The United States has always been a country of immigrants, and US Census projections show an increase in the immigrant population in the coming years. In 1990, immigrants were 7.9% (20 million) of the US population, in 2013 they were 13.1% (41.3 million), and in 2023 the immigrant population is projected to reach 14.8% (51 million) of the total US population.1 The ebb and flow of immigrants and their countries of origin have varied widely historically. The modern era of immigration started with the 1965 immigration reform that reopened legal immigration from Asia after a long hiatus while placing a cap on legal immigration from Latin America for the first time ever. In the subsequent years, labor demand in the United States, coupled with economic dislocation in Mexico, made that country the leading source of migrants to the United States. In addition, war, economic hardship, and political instability leading to violence led many to flee Central America and Southeast Asia, changing the character of first-generation immigrants in the United States from mostly European in the first half of the 20th century to mostly Latin American and Asian since then.

Social policy affecting these immigrants has also ebbed and flowed. The United States helped Cuban and Indo-Chinese refugees settle through special policies (eg, the Indochina Migration and Refugee Assistance Act in 1975). On the other hand, many Central Americans and Haitians who entered the country without authorization were not given lawful permanent resident status but were also not subject to deportation, thus they were in a tenuous, indeterminate position with regard to citizen status and rights. In the 1990s, a number of anti-immigrant social policies were passed and included the 1996 federal legislation that barred many recent legal immigrants from public benefits as well as state-level attempts to bar undocumented children from attending public schools (subsequently ruled unconstitutional by the US Supreme Court).2 Currently, states have a wide variety of laws that either facilitate immigrant health and well-being or complicate life for immigrants.3

Perhaps, fueled by these inconsistencies and social injustices, the scholarship and interest in immigrant health have exploded over the past 15 years. When the first Handbook of Immigrant Health was published in 1998, it provided a comprehensive overview of the existing literature in 30 chapters.4 Since then, whole journals have been established on the topic and an update to the Handbook is now an encyclopedia that contains an astounding 586 chapters.5

The interest in the topic of immigrant health is also indicated by the large number of submissions we received for this theme issue of Family & Community Health. While we received more than 40 submissions, we could only publish 7 articles because of space restrictions. We were pleased with the wide variety of topics and immigrant groups represented. Despite the diversity of immigration to the United States, the literature tends to be overshadowed by research on Mexican immigrants. One of our goals was to publish literature that reflected diverse immigrant populations; thus, while we include research on Mexican migrants, we also feature articles on migrants from Korea, the Philippines, and India. The scope of the articles represents issues currently at the forefront of immigrant health research: health risks (overweight and obesity), mental health and substance abuse, access to health care, childhood development, designing research efforts to include migrant populations, and community interventions. These articles speak to the importance of the social determinants of health, including discrimination, which promotes an adverse social environment and affects the educational, psychological, and social well-being of immigrants and the children of immigrants. Underscoring the potential role of interdisciplinary research, participatory practice, and activist scholarship,6 this series of articles also highlights the complexities of health problems immigrants face as one takes into account socioeconomic status, ethnicity, gender, and other issues:

* Two different studies report on obesity risks in effort to improve prevention activities among immigrants. Park et al document both the challenges and resources of Korean immigrant mothers in preventing childhood obesity, whereas Afable et al find that the well-documented association of length of residence in the United States and obesity exists for Filipino immigrants, but only for those who arrived before the age of 30 years. These studies document not only the common trends that exist across diverse immigrant groups but also the importance of understanding the unique dynamics of different groups.

* Examining effects of internal migration on substance use within an indigenous community in southern Mexico, Zuniga and colleagues find that substance use patterns are associated with having migrated and worked in tourist destinations.

* In 2 different studies, Roberts et al and Sternberg et al report on mental health issues, including stress and sociocultural determinants, as found in an Asian Indian community and among Mexican immigrant women, respectively.

* In their report, Alcala et al identify barriers facing Latinos in accessing and using health care services in East Los Angeles.

* To provide insights on best practices to recruit and retain immigrant women in clinical trials and other research efforts, Han and colleagues interviewed and provide feedback from community health workers' perspectives on approaches to ensure representation of immigrants in future research.

While this special issue provides focused research on the important topic of immigrant health, we see a need for more empirical work as the media continues to report on immigration issues daily. Some of this exposure has been helpful. In fact, a recent Field Poll reported that 58% of California voters, up from 51% in the previous year, supported extending health care coverage to undocumented immigrants.7 At the same time, though, a leading presidential candidate supports the mass deportation of more than 10 million undocumented immigrants.8

The negative postures and attitudes announced so loudly in the media and influencing the nation's policy makers and legislators are often not based on solid facts. The articles in this special issue expand our knowledge on immigrant issues important for family and community health, building the body of facts that can be used to make appropriate decisions in policy and programs. We are hopeful that this research, coupled with other similar efforts, will be used to improve the health status, health care, and general well-being for the newest Americans.

-Steven P. Wallace, PhD

Professor and Chair

Department of Community Health Sciences

University of California Los Angeles

Michael A. Rodriguez, MD, MPH

Department of Family Medicine

University of California Los Angeles

REFERENCES