Longer Duration Of Residence Research Articles

Kuwait is home: perceptions of happiness and belonging among second plus generation non-citizens in Kuwait

ABSTRACTKuwait is an oil-rich Gulf country where temporary foreign workers and their families comprise two-thirds of the population, without access to permanent residence or citizenship. Several residents, however, stay for long durations, raising a second or third generation there. Surveys of second plus generation non-nationals were conducted among 973 high school students and 246 working persons in 2012. These surveys were analysed in order to: (i) Advance the understanding of how non-citizens relate to their impermanent status in terms of being happy in Kuwait and considering it home; and (ii) To identify characteristics that enhance the above perceptions. Among students, 48 per cent were extremely happy and 52 per cent considered it as home very strongly; corresponding percentages among working persons were 35 per cent and 48 per cent, respectively. Arab nationality, female gender, longer duration of residence and bilingual proficiency were positively associated with perceptions of belongingness, which may enhance societal harmony.

Prevalence of non-food allergies among non-immigrants, long-time immigrants and recent immigrants in Canada.

The prevalence of allergic conditions has been increasing worldwide, with the highest rates seen in Western countries like Canada. The development of allergies is known to be related to both genetic and environmental factors, but the causal pathways remain unclear. Studies on immigrants provide a unique opportunity to disentangle these two factors and provide a better understanding of the disease aetiology. The aim of this study was to investigate the relationship between immigration status and prevalence of non-food allergies in a population-based study of Canadians. Data of 116,232 respondents from the Canadian Community Health Survey (Cycle 3.1, 2005) were used in a multivariable logistic regression to assess the association between immigration status (non-immigrant, long-time immigrant [>10 years] and recent immigrant [≤10 years]) and self-reported doctor-diagnosed non-food allergies, adjusting for potential confounders. The highest prevalence of non-food allergies was found among non-immigrants (29.6%), followed by long-time immigrants (23.9%) and then recent immigrants (14.3%). The odds of non-food allergies were reduced by 60% (OR = 0.40, 95% CI: 0.35, 0.45) among recent immigrants and 25% (OR = 0.75, 95% CI: 0.70, 0.80) among long-time immigrants, compared with non-immigrants, after adjusting for sex, age, socio-economic status and rurality. This study finds a distinctly lower prevalence of non-food allergies among immigrants compared with non-immigrants, with the difference diminishing with longer duration of residence in Canada. The findings highlight the potential of environmental determinants of allergy development that warrant further investigation, and demonstrate the need for multicultural strategies to manage the public health burden of allergic conditions.

Alcohol use among immigrants in Ontario, Canada.

This study examined prevalence of alcohol consumption among immigrants and the Canadian-born populations of Ontario by ethnic origin, and the association between ethnicity, country of birth, age at arrival, length of residence in Canada and drinking measures. Data were derived from the Centre for Addiction and Mental Health (CAMH) Monitor, a cross-sectional survey of Ontario adults, conducted between January 2005 and December 2010 (n = 13,557). The prevalence of alcohol consumption and risk drinking was generally lower among foreign-born than Canadian-born respondents, but significant variations across ethnic groups were found. In general, foreign-born respondents of European descent reported higher rates of alcohol use and risk drinking than foreign-born respondents from other ethnic groups. We also observed that ethnicity effects varied by whether or not respondents were born in Canada, and by the age at which they arrived in Canada. While previous studies generally found an increase in immigrants' alcohol consumption with years in Canada, our data suggest that longer duration of residence may have either positive or negative effects on immigrants' alcohol use, depending on the country of origin/traditional drinking pattern. More research is needed to explore determinants of alcohol use and risk drinking among immigrants and to identify those groups at highest risk.

Factors associated with establishment-based female sex workers accessing health care services in Shanghai

