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

Immigrants Traditional belief is that immigrants are at higher risk of mental health problems Traditional belief is that immigrants are at higher risk of mental health problems This is thought to be due to the effects of migration, economic deprivation and loss (Escobar et al, 2000) This is thought to be due to the effects of migration, economic deprivation and loss (Escobar et al, 2000) At times, they have been thought to be “defective” or backwards. At times, they have been thought to be “defective” or backwards. Industrialized countries are increasingly “multicultural” Industrialized countries are increasingly “multicultural”

Immigrants Have higher risk factors than host population: Have higher risk factors than host population: Poverty Poverty Lack of access to health care, insurance Lack of access to health care, insurance Fewer visits to health care professionals Fewer visits to health care professionals

Immigrants In the US Latinos are increasing in number steadily In the US Latinos are increasing in number steadily By 2050 they will be 25% of the US population By 2050 they will be 25% of the US population The majority of Hispanics in the US are of Mexican origin The majority of Hispanics in the US are of Mexican origin In some states they reach 25 to 30% of the population In some states they reach 25 to 30% of the population

Immigrants Degree of “acculturation” Degree of “acculturation” Embracing new values, new language, new costumes and ways of behaving Embracing new values, new language, new costumes and ways of behaving For Mexican immigrant women, more “acculturation” means worse outcomes in terms of health and mental health ( substance use, alcohol abuse, etc.) For Mexican immigrant women, more “acculturation” means worse outcomes in terms of health and mental health ( substance use, alcohol abuse, etc.)

Acculturartion measures Language used at home, e.g. Spanish or English Language used at home, e.g. Spanish or English Language familiarity and preference Language familiarity and preference Child rearing preferences Child rearing preferences Electronic media interest Electronic media interest Ethnic pride and idetity Ethnic pride and idetity Food, music, generational proximity Food, music, generational proximity

Acculturation measures Coworkers Coworkers Ethnicity of neighbors and close friends Ethnicity of neighbors and close friends Cultural heritage and celebrations Cultural heritage and celebrations Music Music Childhood cultural characteristics Childhood cultural characteristics Cultural exposure. Bicultural involvement Cultural exposure. Bicultural involvement

Acculturation Measuring degree of acculturation in Latinos (Burnam et al. 1987) Measuring degree of acculturation in Latinos (Burnam et al. 1987) Epidemiological Catchment Area study, of rates of psychopathology in US. Related to Latinos: Epidemiological Catchment Area study, of rates of psychopathology in US. Related to Latinos: Less acculturated people, less prevalence of alcohol and drug abuse, phobia, antisocial personality Less acculturated people, less prevalence of alcohol and drug abuse, phobia, antisocial personality Is there a selective effect of migrators? Is there a selective effect of migrators?

Acculturation Rates of mood disorder in Latino population Rates of mood disorder in Latino population Rates lower in Mexican born people vs. US born Latino persons (Kessler et al, 1994) Rates lower in Mexican born people vs. US born Latino persons (Kessler et al, 1994) Lower prevalence of substance abuse in the Mexican born population Lower prevalence of substance abuse in the Mexican born population

Prevalence studies. Mexican American prevalence survey (Vega et al, 1998) 3000 adults in California 3000 adults in California CIDI instrument (Composite Int. Diag.Interv.) CIDI instrument (Composite Int. Diag.Interv.) Rates of psychopathology are twice for US born individuals Rates of psychopathology are twice for US born individuals For women rates of alcohol and drug abuse are 7x for US born women For women rates of alcohol and drug abuse are 7x for US born women

Healthy immigrant effect in women In US Latino women who adhere to their traditional culture have more “positive health behaviors” (Ventura et al, 1997) In US Latino women who adhere to their traditional culture have more “positive health behaviors” (Ventura et al, 1997) Less use of drugs and alcohol Less use of drugs and alcohol Less complications during childbirth Less complications during childbirth Better perinatal health outcomes compared with more acculturated Latino women, diabetes, hypertension Better perinatal health outcomes compared with more acculturated Latino women, diabetes, hypertension

Effect for immigrant women Less acculturation (foreign born) means: Less acculturation (foreign born) means: Lower rate of “small for gestational age babies” (3% Mexican born vs. 14% for US born women) Lower rate of “small for gestational age babies” (3% Mexican born vs. 14% for US born women) Lower rates of prematurity Lower rates of prematurity Lower infant mortality for foreign born than US born women (Collins et al, 2001) Lower infant mortality for foreign born than US born women (Collins et al, 2001)

Latinos in California adults in California 3000 adults in California CIDI instrument (Composite Int. Diag.Interv.) CIDI instrument (Composite Int. Diag.Interv.) Rates of psychopathology are twice for US born individuals Rates of psychopathology are twice for US born individuals For women rates of alcohol and drug abuse are 7x for US born women vs. those born in Mexico For women rates of alcohol and drug abuse are 7x for US born women vs. those born in Mexico

Acculturation Adoption of “new ways”, language, beliefs, practices, while abandoning the old or traditional ones. Adoption of “new ways”, language, beliefs, practices, while abandoning the old or traditional ones. Is acculturation adaptive? Is acculturation beneficial for the health of pregnant women? Is acculturation adaptive? Is acculturation beneficial for the health of pregnant women?

