problems immigrants face in america essay

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Two years ago, I had an incredible, eye opening experience. I was working with several refugee groups in Salt Lake City, Utah, and over the span of one year I found myself constantly impressed and amazed at their perseverance and strength.

You would think that the struggles faced by refugees would be over once they arrived in the land of the free, right? I certainly did. And so did many of the refugees I worked with. I learned, however, that this is far from the case. Refugees, and immigrants especially, are faced with many barriers once they arrive on our shores.

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Here are just a few:

1. Difficulty speaking and learning English

Let’s be honest- my country, the United States, is not known for being multilingual. So imagine arriving here, unable to speak English. Try getting a job, making friends, or even completing basic tasks like buying food or filling out forms.

To address this, many refugees and immigrants take ESL classes, but finding the time between jobs and caring for kids can be difficult. Especially difficult if you weren’t literate in your native tongue to begin with.

2. Raising children and helping them succeed in school

One of the biggest obstacles refugees and immigrant parents report is raising their children in a new, unfamiliar culture. Parents often find that their children are quickly “Americanized,” which may be at odds with their own culture. Additionally, kids tend to pick up English much faster than their parents. This throws off the parent-child dynamic, and you know that kids, especially teens, are going to use this to their advantage.

With regards to school, parents often feel disappointed to see their children struggling to keep up in class, and many parents report bullying and discrimination as a result of cultural differences. Kids are often placed by their age rather than by their ability, and for those who are unable to speak English, it’s virtually impossible to keep up. To add further insult to injury, parents may not have the education or language skills to assist their children, and they may not be able to communicate with faculty to address the problem.

3. Securing work

While most refugees and immigrants are happy to take whatever job is available when they first enter the country, finding a job, and slowly moving up the ladder, is incredibly difficult. Even if you ignore undocumented immigrants who face additional challenges securing work, trouble speaking English is a major problem in positions you might not expect like labor. Refugees and immigrants who are educated and who formerly had strong jobs back home, find it frustrating that they can’t obtain the same jobs here. Employers typically prefer work experience within the US, and certifications outside of the US usually don’t transfer. That’s why it’s not uncommon for your taxi driver to have formerly worked as an educator or engineer.

Additionally, refugees and immigrants are easy victims for discrimination and exploitation in the workplace. Some employers recognize the sense of urgency and desperation among these groups to keep their jobs, so they will have them take the less desirable and even dangerous roles. Undocumented immigrants, particularly, assume they have no rights, and workers who can’t speak English are easy targets.

4. Securing housing

I don’t have to tell you that safe, affordable housing is expensive. So imagine trying to obtain that with low-paying jobs. For that reason, large families often choose to live together, creating stressful, noisy environments that are hardly conducive to studying or resting.

Again, refugees and immigrants fall victim to exploitation, this time from their landlords. In Utah, for instance, I worked with a group of Karen refugees from Myanmar who were forced to live in apartments known by the landlord to have bedbugs. Once, one of those buggers was spotted, the families would be forced to pay an expensive fee to have them removed, and the landlord would attempt to charge them additional fees or threaten to kick them out. Unable to speak English and unfamiliar with our laws, many of the families complied- even though it was clearly a scam.

5. Accessing services

Undocumented immigrants have an especially difficult time accessing services, largely because they are afraid of being deported. Consequently, people will avoid seeing the doctor or reaching out for services like legal guidance when they’re badly needed.

Those who are here legally aren’t necessarily in the clear, though. Difficulty speaking English, trouble taking off work, and limited transportation (we’ll get to that) are all very real issues.

Accessing mental health issues is especially problematic. Many times, refugees and immigrants have been exposed to violence, rape, even torture- but they may not know how to seek help. Furthermore, mental health issues are taboo in many cultures, creating an additional barrier for those in need.

For those who are able to successfully obtain the services they need, the experience is usually negative. In Utah, I heard stories about law enforcement professionals misunderstanding a victim’s statement due to language barriers, and doctors misdiagnosing sick patients for the same reason.

6. Transportation

Like language barriers, trouble with transportation is an issue that affects nearly every aspect of life for refugees and immigrants.

Obtaining a driver’s license, whether documented or not, is extremely difficult for a variety of reasons. For those who don’t speak English, a translator is needed, and they aren’t easy to come by. Also, the driver must be literate in order to to pass the written exam.

With some luck, families will have one car to share among them, but getting kids to and from school, as well as getting adults to and from work can be challenging. Many times, the men will keep the car, leaving it up to the women to find their own rides from friends or coworkers. As you can imagine, having so many people rely on one car makes it incredibly difficult to fit in additional commitments like ESL classes and medical appointments.

