Seeking to Prevent Immigrant Health Declines: Applying the Cultural Resource Hypothesis to Asian Americans

Problem: Despite the many stressors associated with moving to a new country, immigrants tend to arrive in the U.S. with better physical and mental health than their native-born counterparts, a phenomenon termed the “immigrant paradox” and documented among a host of populations (Alegría, 2004; Mossakowski, 2007; Rumbaut, 1996; Takeuchi, 2002; Vega, 1991). Over time, this health advantage erodes such that the health status of long-term immigrants becomes comparable with that of the U.S.-born (Alegría, 2007; Finch, 2003; Frisbie, 2001; Zhang, 2009). Numerous reasons have been proposed to explain this downturn, from exposure to social stresses like discrimination (Gee, 2002; Noh, 2003) and difficulty adjusting to minority status (Mossakowski, 2007) to changes in behavior, lifestyle, social support, and relative socioeconomic status (Cook, 2009; Gong, 2006; Ma, 2004). However, results have been equivocal and it remains unclear whether protective factors exist that might inhibit this health decline, particularly among Asian Americans, a historically under-studied population (Takeuchi, Gong & Gee, 2012).

Objective: Examine whether the “cultural resource hypothesis” proposed by Abdou and colleagues (i.e., 2010, 2012), which posits that nonmaterial resources derived from culture buffer the negative health effects of stressors related to ethnic minority status, can help to explain health outcomes among Asian Americans.

Methods: Data come from the National Latino and Asian American Survey (NLAAS), the first nationally representative epidemiological study of Asian Americans (n=2,095). Logistic regression analyses were conducted to examine the contributions of three types of cultural resources (ethnic identification, religious attendance and native language proficiency) to mental and physical health outcomes. Two-way interactions between each cultural resource and duration of time in the U.S. were entered into a second set of models to explore moderation effects. All models were estimated for the full sample, then stratified by ethnic group (Chinese, Filipino, Vietnamese). Mental health was operationalized as a composite of 11 ICD disorders; physical health as a composite of chronic conditions including cardiovascular, respiratory, pain, and other conditions. All multivariate analyses controlled for sociodemographics and used weighted values to account for the multistage complex survey design.

Results: Findings are suggestive of both direct and indirect effects of cultural resources on health among Asian Americans. Native language proficiency has protective associations with both mental and physical health. Ethnic identification moderates the effect of duration in U.S. on mental health, while native language moderates the effect of duration on physical health. Meanwhile, frequency of religious attendance is associated with an elevated risk of physical health problems.

When stratified by ethnic group, a more nuanced pattern of results emerges. Native language proficiency is protective of mental health among Chinese respondents and of physical health among Vietnamese respondents. Ethnic identification moderates duration in U.S. for Vietnamese physical health.

Implications: The cultural resource hypothesis is a promising framework for explaining heterogeneity in health outcomes among Asian Americans. Programs that promote use of cultural traditions such as maintenance of native language capacity may mitigate the health declines observed among immigrant populations; this protective effect may be especially pronounced among Chinese and Vietnamese ethnic groups.