Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study.

Studies of migration and health focus on a "healthy migrant effect" whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (ß = 0.32; 95% CI = 0.22, 0.43) and at 1-year (ß = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.

Cohort profile: the Health of Philippine Emigrants Study (HoPES) to examine the health impacts of international migration from the Philippines to the USA.

PURPOSE: The Health of Philippine Emigrants Study (HoPES) longitudinally investigates over 3 years whether migrating from the Philippines to the USA results in increased risk for obesity relative to non-migrants in the Philippines. The study is designed to test the healthy immigrant hypothesis by collecting health measures from migrants starting from a pre-migration baseline and enrolling a non-migrant cohort matched on age, gender and education for comparison. PARTICIPANTS: A migrant cohort (n=832; 36.5% of eligible individuals) was recruited from clients of the Commission on Filipinos Overseas prior to exiting the Philippines. A non-migrant cohort (n=805; 68.6% eligible individuals) was recruited from community households in municipalities throughout the cities of Manila and Cebu. By intention, these two cohorts are comparable demographically, including urban/rural status of residency in the Philippines at baseline. FINDINGS TO DATE: At baseline, compared with non-migrants, migrants report significantly better self-rated health and less depression, and have significantly larger hip circumference and lower waist-to-hip ratio, as well as significantly higher mean systolic blood pressure and higher mean level of apolipoprotein B. Baseline results can offer insight into the health status of both migrant and non-migrant populations and may be useful for obesity prevention efforts. FUTURE PLANS: Longitudinal data collection is scheduled to be completed in December 2020 when the final data collection wave (36 months after baseline) will conclude. Both migrant and non-migrant cohorts will be maintained beyond the current prospective study, so long as research funding allows and emerges for new study questions. Findings from future longitudinal analyses can inform the need and design of health-related/relevant interventions, whether clinical, behavioural, educational, or policy, that can be implemented at the individual or population level.

Health of Philippine Emigrants Study (HoPES): study design and rationale.

BACKGROUND: Immigrants to the United States are usually healthier than their U.S.-born counterparts, yet the health of immigrants declines with duration of stay in the U.S. This pattern is often seen for numerous health problems such as obesity, and is usually attributed to acculturation (the adoption of "American" behaviors and norms). However, an alternative explanation is secular trends, given that rates of obesity have been rising globally. Few studies of immigrants are designed to distinguish the effects of acculturation versus secular trends, in part because most studies of immigrants are cross-sectional, lack baseline data prior to migration, and do not have a comparison group of non-migrants in the country of origin. This paper describes the Health of Philippine Emigrants Study (HoPES), a study designed to address many of these limitations. METHODS: HoPES is a dual-cohort, longitudinal, transnational study. The first cohort consisted of Filipinos migrating to the United States (n = 832). The second cohort consisted of non-migrant Filipinos who planned to remain in the Philippines (n = 805). Baseline data were collected from both cohorts in 2017 in the Philippines, with follow-up data collection planned over 3 years in either the U.S. for the migrant cohort or the Philippines for the non-migrant cohort. At baseline, interviewers administered semi-structured questionnaires that assessed demographic characteristics, diet, physical activity, stress, and immigration experiences. Interviewers also measured weight, height, waist and hip circumferences, blood pressure, and collected dried blood spot samples. DISCUSSION: Migrants enrolled in the study appear to be representative of recent Filipino migrants to the U.S. Additionally, migrant and non-migrant study participants are comparable on several characteristics that we attempted to balance at baseline, including age, gender, and education. HoPES is a unique study that approximates a natural experiment from which to study the effects of immigration on obesity and other health problems. A number of innovative methodological strategies were pursued to expand the boundaries of current immigrant health research. Key to accomplishing this research was investment in building collaborative relationships with stakeholders across the U.S. and the Philippines with shared interest in the health of migrants.

Traditional and Modern Contraceptive Method Use in the Philippines: Trends and Determinants 2003-2013.

This study examines recent levels, patterns, and determinants of traditional contraceptive method use, based on pooled data from the 2003, 2008, and 2013 Philippines Demographic and Health Surveys. Most contraceptive users in the Philippines rely on modern methods, but over the past ten years traditional method use has continued to account for about a third of all contraceptive use. Results show women in 2003 and 2008 were more likely to use periodic abstinence (rhythm) over modern methods compared with women in 2013, while withdrawal rather than modern methods was preferred more by women in 2013 than in 2003. The characteristics of women who use traditional methods have changed little over the past decade. Knowing the characteristics of traditional contraceptive method users can help establish policies and programs that promote more effective contraceptive use, including encouraging users of traditional contraceptive methods to switch to the more effective modern methods.

An examination of the causes, consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving-a mixed method study.

BACKGROUND: Dramatic increases in the migration of human resources for health (HRH) from developing countries like the Philippines can have consequences on the sustainability of health systems. In this paper, we trace the outflows of HRH from the Philippines, map out its key causes and consequences, and identify relevant policy responses. METHODS: This mixed method study employed a decentered, comparative approach that involved three phases: (a) a scoping review on health workers' migration of relevant policy documents and academic literature on health workers' migration from the Philippines; and primary data collection with (b) 37 key stakeholders and (c) household surveys with seven doctors, 329 nurses, 66 midwives, and 18 physical therapists. RESULTS: Filipino health worker migration is best understood within the context of macro-, meso-, and micro-level factors that are situated within the political, economic, and historical/colonial legacy of the country. Underfunding of the health system and un- or underemployment were push factors for migration, as were concerns for security in the Philippines, the ability to practice to full scope or to have opportunities for career advancement. The migration of health workers has both negative and positive consequences for the Philippine health system and its health workers. Stakeholders focused on issues such as on brain drain, gain, and circulation, and on opportunities for knowledge and technology transfer. Concomitantly, migration has resulted in the loss of investment in human capital. The gap in the supply of health workers has affected the quality of care delivered, especially in rural areas. The opening of overseas opportunities has commercialized health education, compromised its quality, and stripped the country of skilled learning facilitators. The social cost of migration has affected émigrés and their families. At the household level, migration has engendered increased consumerism and materialism and fostered dependency on overseas remittances. Addressing these gaps requires time and resources. At the same time, migration is, however, seen by some as an opportunity for professional growth and enhancement, and as a window for drafting more effective national and inter-country policy responses to HRH mobility. CONCLUSIONS: Unless socioeconomic conditions are improved and health professionals are provided with better incentives, staying in the Philippines will not be a viable option. The massive expansion in education and training designed specifically for outmigration creates a domestic supply of health workers who cannot be absorbed by a system that is underfunded. This results in a paradox of underservice, especially in rural and remote areas, at the same time as underemployment and outmigration. Policy responses to this paradox have not yet been appropriately aligned to capture the multilayered and complex nature of these intersecting phenomena.

Order Amidst Change: Work and Family Trajectories in Japan.

Substantial family and work macro-level change has been occurring in Japan. Examples include a decline in the availability of jobs that afford lifetime protection against unemployment, an increase in jobs that do not carry benefits such as a pension, an increase in age at marriage and at first birth, and an increase in marital dissolution. Using life history data from the 2000 National Survey on Family and Economic Conditions, young Japanese appear to have responded to these macro-level changes in a fairly orderly manner. Marriage and childbearing have been postponed, but marriage still precedes childbearing. Education is completed prior to starting work. For men, once work commences they continue working. For women, the classic conflict between work and family roles is evident. For men and women in both the family and work spheres Japanese young adults have more orderly life course trajectories than American young adults.