But hey, what about public transportation? While many refugees and immigrants do rely on public transportation to get around, it can be incredibly frightening for some. In Utah, a man I worked with from the International Rescue Committee shared a story about one of his clients. The client was from a very rural town where there were no paved roads or traffic signs. My coworker recognized that because of her limited English, she might need assistance figuring out how to take the bus to reach the IRC for her appointments. He accompanied the woman to and from the IRC for her first appointment, but assumed she would be fine on her own from then on. The next week, he received a call from her, crying and terrified. Because she was not familiar with our roads, she had never learned how to cross the street safely nor how to read the traffic signs. Consequently, several cars honked at her while she illegally crossed the street. She then got on the correct bus, but became confused as to what stop she needed to get off at and was unable to ask. I can only imagine how scary that must have been for her.

7. Cultural barriers

Again, just like transportation and trouble speaking English, cultural barriers transcend each and every aspect of life for refugees and immigrants.

Here’s an example. In Utah, a group of Latter Day Saints were organizing a week long hike for youth in the desert. Some of the organizers thought it might be a nice idea to include some of the refugee youth, as a way in integrate them into the community and help them make friends with some of the local kids. I remember hearing about this and thinking it was such a wonderful idea. But, less than a day into the hike, some of the refugee kids became very upset. The hike, it turned out, had reminded them of the time when they were forced to flee their homes. Now, despite the group’s kindest intentions, these kids were being retraumatized. This just goes to show how easy it is for these kinds of cultural misunderstandings to take place.

In spite of all of these challenges, the people I worked with were incredibly strong and grateful for the opportunity to be in the United States. Most of them had such basic desires: to have their children succeed in school and to be be able to put a roof over their heads. After everything they had already been through, they were doing all that they could to keep their families afloat in this new, scary place.

Curious what you can do? It’s simple! So many refugees and immigrants, particularly undocumented, feel like outsiders, or worse- they feel invisible. So if you come across someone who who can tell is new to the country, start a conversation! I’m guessing he or she will have some amazing stories to share.

To learn more, download this PDF published by the Robert Wood Johnson Foundation

Demand Equity

7 of the Biggest Challenges Immigrants and Refugees Face in the US

Dec. 12, 2014

Immigration Issues in the United States Essay

Introduction, national concerns, self-identity, benefits of immigration, discussion and recommendations.

Immigration is a vital context of the American Dream and national identity. However, the outdated immigration system and globalization trends have led to a shift in perception of immigration as white nationalism is on the rise. There are socio-political concerns about the impact of immigration on self-identity and security of the United States. This report seeks to investigate these fears and compare them to the benefits for the country to determine if immigration should be curbed. A discussion is held regarding the perceptions and realities of international migration and its principles from a political and ethical perspective. Recommendations are then provided regarding reform of the national immigration system.

Immigration is the foundation of the United States as a country. It was built on the labor, ideas, and cultural melting pot of immigrants coming to the US in the hopes of achieving the American dream, finding a new life, and establishing a home for their families. This report seeks to investigate whether the United States should be defined as a nation of immigrants or should it take extensive efforts to curb foreign entry into the country. The United States has built its self-identity on immigration and its extraordinary socio-economic and technological progress depends on it, but in the realities of an unstable global society, measures should be taken to ensure neutrality and competence in immigration policy.

The US has one of the largest immigrant populations in the world, exceeding 40 million individuals, which is around 14% of the total population (Migration Policy Institute, 2019). In recent years, there has been a rise in nationalism which places the blame on the nation’s socio-economic issues on immigration and challenging the concept of the US self-identity. There is an overwhelming public debate and policymakers are commonly unable to reach an agreement on immigration due to the complexity of economic, security, and humanitarian concerns.

From an economic standpoint, anti-immigration critics consider immigrants to be taking away jobs and creating a strain on public services funded by taxes. Security is being challenged as a significant amount of violence and drug crime is attributed to immigrants, particularly those illegally entering the country. The current Trump administration was elected and continues to gather massive support on its strong anti-immigration policies, particularly targeting Muslim and Hispanic migrants for security purposes (Felter & Renwick, 2018).

The words of an identity crisis are unheard of in other parts of the world where everyone is classified based on their characteristics, family, or religion. Mukherjeee (1997) recalls “The concept itself — of a person not knowing who he or she is — was unimaginable in our hierarchical, classification-obsessed society” (par. 6). However, the United States and many countries in Europe have been or becoming increasingly culturally pluralistic and diverse.

