Collecting Biological & Other Sensitive Health Data from
Legal and Unauthorized Migrants in Household Surveys
Enrico Marcelli
San Diego State University
enrico.marcelli@sdsu.edu
7th Annual Institute on Migration & Global Health
The California Endowment (Tahoe Room)
1000 North Alameda Street
Los Angeles, CA
1:30-4:30pm, June 25th, 2012
Rep. Joe Wilson (R – S.C.) Apologizes
for Calling President Obama a Liar
"This evening I let my emotions get the
best of me when listening to the
President's remarks regarding the
coverage of illegal immigrants in the
health care bill. While I disagree with the
President's statement, my comments
were inappropriate and regrettable. I
extend sincere apologies to the President
for this lack of civility.” (September 10th,
2009)
Some States, Locales & CBOs Also Concerned
Conflicting Messages on June 15th & Today
Outline
I.
Why Collect Representative Migration & Health Data?
II. Two Decades of Community-based (Bio)Demographic
Migrant Household Surveys with Legal Status & Health Data
III. Survey Methodology (e.g., 2007 Harvard-UMASS Boston
Metro Immigrant Health & Legal Status Survey)
IV. Interviewer Deference & Experience Effects on Collecting
Biological and Other Sensitive Health Data
V. Workshop Participant Activities
• How would we collect deportation data?
• How would we collect data on “stress”?
VI. Discussion
I. Motivations
• Benefits of representative behavioral & biological health data
from relatively young foreign-born migrants (Crimmins &
Seeman 2000, Hayes-Batista 2002; McDade et al. 2007)
• Biodemographic methods for using nonmedically trained
interviewers to collect biological data in household surveys
(Christensen 2000; Ice & James 2007; Jaszczak 2009)
• Collection of biological data from legal and unauthorized
migrants in household surveys (Marcelli et al. 2007; Holmes and
Marcelli 2012; Marcelli and Holmes 2012)
• Conflicting findings regarding the Latino health (biological
risk profile) paradox (Crimmins et al. 2007; Finch et al. 2009)
• Few studies on interviewer effects on collecting biological &
other sensitive health data from migrants (Blom et al. 2011)
II. Household Surveys with Representative
Legal Status and/or Health Data
• Despite expressed skepticism (Jasso 2004; Massey & Bartley 2005;
Massey and Capoferro 2004; Van Hook & Bean 1998), researchers have
been collecting migrant legal status in sample surveys for decades:
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1980-1981 Los Angeles County Parents Survey (LACPS)
1988 National Agricultural Workers Survey (NAWS)
1994/2001 L.A. County Mexican Immigrant Legal Status Survey (LAC-MILSS)
1996 Survey of Income and Program Participation (SIPP)
1996-1997 Hispanic Immigrant Health Care Access Survey (HIHCAS)
1999-2000 L.A.-NYC Immigrant Survey (LANYCIS)
1999 California Health Interview Survey (CHIS)
2000-2001 L.A. Family and Neighborhood Survey (LAFANS)
2004 Mexican Immigrant Migration and Mobility Survey (MIMMS)
2005 Chicago Metro Mexican-origin Population Study
2007 Boston Metro Immigrant Health & Legal Status Survey (BM-IHLSS)
III. Boston & Los Angeles Survey Methods
2007 Boston Metro Immigrant Health &
Legal Status Survey (BM-IHLSS)
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Harvard University & UMASS Boston Researchers
• Enrico Marcelli, Ph.D., Principal Investigator
• Gary Bennett, Ph.D., Co-Principal Investigator
• Howard Koh, Ph.D., Co-Principal Investigator
• Phillip Granberry, Ph.D., Project Manager (BM-IHLSS, Dominican)
• Louisa Holmes, Project Manager (BM-IHLSS, Brazilian)
• Orfeu Buxton, Ph.D., Consultant
• Anthony Roman, MA, Consultant
• Jonathan Winickoff, Ph.D., Consultant
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Community Partners
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Fausto de Rocha, Executive Director, Brazilian Immigrant Center
Magalis Troncoso, Executive Director, Dominican Development Center
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Robert Wood Johnson Foundation
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NCI Harvard-UMASS Boston U56, UMASS Boston & Blue Cross Blue Shield
