Abstract
Although education is among the major socioeconomic status (SES) resources that influence populations' and individuals' health, social marginalization may reduce the health gain that follows access to SES indicators such as education, a pattern called marginalization-related diminished return (MDR). The literature on MDRs, however, has been mainly derived from studies that have defined marginalization based on race, ethnicity, and sexual orientation. Thus, more research is needed on MDRs that may follow as a result of immigration. To extend what is known on immigration status related MDRs, this study compared a national sample of immigrants and non-immigrants for the effect of education on the poor self-rated health (SRH) of adults in the United States. With a cross-sectional design, this study employed data from the 2015 National Health Interview Survey (NHIS), a survey that had enrolled 33,654 adults who were either immigrants (n = 6225; 18.5%) or non-immigrants (n = 27 429; 81.5%). The independent variable was education level, treated as a categorical variable. The dependent variable was SRH treated as a dichotomous variable. Race, ethnicity, age, gender, marital status, and region were the confounders. Immigration (nativity) was the moderator. Logistic regression was used for data analysis. Higher education credentials were associated with better SRH in the pooled sample; however, immigration showed a significant statistical interaction with education level (college graduation) on the outcome. This interaction was indicative of a smaller protective effect of college graduation on poor SRH among immigrants than non-immigrant adults. In line with the MDRs framework, the effect of education on SRH is weaker for immigrants than for non-immigrant adults. There is a need to help highly educated immigrants to mobilize their human capital to secure their best health outcomes, similar to non-immigrants. Such strategies may require bold and innovative policy solutions to reduce discrimination against immigrants, so they can more effectively translate their education and human capital into tangible outcomes such as health.
Highlights
Education is among the major socioeconomic status (SES) resources that influence populations’ and individuals’ health, social marginalization may reduce the health gain that follows access to SES indicators such as education, a pattern called marginalization-related diminished return (MDR)
The current study showed that immigration causes MDRs
While education reduces the odds of the poor self-rated health (SRH) status of American adults, this influence is weaker for immigrants than for non-immigrants
Summary
Education is among the major socioeconomic status (SES) resources that influence populations’ and individuals’ health, social marginalization may reduce the health gain that follows access to SES indicators such as education, a pattern called marginalization-related diminished return (MDR). As a result of these MDRs, the effects of SES indicators such as education level on mental health,[17,18] physical health,[19,20,21,22] and health behaviors[23,24,25] are weaker for marginalized people than for the majority group These MDRs, are shown for education,[25] and income,[26,27,28,29,30] employment,[31,32] and marital status.[33,34] MDRs35,36 are shown for Blacks,[12,13] Hispanics,[26,37] Asian Americans,[38] Native Americans,[10] lesbian, gay, bisexual, and transgender (LGBT),[39,40,41] and even marginalized Whites.[42] For example, highly educated LGBT people remain at high risk for poor mental well-being,[39] obesity,[41] and smoking.[40]
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