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

Abstract

PurposeThe 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.ParticipantsA 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 dateAt 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 plansLongitudinal 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.

Type 2 Diabetes Among Filipino American Adults in the Multiethnic Cohort

“…Our results align with the hypothesis that increasing BMI and other lifestyle behaviors may be responsible for the rising type 2 diabetes rates and agrees with findings among women with Filipino ancestry (31), young adults in the Philippines (32), Japanese migrants to the US (33), and a re- view of worldwide migrant populations (34). Once Filipino immigrants acculturate to the US, they may start to consume a more American diet and eat fewer Filipino foods (13), in addition to adopting other disease risk factors of the host country, as is often described in migration studies (17,21). Indeed, our results indicate that 2nd-and 3rd-generation Filipino American adults were more likely to smoke, consume alcohol, be overweight or obese, and score lower on fruit intake than 1st-generation individuals who had left their home country.…”

“…Selection bias -sometimes called the "healthy immigrant hypothesis," which states that healthier individuals are more likely to migrate than those in poor health -may underlie the often-seen better health outcomes for 1st-generation immigrants (18,19). In the new country, however, immigrants and their descendants typically experience changes in risk factors (17). As shown for cancer incidence among Japanese (20) and Filipino (21) migrants, risks align more closely to the levels of the host country, often after adoption of behaviors prevalent in the new country.…”

“…Migrant studies comparing risk factors and disease incidence across generations have made important contributions to the understanding of disease etiology, as generational status, shift in risk factors, prevalence, and age at migration have a role in understanding how changes in exposure affect disease risk ( 17 ). Selection bias — sometimes called the “healthy immigrant hypothesis,” which states that healthier individuals are more likely to migrate than those in poor health — may underlie the often-seen better health outcomes for 1st-generation immigrants ( 18 , 19 ). In the new country, however, immigrants and their descendants typically experience changes in risk factors ( 17 ).…”

Heterogeneity in Migrant Health Selection: The Role of Immigrant Visas

“…The present analyses utilized HoPES baseline data for migrants and nonmigrants. The response rates were 36.5% for migrants and 68.6% for nonmigrants (de Castro et al 2019). A total of 1,637 migrants and nonmigrants completed the baseline assessment in English, Tagalog, or Cebuano.…”

Strategies to Enhance Retention in a Cohort Study Among Adults of Turkish Descent Living in Berlin

“…While many studies described reasons for non-participation in population-based studies, there have been only a restricted number of migrant cohorts; hence, little is known about characteristics of non-participants in such cohorts [25]. Persons of Turkish descent represent the largest group of persons with migration backgrounds in Germany and, thus, they are an important target group [26].…”