As a result of populations and cultures intertwining, influences and opinions coming from many directions, and new generations being born into varied mixed backgrounds, identity is becoming lost. Some regions are experiencing violence, instability, and lack of direction due to immigration and pluralism (Chua, 2007). This is concerning for the core white population of the United States, not just due to the concern about the loss of control and privilege, but also the prolonged effect immigration has on national stability, value system, and institutions.

Immigration has been studied for centuries, and in the United States, it has been a vital part of cultural and economic development. First, it is considered to be almost universally by experts to be an economic driver to the country by contributing to demographic growth, human capital, talent acquisition, and innovation. If the immigrant flow is managed flexibly and efficiently, it can generate U.S. economic growth at times of relative stagnation.

A restrictive policy is detrimental as the legislation limits legal work-related immigration among highly-educated scientists and engineers as well as the less educated labor force in construction and agriculture that few core Americans would participate in (Orrenius, 2016). The mobility, specialization, and motivational drive of immigrants have proven continuously to be a significant economic benefit.

In terms of self-identity and national culture, immigration holds various benefits as well. It introduces new customs, beliefs, and ideas into the general folklore and traditions of the nation. Many of the things that are considered innately American have their origins from immigrants bringing these aspects into the country for centuries and celebrating them in local communities. Immigrants are also known for their rich and active culture and civic lives as they participate in the American democratic process and local communities, allowing for the establishment of international and tolerant networks.

Furthermore, it is important to consider that migrants often link together, and a healthy immigration base in the country that actively engages in the aspects described above ensures that incoming immigrants are more likely to do so and less willing to participate in radical or criminal activity (McCarthy, 2018).

In a modern liberal society, free movement is considered to be an inalienable right, which if limited would provide a precedent for limitation of other human rights. However, these rights are realistically only observed within country borders. International migration is often done to improve lives and those of their families; therefore, instilling a system of migration control would be coercion, that has historically and will continue to produce violence at the borders. This not only applies to border checkpoints and building the “Wall”, but various aspects such as measures that peaceful migrants attempt to gain entry into the country and threats that they face once settled down, for both legal and illegal aliens (Waldinger, 2018).

The reality is that there is no country without borders, and although such boundaries do imply discrimination, it is necessary to protect U.S. citizens. In a world where the number of immigrants exceeds the capacity of a country to take them in, choices must be made regarding admissions criteria of whom the country would be willing to accept as residents. This remains to be the primary socio-political debate from which the U.S. society will never find an escape. However, should be considered that immigration serves as both, a source for international integration and national fragmentation (Waldinger, 2018).

In the context of immigration, with its threats and benefits, it is evident that the immigration system requires comprehensive and intelligible reform. In her essay, Chua (2007) suggests, “if the U.S. immigration system is to reflect and further our ethnically neutral identity, it must itself be ethnically neutral, offering equal opportunity to [all]” (p. 3). Based on the discussion earlier, there should be more concrete criteria that would allow for a modern rules-based approach to immigration.

Most Americans support legal immigration and accept it as part of the American social contract despite the highly emotional nature of it. Historically, there have always been regulations in place regarding nationality and family ties, with very few people being able to afford passage to the United States. These rules were relaxed in the late 20th century, and it is ultimately left to the voters whether a new system should be re-established again.

The U.S. should bring forward incentives for immigration that were present in the past while laying down harsh penalties for violations of the law by individuals and companies. The aspects of immigration that are commonly exploited such as birthright tourism should be eliminated. Meanwhile, incentives such as professional opportunities under a legal status and safety if following proper refugee procedures would help establish a competent system (Gray, 2019). Although there would be challenges and undoubtedly, debate, the system eventually will balance out if a non-ideological and politically correct approach is taken to reforming it.

Immigration is a critical issue in the current political agenda. There are legitimate national concerns regarding security and national identity. However, immigration brings tremendous benefits economically, socially, and culturally, allowing to form a unique melting pot that promotes inclusivity and tolerance while driving forward economic growth and innovation. Nevertheless, the United States had been built on immigration and it should not be curbed significantly, but rather strong measures taken in policy reform to incentivize legal and dedicated immigrants while eliminating those seeking to use it for enrichment or illegal purposes.

Chua, A. (2007). The right road for America? Washington Post. Web.

Felter, C., & Renwick, D. (2018). The U.S. immigration debate . Web.

Gray, M. W. (2019). America’s immigration policy needs an overhaul . National Interest. Web.