Foundation of Massachusetts
2007 BM-IHLSS
• Stratified Multistage Systematic Cluster Household Probability
Sample (e.g., Brazilian adult migrants residing in the BostonCambridge-Quincy Metro Area, n=427)
• Self-reported and biological data collected between June and
September, 2007
• Instrument included household roster, adult questionnaire, child
questionnaire, and biological data collection checklist
• Adult questionnaire divided into five sections: (1) Migration
experience, (2) SES, (3) Social Capital, (4) Health, and (5) Sociopolitical identity
• Biological data collection included: (1) Height, weight and blood
pressure, (2) saliva, and (3) blood droplets
Boston-Cambridge-Quincy Metropolitan Area
307 Brazilian Questionnaires (73 Neighborhoods)
Census Block Canvassing
Household Screening & Consent
Questionnaire: Household
Questionnaire: Adult Migration
Questionnaire: Adult SES
Questionnaire: Adult Social Capital
Questionnaire: Adult Health
Questionnaire: Child Well-Being
Differential Responsiveness
160
Brazilian
Dominican
46%
140
44%
Number of Households
120
33%
100
29%
80
25%
24%
60
40
20
0
1
2
Number of Interviewer Attempts to Complete Questionnaire
3
CBO-Funder Reports and Journal Articles
IV: Two Hypotheses Regarding Interviewer
Influences on Migrant Health Data Collection
• The Deference Hypothesis (Groves et al. 2004)
Migrants are more likely to provide biological and sensitive health
behavior data if the interviewer is, or is perceived to be, of a
higher socioeconomic status (e.g., more education, lighter skin
pigmentation)
• The Experience Hypothesis (Cannell et al. 1977)
Migrants are more likely to provide biological and sensitive health
behavior data if the interviewer is, or is perceived to be, a more
experienced interviewer or more mature (e.g., more survey
experience, older)
Research Question & Analytical Categories
How do interviewer characteristics and behaviors influence
obtaining sex partner and biological health data from legal and
unauthorized migrants in household probability sample surveys?
1.
2.
3.
4.
5.
6.
7.
Interviewer characteristics & behaviors
Migrant (subject) characteristics
Questionnaire design
Data collection mode
Family (household) environment
Neighborhood composition and context
“Social capital” (networks and civic group participation)
Sources: Groves (1987); Groves et al. (2004: 169-199, 269-301); Tourangeau and
Smith (1996)
5 Major Biological Systems
Related to Allostatic Load
Crimmins and Seeman (2000: 20)
Brazilian Migrants Having Provided Sex Partner
or Biological Health Data, 2007 BM-IHLSS
Interviewer Skin Color & Provision of Blood Droplets
Probability of Having Provided Blood Droplets
70%
65%
60%
55%
Legal Brazilian Migrant
50%
45%
40%
Unauthorized Brazilian Migrant
35%
30%
1
2
3
4
5
6
7
Interviewer Skin Color (Massey and Martin 2003)
8
9
10
Probability of Having Answered Sexual Partner Question
Probability of Having Provided Height,
Weight & Blood Pressure Data
Probability of Having Provided Saliva
Probability of Having Provided Blood Droplets
Workshop Participant Activities
Group 1: How would you collect representative
deportation data from migrants
residing in the USA as part of a
household survey?
Group 2: How would you collect representative
data on “stress”?
Discussion
• Building on more than two decades of successful legal status survey
data collecting in the USA, and recent developments in
biodemography (McDade 2007) and social epidemiology (Berkman
and Kawachi 2000), the 2007 Boston Metro Immigrant Health &
Legal Status Survey (BM-IHLSS) shows that Brazilian migrants are
willing to provide biological and other sensitive health data in
probabalistic household surveys
• The probability of providing biological and behavioral health data is
conditioned on the level of sensitivity associated with the outcome,
and unaffected by migrant legal status
• Biomarker results (but sexual behavior results partly) support the
subject deference and interviewer experience hypotheses, and
suggest that extra-individual level factors also influence migrant
subject willingness to provide sensitive health data