Female sex workers are a priority population for HIV prevention and health promotion in China. This paper examines the patterns of and factors associated with the utilisation of HIV-related and general health services by establishment-based sex workers in Hongkou District, Shanghai. Participants were recruited through a three-stage sampling strategy and invited to self-complete a brief survey in 2012. The median age of the 400 participants included in the analyses was 33 years (range = 18–52 years old), with over three-quarters being married at the time of the survey. Participants were mostly internal migrants, more than half had lived in Shanghai for six months or longer and nearly two-thirds were working in an establishment with a total of less than five female sex workers. Routine physical examination and HIV testing were the most commonly accessed health services in the previous 12 months. Altogether, 347 women (86.8%) had actively sought, including 157 women had obtained, free health services mainly from local Community Health Service Centres (CHSCs) in the previous 12 months. The active seeking of free, largely CHSC-provided health services was associated with a longer duration of residence in Shanghai (adjusted odds ratio [AOR] = 2.55, 95% CI = 1.32–4.93; p < 0.01) and having tested for HIV in the previous 12 months (AOR = 3.68, 95% CI = 1.84–7.38; p < 0.001). Conversely, a higher annual income (AOR = 0.41, 95% CI = 0.21–0.80; p < 0.01), working in a larger establishment (AOR = 0.40, 95% CI = 0.20–0.79; p < 0.01) and knowing that HIV can be transmitted through blood transfusion with unscreened blood (AOR = 0.21, 95% CI = 0.05–0.91; p < 0.05) were associated with not actively seeking such services. Free, community-based health services are highly demanded by establishment-based female sex workers in Shanghai. Scaling-up of free and integrated health services provided by community-based health service providers in metropolitan areas in China and beyond holds promise for promoting health and well-being of female sex workers.

Duration of residence and psychotropic drug use in recently settled refugees in Sweden--a register-based study.

IntroductionRecently settled refugee populations have consistently been reported to have high rates of mental health problems, particularly Post-traumatic stress disorder, depression, and anxiety disorders. The aim of this study was to investigate psychotropic drug use among young adult refugees according to duration of residence during the first 10 years in Sweden.MethodsCross-sectional register study of a national cohort of 43 403 refugees and their families (23–35 years old) from Iraq, Iran, Eritrea, Ethiopia, Somalia and Afghanistan and a comparison population of 1.1 million Swedish-born residents. Logistic regression was used to assess the association between duration of residence in Sweden and the dispensing of at least one psychotropic medication during 2009 in four categories (any drug, neuroleptics, antidepressants and anxiolytics/hypnotics), adjusting for age, gender and domicile.ResultsRates of dispensed psychotropic drugs among recently settled refugees were low, compared to the Swedish-born, with an increase with duration of residence. For refugee men and women from Iraq/Iran who had resided for 0–3 years the adjusted ORs compared to Swedish natives, were 0.83 (95% CI 0.77-0.90) and 0.48 (0.44-0.53) respectively; for men and women from the Horn of Africa the ORs were 0.50 (0.42-0.61) and 0.36 (0.30-0.41) respectively. After 7–10 years of residence, the ORs in these refugee groups approached the Swedish comparison population. Refugees from Afghanistan presented ORs similar to the Swedish-born, with no consistent trend by duration of residence. Women from the Horn of Africa and Iraq/Iran consumed less psychotropic drugs compared with men from these regions of origin, relative to the Swedish-born (p < 0.01). The ORs for dispensed neuroleptics were similar between the different refugee study groups, while the ORs for dispensed antidepressants differed fourfold between the group with the lowest (Horn of Africa) and the highest (Afghanistan).ConclusionThe rates of dispensed psychotropic drugs in the newly settled refugee populations in this study were low, with an increase with longer duration of residence. This pattern suggests barriers to access mental health care. Interventions that can lower these barriers are needed to enable newly settled refugees to access mental health care on equal terms with the native population.

Association of the duration of residence with obesity-related eating habits and dietary patterns among Latin-American immigrants in Spain.

The dietary patterns of immigrants usually change with the duration of residence and progressively resemble those of the host country. However, very few studies have investigated individuals migrating to countries with a high-quality diet, such as the Mediterranean diet (MD), and none has yet focused on Latin-American immigrants. The present study examined the association of the duration of residence with obesity-related eating habits and dietary patterns among Latin-American immigrants residing in Spain. A cross-sectional study was conducted in 2008-10 in a representative sample of the adult population residing in Spain. Adherence to the MD was defined as a MD Adherence Screener score ≥9. Analyses were conducted by including 419 individuals aged 18-64 years born in Latin-American countries. Compared with immigrants residing in Spain for <5 years, those residing for ≥10 years accounted for a lower percentage of individuals who habitually ate at fast-food restaurants and never trimmed visible fat from meat. Moreover, these immigrants were found to have a lower intake of sugary beverages and a higher intake of Na, saturated fat, fibre, olive oil, vegetables and fish and to more frequently strictly adhere to the MD. A longer duration of residence in Spain was found to be associated with both healthy and unhealthy changes in some eating habits and dietary patterns among Latin-American immigrants. Some of the healthy changes observed contrasted the 'Westernisation' of the diet reported in studies conducted in other Western countries. The results of the present study support the role of the food environment of the host country in the modification of the dietary patterns of immigrants.

