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

Abstract

BackgroundImmigrants 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.MethodsHoPES 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.DiscussionMigrants 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.

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

“…For example, according to the 2011–2013 American Community Survey (https://www.census.gov/programs-surveys/acs), among immigrant Filipinos who have been in the USA for less than 2 years, 11% are men aged 20–34 with a college education, which is the same percentage of this same group in the HoPES migrant cohort. Additional details are reported elsewhere 30…”

Pre-acculturation as a risk factor for obesity: Findings from the Health of Philippine Emigrants Study (HoPES)

“…Data come from the Health of Philippine Emigrants Study (HoPES). We briefly describe the study below; additional details are available (Gee et al, 2018). HoPES has 2 cohorts, a migrant sample (n = 832) that planned to emigrate to the U.S. and a non-migrant sample (n = 805) that remained in the Philippines.…”

“…Only 1.4% would depart more than 2 months from baseline. HoPES participants are representative of the recent Filipino immigrant population in the U.S. (Gee et al, 2018).…”

“…Trained staff measured participants’ height, weight, waist circumference, and hip circumference using a standardized protocol (Gee et al, 2018). All measures were taken thrice, and a fourth measure was taken if discrepancies among measurements exceeded pre-established thresholds; the three closest measures were averaged.…”

“…The U.S. is the top receiving country for Filipino immigrants (Commission on Filipinos Overseas, 2010). In 2016, approximately 1.9 million Filipino immigrants resided in the U.S., making them the fourth largest immigrant population (behind those from Mexico, India, and China) (Gee et al, 2018).…”