 2008, Vol 98, No. 11 | American Journal of Public Health
Felipe Gonza´lez Castro, PhD, MSW Associate Editor AJPH
Mary E. Northridge, PhD, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Mary T. Bassett, MD, MPH Felipe Gonza´lez Castro, PhD, MSW Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Sydney, Australia) DEPARTMENT EDITORS Leslie Beitsch, MD, JD Government, Politics, and Law Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Bernard M. Dickens, PhD, LLD, FRSC Health Policy and Ethics Forum Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Neil Hann, MPH, CHES (2010), Chair Hector Balcazar, PhD (2008) Bobbie Berkowitz, PhD, RN (2008) Russell Brewer, DrPH (2010) Bonnie Duran, DrPH (2008) Vanessa Northington Gamble, MD, PhD (2009) Alice M. Horowitz, PhD, MA (2009) Cassandra L. Joubert, ScD (2009) Louise-Anne McNutt, PhD (2010) Dana B. Mukamel, PhD (2010) Brian Saylor, PhD, MPH (2010) Allan Steckler, DrPH (2009) Henrie M. Treadwell, PhD (2008) Lynne S. Wilcox, MD, MPH (2009) Christie Zunker, MA (2008) STAFF Georges C. Benjamin, MD, FACP Executive Director/Publisher Nancy Johnson, MA, Executive Editor Brian Selzer, Journal Production Manager Alexandra T. Stupple, Assistant Production Editor Sarah Smith, Production Coordinator Ashell Alston, Director of Advertising Maya Ribault, Editorial Assistant Jennifer Strass, Graphic Designer Vivian Tinsley, Subscriptions Coordinator Jacalyn W. Houston, Reviews Coordinator FREELANCE STAFF Janis Foster, Greg Edmondson, Michele Quirk, Gretchen Becker, Alisa Guerzon, Alison Moore, John Alexander, Trish Weisman, Gary Norton, Jennifer Holmes, Brent Winter, David Stockhoff, Copyeditors Alison Moore, Chris Filiatreau, Alexe van Beuren, Eileen Wolfberg, Proofreaders Vanessa Sifford, Michele Pryor, Graphic Designers
doi:10.2105/AJPH.2008.148577
Editor’s Choice | 1933