Acculturation and Subclinical Atherosclerosis among U.S. South Asians:Findings from the MASALA study

Longer duration of residence among immigrants to the United States, a proxy measure of acculturation, has been associated with higher subclinical atherosclerosis. South Asian immigrants are the second fastest growing immigrant group in the U.S. but little is known about the effects of acculturation with atherosclerosis in this high cardiovascular risk population. We conducted a cross-sectional analysis using data from a community-based cohort called the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Participants (n=900) were between ages of 40-84 years and had no existing cardiovascular disease. We developed a multi-dimensional measure of acculturation in South Asians, called traditional cultural beliefs, and measured other proxy measures of acculturation to determine whether they were associated with higher levels of subclinical atherosclerosis after controlling for socioeconomic, behavior/lifestyle, and cardiovascular risk factors. Mean duration of residence in the U.S. was 27±11 years and tertiles of strength of traditional cultural beliefs were examined. Longer duration of U.S. residence was associated with higher levels of coronary artery calcium even after adjustment for covariates and lifestyle mediators. The novel measure of strength of traditional cultural beliefs was associated with lower common carotid intima media thickness among those with moderate traditional beliefs only. These findings support the need for better conceptualization and measurement of how migration influences cultural beliefs and practices, and their subsequent influence on health behaviors and cardiovascular disease risk.

The Relationship Between Duration of U.S. Residence, Educational Attainment, and Adult Health Among Asian Immigrants.

There is substantial educational heterogeneity among Asian immigrants to the United States, suggesting that the association between duration of U.S. residence with their health outcomes and behaviors may vary considerably by educational attainment. Using data from the 2003 New Immigrant Survey (N=2,373), we find strong evidence that the detrimental associations between duration of U.S. residence and self-reported health, activity limitation status, chronic health conditions and current smoking are concentrated among Asian immigrants with less than a high school education; in contrast, the health outcomes and behaviors of Asian immigrants who have at least a high school degree exhibit very few differences by duration of U.S. residence. These distinct duration-health patterns by educational attainment are not explained by duration related differences in country of origin, class of admission, or English speaking skills. We also find a stronger duration relationship with current smoking than those with the health status measures among the least educated Asian men, indicating a potential behaviorally-based explanation for poorer health among Asian immigrant men with longer duration of residence.

Residents’ interactions with and attachments to Retezat National Park, Romania: implications for environmental responsibility

Community residents’ attitudes, behaviours and emotional connections with adjacent natural areas are integral to the optimal management of those areas. Residents in communities proximal to Romanian protected areas have been described in various studies as passive, lacking environmental sensibility and ascribing responsibility for resource protection to authorities. Given little evidence supporting such assertions, this study examined the social and natural landscape interactions and connections of community residents neighbouring a Romanian national park and residents’ perceptions of attachment to the park. The relationship between park attachment and ascribed environmental responsibility was also analysed. Two block model regressions revealed that residents with longer duration of residence, who interacted more with friends and public officials, and those who hiked in the park, reported higher levels of park attachment. Park attachment, time spent in the community, female gender and level of education, positively contributed to the ascription of self-responsibility for environmental protection. Results underscore the importance of the social environment in facilitating attachments to a park. Furthermore, park attachment was found to facilitate increased self-ascription of environmental responsibility. Managerial implications to encourage interactions and ascribed environmental responsibility are discussed.

Association of duration of residence in the southeastern United States with chronic kidney disease may differ by race: the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study

BackgroundPrior evidence suggests that longer duration of residence in the southeastern United States is associated with higher prevalence of diabetes and hypertension. We postulated that a similar association would exist for chronic kidney disease (CKD).MethodsIn a national population-based cohort study that enrolled 30,239 men and women ≥ 45 years old (42% black/58% white; 56% residing in the Southeast) between 2003 and 2007, lifetime southeastern residence duration was calculated and categorized [none (0%), less than half (>0-< 50%), half or more (≥50-< 100%), and all (100%)]. Prevalent albuminuria (single spot urinary albumin:creatinine ratio of ≥30 mg/g) and reduced kidney function (estimated glomerular filtration rate <60 ml/min/1.73 m2) were defined at enrollment. Incident end-stage renal disease (ESRD) during follow-up was identified through linkage to United States Renal Data System.ResultsWhite and black participants most often reported living their entire lives outside (35.7% and 27.0%, respectively) or inside (27.9% and 33.8%, respectively) the southeastern United States. The prevalence of neither albuminuria nor reduced kidney function was statistically significantly associated with southeastern residence duration, in either race. ESRD incidence was not statistically significantly associated with all vs. none southeastern residence duration (HR = 0.50, 95% CI, 0.22-1.14) among whites, whereas blacks with all vs. none exposure showed increased risk of ESRD (HR = 1.63, 95% CI, 1.02-2.63; PraceXduration = 0.011).ConclusionsThese data suggest that blacks but not whites who lived in the Southeast their entire lives were at increased risk of ESRD, but we found no clear geographic pattern for earlier-stage CKD.

