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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

Article ID: 1015
Vol 5, Issue 1, 2019, Article identifier:1-12

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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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