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What’s in a word? Language and self-assessed health in the National Health and Nutrition Examination Survey

Meredith Van Natta, Zachary Zimmer


This study examines the extent to which the Spanish language influences the way in which respondents report health using the ubiquitous self-assessed health (SAH) outcome. We account for citizenship status, ethnicity, and a series of other covariates. The study uses the 2003-2016 national health and nutrition examination survey (NHANES) (n=39,107). Analyses treat SAH as non-ordered categorical and employ multinomial regressions. Results indicate that those answering in Spanish are considerably and significantly more likely to rate health as “fair/regular” ceteris paribus. Non-U.S. citizens and naturalized citizens are significantly more likely to rate their health favorably in comparison to U.S.-born; those identifying as Hispanic, Black, and other/multiracial are likely to rate health less favorably than others regardless of citizenship or interview language. A model that examines only foreign-born and accounts for years lived in the U.S. shows Spanish language still strongly predicted SAH outcomes, but years spent in the U.S. did not, a finding that does not support notions of acculturation. The study concludes that there is a language bias in the standard SAH measure typically used national-level health surveys and national-level surveys such as NHANES should adjust the question translation to better understand the health of immigrants.


self-assessed health; citizenship status; immigrant health; NHANES; survey language

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