Family Ties and Urban–Rural Linkages among Older Migrants in Nairobi Informal Settlements

ABSTRACTBuilding on African migration as a household survival strategy; urban–rural linkages as critical for migrants' continued engagement with origin communities; reintegration in case of return; and safety net for supplementing precarious urban incomes; we examine the role of family ties in rural origin linkages among 1,693 older migrants living in Nairobi informal settlements. Despite the grim of slum residence, 80% of older migrants in Nairobi slums maintained contact with their rural origin homes during a full year of observation. Family‐related factors, especially members of the nuclear family residing in rural origin, explained 45% of explained linkages. Religion, ethnicity, land ownership at origin, and current health and economic statuses are other key predictors. The patterns and reasons of linkages are consistent with migrants' positive contributions to the upkeep of rural origin households. Our findings are well‐anchored in the larger continental literature that has shown the urban migrant as not a ‘disembedded individual’ but instead part of rural origin collectives. Against the weakness of state safety net system, the study sheds crucial light on the enduring importance of sociocultural networks in people's everyday lives, particularly the importance of family ties for older migrants. To the extent that poor health status, being aged 60 years or older, and long duration of residence in the slums, which are predictors of low propensities to maintain contacts with rural origin, are also indicators of diminished social engagement, policy interventions among the urban poor may need to include efforts to enhance rural origin reintegration of the most‐aged individuals. Copyright © 2012 John Wiley &amp; Sons, Ltd.

Iodine deficiency influences thyroid autoimmunity in old age – A comparative population-based study

Objective To assess thyroid autoimmunity among elderly people living in an area with low iodine intake compared to the sustained recommended iodine intake from a natural source, and to estimate the importance of migration. Design and setting Iodine content of drinking water is highly different in the Danish towns Randers and Skagen. We collected blood and spot urine samples from 430 long-term Randers and Skagen dwellers aged 75–80 years, who filled in a questionnaire. We measured thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in serum and iodine and creatinine in urine. Results Participation rate was 47% ( n = 212 (men/women 82/130) in Randers; 218 (84/134) in Skagen). Iodine deficiency prevailed in Randers while Skagen dwellers were iodine replete (median urinary iodine 74 μg/24 h vs. 184 μg/24 h, p < 0.001). Thyroid antibodies were more frequent in Randers than in Skagen residents (42% vs. 32%; p = 0.006) and more likely with iodine excretion <50 μg/24 h (OR, 95%CI: 1.9, 1.1–3.4). Differences between towns increased with longer duration of residence as trends in the occurrence of TGAb and TPOAb were opposite ( p < 0.001; p = 0.007). Conclusions Thyroid autoantibodies were common in old age, influenced by the iodine intake level, and the lowest frequency was found at the recommended iodine intake level.

Do migrant studies help to identify causes of asthma?

Do migrant studies help to identify causes of asthma?

Considerations affecting dietary behaviour of immigrants with type 2 diabetes: a qualitative study among Surinamese in the Netherlands

Purpose. The purpose of this study was to explore the sociocultural factors affecting the dietary behaviour of Dutch Surinamese patients with type 2 diabetes. Methods. In this qualitative study, 32 Surinamese primary care patients with type 2 diabetes mellitus participated in semi-structured interviews (16 African Surinamese and 16 Hindustani Surinamese). Interviews were recorded and transcripts were analysed and coded into themes using principles of grounded theory and MAXQDA software. Results. Surinamese food was eaten regularly by all respondents. Most participants were aware of the need to change their diet but reported difficulty with changing their dietary behaviour to meet dietary guidelines. Many perceived these guidelines to be based on Dutch eating habits, making it difficult to reconcile them with Surinamese cooking and eating practices. Firstly, respondents indicated that they did not choose foods based on their nutritional qualities. Instead, choices were based on Surinamese beliefs regarding ‘good’ (e.g., bitter vegetables) or ‘bad’ (e.g., spicy dishes) foods for diabetes. Secondly, respondents often perceived recommendations such as eating at fixed times as interfering with traditional values, for example hospitality. Above all, the maintenance of Surinamese cooking and eating practices was regarded as extremely important since the respondents perceived these to be a core element of their identity as Surinamese. Conclusions. For Surinamese diabetes patients, cooking and eating practices are related to deeply rooted cultural beliefs and values. The wish to maintain one's Surinamese identity may pose difficulty for patients’ adherence to dietary guidelines, as these are perceived as being based on ‘Dutch’ habits. This suggests that immigrants with a long duration of residence in the host country like the Surinamese, who are seen as well integrated might benefit from culturally sensitive diabetes education that is adapted at surface and deep structure.

