The Social Determinants of Immigrant Well-Being: An Intersectional Analysis

Background

Despite the increasing understanding of migration as a gendered process, scholars have not fully explored the importance of examining the influence of structural forces through factors such as gender, race/ethnicity, and class, crucial for mitigating gaps in achieving immigrant health equity. What is still not clear is how these multiple dimensions of power structures intersect and impact overall immigrant well-being outcomes. Yet, without such understanding, we are left with an inadequate analysis of macro-level structural factors such as the social, political, and economic context that creates ill-informed health policy decisions in achieving health equity and sustaining communities. Findings from this study highlight larger discourses about structural vulnerabilities and its overlapping effects on immigrant well-being in the US.

Methods

Using a complex survey analysis (N=11,181) of the California Health Interview Survey 2012, this study examined the incremental variance of social and intermediary determinants of health on immigrant well-being. Through Stata SE v.14, this study accounted for the elements of sampling design, stratification, clustering, and raking adjustments of the CHIS dataset. It included the survey weight and 80 replicate weights created using the jackknife delete-2 method in the computation of four phased statistical analysis: Descriptive Analysis, Confirmatory Factor Analysis, Moderated Hierarchical Regression, and Intersectional Analysis.

Results

Results showed that the effects of moderated relationships between structural vulnerability factors are significant predictors of immigrant well-being and this is conditional based on gender, race, class, age, and marital status. Structural & intermediary determinants of health such as income, education, employment, immigrant status, social cohesion, food security, and home and work environment were powerful predictors of immigrant well-being. There was a negative association between gender and well-being for women (β= -.169, p<.05). Within the Asian population, women (β=.174) were likely to have higher levels of well-being compared to men (β=.113, p<.05). However, when class was taken into account, women showed lower levels of well-being. Levels of well-being for women in a higher class was comparable to well-being levels for men in a lower class (FPL3 women β= -.2399, p<.05, FPL2 men β= -.2210, p<.05). There were significant moderation effects between gender, race, and class among specific racial/ethnic and gender groups [Asian men (β= -.314, p<.05), Latino men (β = -.616, p<.05), Pacific Islander women (β=-.247, p<.05), and Black women (β=-.169, p<.05). Marital status with age decreased well-being levels among women while it increased among men. There were significant moderation effects between gender and race for men who belonged to Black race/ethnicity (β= .362, p<.05). When class was added, however, women who belonged to Pacific Islanders and Black populations showed decreased levels of well-being. Findings affirm that the intersections of structural vulnerabilities can magnify the adverse impact on freedoms and daily functioning, creating structural barriers for vulnerable groups such as minority immigrants resulting in health inequities, ultimately affecting their overall well-being.

Implications

The study provides implications for social determinants of health frameworks, policy implications for data disaggregation, and lays the groundwork for social work theorizing and research as we ensure healthy development of all youth.