Examining the Association of Sexual Health Behaviors and Immigration Status Among Community Health Center Patients

Background and Purpose: The heterogeneity of immigration in the US reflects complex cultural processes of acculturation, racial socialization, and assimilation that influence sexual health behaviors in unique ways. There is limited research, which explores how the process of acculturation and racial/ethnic variations within immigrant populations influences sexual and reproductive health (SRH) behaviors. One critical factor that contributes to sexual health disparities among US born and foreign-born populations is the number of sexual partners. Higher numbers of sexual partners can lead to an increased risk for sexually transmitted infections. This study examines the relationship between immigration status and sexual health behaviors, specifically number of sexual partners, among a sample US born and foreign population.

Methods: The study included a sample of 5661 US born and foreign-born community health center patients (age range = 18−45). Data was obtained from the 2017 New York State Community Health (CHS) survey, conducted in New York State. The dependent variable is the number of sexual partners in the last 12 months (0 = no partners, 1= one partner, 2= two or three partners, and 4 = four and above). The focal independent variables are race (white or black) and immigrant status (US born or Foreign born). The study categorized the sample into four groups (US born white, US born black, Foreign born white, and Foreign born black). Descriptive statistics and a series of ordinal logistic regression models were conducted. Analyses included socio-demographic variables (such as age, gender, education, and so on).

Results: The sample includes US born white (n=2495, 43.92%), US born black (n=1407, 24.77%), Foreign born white (n=937, 16.49%), and foreign born blacks (n=842, 14.82%). Descriptive results indicated variations in the number of sexual partners by race and immigration status. For example, compared to US born black patients, foreign born black patients are 20% less likely to have higher (4 or more) number of sexual partners. Similar results are obtained from the ordinal logistic regression analyses. US born black patients have the highest likelihood to report a greater number of sexual partners, and US born white patients have a slightly lower odds ratio (.94) which is not statistically significant at the level of .05 (p =.41). Compared to US born black patients, both Foreign born white patients(OR=.80, p<.05) and black patients (OR =.80, p<.05) showed reduced odds of identifying more sexual partners.

Conclusions and Implications: Findings indicate that differences in sexual partners among immigrants and US born population exists within black groups. This result adds support to previous literature suggesting that black populations are heterogeneous and tailored culturally appropriate approaches are needed to examine diverse sexual health practices within this group. In addition, the results suggest that indicators for risky sexual behaviors, such as number of sexual partners may vary by immigration status. These findings may prove to be beneficial and prioritize specific groups for tailored health intervention education and policies. Future research will further explore the intersection of sexual health behaviors, immigration status and racial/ethnic groups.