Aircraft Noise and Myocardial Infarction Mortality

The authors respond: We thank Mark Brink1 for his interest in our work. Zurich aircraft noise levels as applied in our study were calculated on the basis of actual flight movements on an annual basis, and all calculations were carried out by the Swiss Federal Laboratories for Materials Testing and Research.2 For Zurich airport, we used the energetic average from the years 2001 to 2005, the time period covering the mortality data in our analysis. Reports on the computational noise modeling for all other airports can be accessed online.3 For these airports, we used available exposure data that usually referred to 1 year (eg, Basel year 2004, Geneva year 2000). Between 2001 and 2005, there was indeed a slight decrease of noise exposure (1-2 dB) around Zurich airport, but the exposure levels between these years are highly correlated, as the same areas are affected by aircraft noise. We agree that it would be interesting to know whether persons with a long duration of residence entered our calculations with an underestimation of the noise levels, and to take long-term exposure history into account. However, there is uncertainty about the latency time of noise exposure and a resulting myocardial infarction (MI) event. It is well known that chronic as well as acute stress can trigger an MI.4 If myocardial infarction mortality is the consequence of acute exposure applying past exposure levels could introduce an error into the calculation. It is thus unclear how best to evaluate noise-exposure history. In addition, the high temporal correlation of the exposure levels means that firm conclusions about the relevant exposure time window cannot be drawn. The increasing risk observed with duration of residency may also reflect the fact that long-term residents were less likely to live in new or renovated buildings with better sound insulation; while 30% of the highly exposed persons lived in an old or not-renovated building at the time of the census, this percentage increased to 36% in long-term residents. In summary, the results of our study (as well as others)5 do not suggest a well-defined threshold below which no harmful effects occur. Instead our study indicates a continuous risk increase with increasing exposure levels. Noise abatement policy should therefore focus on the health benefit that any noise reduction might bring. Anke Huss Institute of Social and Preventive Medicine University of Bern Bern, Switzerland Institute for Risk Assessment Sciences University of Utrecht Utrecht, The Netherlands Adrian Spoerri Matthias Egger Institute of Social and Preventive Medicine University of Bern Bern, Switzerland [email protected] Martin Röösli Department of Epidemiology and Public Health Swiss Tropical and Public Health Institute Basel, Switzerland University of Basel Basel, Switzerland For the Swiss National Cohort Study Group

Patterns of Residential Crowding among Hispanics in Later Life: Immigration, Assimilation, and Housing Market Factors

We describe patterns of residential crowding among older Hispanics and non-Hispanic Whites. We also examine hypotheses about the relationship of residential crowding with assimilation (language and duration of residence) and housing market characteristics. We employ a multilevel research design, using data from the 2000 U.S. Census of Population. Hierarchical linear models are utilized to estimate the association between residential crowding and both individual and housing market factors. Approximately one third of older Hispanics in metropolitan areas live in crowded housing compared with only one tenth of older non-Hispanic Whites. Foreign-born older persons report higher levels of crowding than U.S.-born older persons. Residential crowding differences between older Hispanics and non-Hispanics are not eliminated after controls are included. Older Hispanics who report better English language skills and a longer duration of residence in the United States live in less crowded housing. We do not find evidence for a relationship between crowding and residential segregation, but we find consistent evidence for an association between residential crowding and relative size of the Hispanic population. The forces that shape household composition and access to housing among older Hispanics appear to result in higher levels of residential crowding for this population.

