Collecting Biological & Other Sensitive Health Data from Legal and Unauthorized Migrants in Household Surveys

1. Collecting Biological & Other Sensitive Health Data from Legal and Unauthorized Migrants in Household Surveys EnricoMarcelli 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

2. 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)

3. Some States, Locales & CBOs Also Concerned

4. Conflicting Messages on June 15th & Today

5. Outline • Why Collect Representative Migration & Health Data? • Two Decades of Community-based (Bio)Demographic Migrant Household Surveys with Legal Status & Health Data • Survey Methodology (e.g., 2007 Harvard-UMASS Boston Metro Immigrant Health & Legal Status Survey) • Interviewer Deference & Experience Effects on Collecting Biological and Other Sensitive Health Data • Workshop Participant Activities • How would we collect deportation data? • How would we collect data on “stress”? • Discussion

6. 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)

7. II. Household Surveys with Representative Legal Status and/or Health Data • Despite expressed skepticism (Jasso2004; Massey & Bartley 2005; Massey and Capoferro2004; Van Hook & Bean 1998), researchers have been collecting migrant legal status in sample surveys for decades: • 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)

8. III. Boston & Los Angeles Survey Methods 2007 Boston Metro Immigrant Health & Legal Status Survey (BM-IHLSS) • Harvard University & UMASS Boston Researchers • EnricoMarcelli, 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 • Community Partners • Fausto de Rocha, Executive Director, Brazilian Immigrant Center • MagalisTroncoso, Executive Director, Dominican Development Center • Robert Wood Johnson Foundation • NCI Harvard-UMASS Boston U56, UMASS Boston & Blue Cross Blue Shield Foundation of Massachusetts

9. 2007 BM-IHLSS • Stratified Multistage Systematic Cluster Household Probability Sample (e.g., Brazilian adult migrants residing in the Boston-Cambridge-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) Socio-political identity • Biological data collection included: (1) Height, weight and blood pressure, (2) saliva, and (3) blood droplets

10. Boston-Cambridge-Quincy Metropolitan Area

11. 307 Brazilian Questionnaires (73 Neighborhoods)

12. Census Block Canvassing

13. Household Screening & Consent

14. Questionnaire: Household

15. Questionnaire: Adult Migration

16. Questionnaire: Adult SES

17. Questionnaire: Adult Social Capital

18. Questionnaire: Adult Health

19. Questionnaire: Child Well-Being

20. Differential Responsiveness

21. CBO-Funder Reports and Journal Articles

22. 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)

23. 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? • 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)

24. 5 Major Biological Systems Related to Allostatic Load Crimmins and Seeman (2000: 20)

25. Brazilian Migrants Having Provided Sex Partner or Biological Health Data, 2007 BM-IHLSS

26. Interviewer Skin Color & Provision of Blood Droplets

27. Probability of Having Answered Sexual Partner Question

28. Probability of Having Provided Height, Weight & Blood Pressure Data

29. Probability of Having Provided Saliva

30. Probability of Having Provided Blood Droplets

31. 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”?

32. 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