Women and pregnancy In US Latino women who adhere to their traditional culture have more “positive health behaviors” (Ventura et al, 1997) In US Latino women who adhere to their traditional culture have more “positive health behaviors” (Ventura et al, 1997) Less use of drugs and alcohol Less use of drugs and alcohol Less complications during childbirth Less complications during childbirth Better perinatal health outcomes compared with more acculturated Latino women, diabetes, hypertension Better perinatal health outcomes compared with more acculturated Latino women, diabetes, hypertension

Pregnancy and domestic violence. Pregnant Latina Women (Matson and Rodriguez, 1999) 150 women, immigrant and US Born, rural and urban 150 women, immigrant and US Born, rural and urban Highest rate of domestic violence in US born rural Latina (highest level of acculturation) Highest rate of domestic violence in US born rural Latina (highest level of acculturation)

Latina women More acculturated young Latina women More acculturated young Latina women Start intercourse earlier in age Start intercourse earlier in age Higher rate of non-marital births (Loue, 1987 Higher rate of non-marital births (Loue, 1987

US Mexico border study of adolescents (Pumariega et al, 1992) 4000 adolescents, 11 to 18 years old 4000 adolescents, 11 to 18 years old Rates of depression and distress (Panamerican Youth Inventory and Center for Epidemiologic Studies Depressive Scale) Rates of depression and distress (Panamerican Youth Inventory and Center for Epidemiologic Studies Depressive Scale) Rate of drug abuse was 4x higher in US born adolescents (21% vs 5%) Rate of drug abuse was 4x higher in US born adolescents (21% vs 5%) Higher levels of distress and suicidal ideation in US born teenagers. Higher levels of distress and suicidal ideation in US born teenagers. Other studies: less risk of suicide Other studies: less risk of suicide

US Mexico border study Risk factors: More time watching television Risk factors: More time watching television Less time spent in family activities Less time spent in family activities Less involvement with friends Less involvement with friends Less involvement in sports Less involvement in sports

U. Of California Irvine. Disorders in primary care (Escobar et al, 1998) 1500 adolescents several groups 1500 adolescents several groups Mexican and Central American born : Mexican and Central American born : Lower levels of posttraumatic disorder, depression, panic disorder Lower levels of posttraumatic disorder, depression, panic disorder Better levels of physical functioning Better levels of physical functioning Higher rates of “somatization” Higher rates of “somatization”

Acculturation. Turkish children in Germany Less acculturation meant: Less acculturation meant: Lower rates of asthma Lower rates of asthma Lower rates of allergic sensitization Lower rates of allergic sensitization Lower rates of atopy Lower rates of atopy (Gruber et al, 2002) (Gruber et al, 2002)

Acculturation and diet Less acculturated Latinos in US Less acculturated Latinos in US “healthier diet” “healthier diet” Less consumption of fat, saturated fat, sodium,more consumption of fiber and vitamines Less consumption of fat, saturated fat, sodium,more consumption of fiber and vitamines More consumption of vegetables More consumption of vegetables Regular eating of breakfast Regular eating of breakfast

Acculturation and “heatlh behaviors” Less acculturation of Latinos in US Less acculturation of Latinos in US Higher use of seat belt Higher use of seat belt Higher level of immunization of children Higher level of immunization of children

TRANSCULTURATION ISOLATION AND ENTRENCHMENT asimilation

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

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

Feeding the infant Baby should sleep alone? Baby should sleep alone? Baby should sleep with mother? Baby should sleep with mother? What to do if the baby wakes up? What to do if the baby wakes up? What to do if the baby cries? What to do if the baby cries? Hammock, box, crib, mother’s bed, side bed, “motorcycle bed” Hammock, box, crib, mother’s bed, side bed, “motorcycle bed” Should baby be swaddled? Should baby be swaddled?

Possible protective effects Role of “familismo”: social support and collective loyalty Role of “familismo”: social support and collective loyalty Extensive social networks Extensive social networks Culturally based respect for parents and for parenting role? Culturally based respect for parents and for parenting role? Greater social support and control Greater social support and control

Protective effects? Support network of extended family, traditional roles, use of cultural markers and language (Escobar et al, 2000) Support network of extended family, traditional roles, use of cultural markers and language (Escobar et al, 2000) Social control exerted over health related behaviors such as drug and alcohol use Social control exerted over health related behaviors such as drug and alcohol use Less isolation during pregnancy and delivery Less isolation during pregnancy and delivery