Breastfeeding and weaning practices among Hong Kong mothers: a prospective study

BackgroundBreastfeeding provides optimal and complete nutrition for newborn babies. Although new mothers in Hong Kong are increasingly choosing to breastfeed their babies, rates of exclusive breastfeeding are low and duration remains short. The purpose of this study was to describe the breastfeeding and weaning practices of Hong Kong mothers over the infant's first year of life to determine the factors associated with early cessation.MethodsA cohort of 1417 mother-infant pairs was recruited from the obstetric units of four public hospitals in Hong Kong in the immediate post-partum period and followed prospectively for 12 months or until weaned. We used descriptive statistics to describe breastfeeding and weaning practices and multiple logistic regression to investigate the relationship between maternal characteristics and breastfeeding cessation.ResultsAt 1 month, 3 months, 6 months and 12 months only 63%, 37.3%, 26.9%, and 12.5% of the infants respectively, were still receiving any breast milk; approximately one-half of breastfeeding mothers were exclusively breastfeeding. Younger mothers, those with a longer duration of residence in Hong Kong, and those returning to work postpartum were more likely to wean before 1 month. Mothers with higher education, previous breastfeeding experience, who were breastfed themselves and those who were planning to exclusively breastfeed and whose husbands preferred breastfeeding were more likely to continue breastfeeding beyond 1 month. The introduction of infant formula before 1 month and returning to work postpartum were predictive of weaning before 3 months.ConclusionsBreastfeeding promotion programs have been successful in achieving high rates of breastfeeding initiation but the focus must now shift to helping new mothers exclusively breastfeed and sustain breastfeeding for longer.

Cognitive performance during long-term residence in a polar environment

The objective of this study was to determine whether there was significant change in cognitive performance by prolonged duration of residence in polar environment. We examined volunteers ( N = 23, scientific and logistic personnel) who spent fourteen months of continuous stay at ‘Maitri’ – The Indian research base in Antarctica (70 °45′S, 11 °44′E). Cognitive measures (tests of task acquisition, delayed recognition, attention and concentration, and digit symbol substitution) were obtained at the beginning (second month), the middle (seventh month) and the final (twelfth month) phases of prolonged residence in Antarctica. A repeated-measures MANOVA was conducted and the findings indicated a significant increase in percent accuracy in performance of task acquisition, delayed recognition and digit symbol tests that assessed recognition memory and learning. The test of attention and concentration that measured short-term memory for digits showed stable performance over a long-duration of residence in polar environment.

Non-Melanoma Skin Cancer Incidence and Risk Factors After Kidney Transplantation: A Canadian Experience

Non-melanoma skin cancer (NMSC) after kidney transplantation is common and can result in significant morbidity and mortality. Incidence and risk factors for NMSC can vary between geographic locations and there is no literature describing the incidence or risk factors for NMSC in Canada. The purpose of this retrospective cohort study was to determine the incidence of NMSC, the time of development of NMSC, and risk factors (including sun exposure history) for NMSC in kidney transplant recipients between 1990 and 2003 in our center (n=926). We observed a 9.7% incidence of NMSC lesions after kidney transplant with a median time of development of a first NMSC lesion of 4 years. Risk factors for NMSC (multivariate analysis) include older men (>45 years), a history of posttransplant warts, and longer duration of residence in a northern climate. We conclude that NMSC is common after kidney transplantation in a northern climate and these individuals require disease prevention-specific education, more vigilant surveillance and early referral and treatment.

Risk for Psychiatric Disorder Among Immigrants and Their US-Born Descendants

Although previous research has consistently documented that immigrants to the United States have better mental health than US natives, little is known about why this difference occurs. DSM-IV anxiety, mood, impulse control, and substance use disorders were assessed in a nationally representative survey of the US household population, the National Comorbidity Survey Replication. Differences in risk for disorder between immigrants (N = 299) and 5124 natives (N = 5124) were examined using discrete time survival models. Differences were estimated by generation, age of immigration, and duration of residence in the United States. Immigrants had lower lifetime risk of disorder than natives (OR = 0.7; 95% CI, 0.5-0.9). Risk was equally large for natives who were children of immigrants as for natives of subsequent generations. For mood and impulse control disorders, risk equal to that of natives was also found among immigrants who arrived in the United States as children (12 years of age or younger). Immigrants had lower risk than natives prior to arrival in the United States, but there was a trend toward equalization of risk with longer duration of residence in the United States. Differences in risk for disorder emerge within a single generation following immigration, consistent with a strong effect of environmental factors on changes in risk among immigrant populations. This pattern is consistent with either of two causal processes, one involving early socialization in the United States and the other involving postmigration experiences among immigrants who arrive in the United States as adults.