Latinx Sexual Minorities, Linguistic Acculturation, and Behavioral Health: A Healthy Migrant Effect?

Background and Purpose: Sexual orientation is a frequent motivation for migrating from Latin America. Sexual minorities have long been found to have a higher prevalence of adverse behavioral health outcomes, as predicted by minority stress theory. Cultural stress theory also predicts that language-related stress for non-English speakers will also result in a higher prevalence of adverse behavioral health outcomes. However, foreign-born Latinx individuals have typically been found to have a lower prevalence of adverse behavioral health outcomes, referred to as the “healthy migrant effect.” This study explores the extent to which the healthy migrant effect is observed among LGB Latinx individuals by examining the relationship between English language proficiency (a proxy for acculturation) and behavioral health outcomes.

Method: We used pooled cross-sectional data from the Latinx respondents to the 2015-2019 National Survey on Drug Use and Health, resulting in an analytic sample of 35,435. English language proficiency (ELP) was measured on a three-point scale regarding how well the respondent reported speaking English: “Very well,” “Well,” and “Not well/Not at all.” A dichotomous variable was created for sexual minority status, combining individuals identifying as gay, lesbian, or bisexual. We used logistic regression models to examine the association of ELP with past-year major depressive episode (MDE) and past-year substance use disorder (SUD). Given the use of non-linear models, interactions were tested by examining marginal effects to determine if sexual minority status moderated the association between ELP and behavioral health outcomes. Models were adjusted for sociodemographic variables and survey year. Sensitivity analyses were conducted by stratifying analyses by gender.

Results: Limited English proficiency was negatively correlated with MDE and SUD (aOR: 0.67, 95%CI: 0.59-0.75 and aOR: 0.65, 95%CI: 0.58-0.73) and sexual minority status was positively correlated with both outcomes (aOR for MDE: 2.72, 95%CI: 2.24-3.31 and aOR for SUD: 2.26, 95%CI: 1.96-2.61). The average marginal effect (AME) of sexual minority status on MDE was 9.1 (95%CI: 6.5-11.7pp) percentage points (pp) for individuals who spoke English “Very well” and 4.6 (95%CI: 1.4-7.8pp) for individuals who spoke English “Well.” The AME was not significant for individuals who spoke English “Not well/Not at all” (2.5pp, p=0.200). A similar trend was observed for SUD. The AME of sexual minority status on SUD for individuals who spoke English “Very well” was 7.4pp (95%CI: 5.6-9.2pp) for sexual minorities and 3.8pp (95%CI: 1.6-6.0pp) for individuals who spoke English “Well.” The AME was not significant for individuals who spoke English “Not well/Not at all” (1.6pp, p=0.250).

Conclusions and Implications: Latinx sexual minority individuals with limited English proficiency were less likely to report adverse behavioral health outcomes than their sexual minority counterparts with greater English proficiency. Latinx sexual minorities with limited English proficiency did not differ significantly from their heterosexual counterparts also reporting limited English proficiency. Results suggest a healthy migrant effect with regards to sexual minority migrants and behavioral health, and indicate that acculturation may be a strong risk factor for sexual minorities. LGBT+ Latinx migrants may particularly benefit from preventative measures to avoid adverse behavioral health outcomes from developing.