McCarthy, J. (2018). 5 ways immigration enhances a country’s culture . Global Citizen . Web.

Migration Policy Institute. (2019). Frequently requested statistics on immigrants and immigration in the United States . Web.

Mukherjee, B. (1997). American dreamer . Mother Jones . Web.

Orrenius, P. (2016). Benefits of immigration outweigh the costs . The Catalyst, 2 . Web.

Waldinger, R. (2018). Immigration and the election of Donald Trump: Why the sociology of migration left us unprepared … And why we should not have been surprised. Ethnic and Racial Studies, 41 (8), 1411-1426. Web.

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IvyPanda. (2021, June 8). Immigration Issues in the United States. https://ivypanda.com/essays/immigration-issues-in-the-united-states/

"Immigration Issues in the United States." IvyPanda , 8 June 2021, ivypanda.com/essays/immigration-issues-in-the-united-states/.

IvyPanda . (2021) 'Immigration Issues in the United States'. 8 June.

IvyPanda . 2021. "Immigration Issues in the United States." June 8, 2021. https://ivypanda.com/essays/immigration-issues-in-the-united-states/.

1. IvyPanda . "Immigration Issues in the United States." June 8, 2021. https://ivypanda.com/essays/immigration-issues-in-the-united-states/.

Bibliography

IvyPanda . "Immigration Issues in the United States." June 8, 2021. https://ivypanda.com/essays/immigration-issues-in-the-united-states/.

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Guest Essay

How to Fix America’s Immigration Crisis

Attempted crossings at the U.S. southern border in 2023

3.1 million

600k estimate

“Encounters” by U.S. Customs and Border Protection

2.5 million

Expelled under

Processed under Title 8

1.9 million

New immigration

court cases

added this year

1.5 million

New immigration court

cases added this year

In ongoing proceedings or legal limbo

1.8 million

Deportation order, expulsion, etc.

Relief granted

The immigration problem Congress faces is large and complex. Let’s break it down. Between October 2022 and September 2023, there were 3.1 million attempted crossings along the U.S. southern border.

Of that, an estimated 600,000 migrants were able to cross the border undetected, according to the Department of Homeland Security.

The U.S. government had 2.5 million migrant “encounters” , 83 percent of which occurred between designated ports of entry, often in dangerous, remote locations like the Sonoran Desert .

Over half a million migrants were expelled under Title 42, a policy enacted during the pandemic that allowed border officials to expel migrants without a deportation hearing. The Biden administration lifted the policy in May 2023.

Most were processed under Title 8 immigration law , which covers a wide range of issues, including asylum, visas, refugees and deportations.

Almost 200,000 were placed into expedited removal proceedings, usually because of a criminal record or a prior border apprehension. Others voluntarily left to avoid further processing.

Roughly 300,000 migrants were given humanitarian parole at the border and allowed to temporarily live in the United States — a status available to migrants from a handful of countries such as Venezuela and Nicaragua.

Including migrants who were apprehended elsewhere or were referred after other proceedings, nearly 1.5 million new cases were added to the immigration court system in the last fiscal year.

Only a small number of new cases were decided in the year they were added. As of the end of 2023, some 1.8 million of the new arrivals remained in the United States with their case waiting in the backlog or with some other form of temporary status.

Only a minute fraction of new court cases ended in a deportation last year. But nearly 900,000 migrants were removed through other channels.

Of the nearly two million migrants who were processed under Title 8 last year, just 2,700 were granted formal relief in the form of asylum and other paths towards permanent residency.

Sources: U.S. Customs and Border Protection, Transactional Records Access Clearinghouse, U.S. Immigration and Customs Enforcement and the Department of Homeland Security. Note: These figures are for fiscal year 2023, which starts in October 2022 and ends in September 2023.

By Steven Rattner and Maureen White Graphics by Taylor Maggiacomo

Mr. Rattner served as counselor to the Treasury secretary in the Obama administration. Ms. White is a senior fellow at the Johns Hopkins School of Advanced International Studies, specializing in refugee issues.

The recent surge of migrants at our southern border, which reached a high in December, has, at long last, brought Democrats and Republicans closer to agreement on one thing: the need for immediate attention to our broken immigration system.

We have an underfunded immigration apparatus that is swaddled in bureaucracy, complicated beyond imagination, bound by decades-old international agreements, paralyzed by divisive politics and barely functional under the best of circumstances.

Now we face the terrible consequences. In fiscal year 2023 alone (from October 2022 to September 2023), the United States had two and a half million “encounters” along its 2,000-mile border with Mexico, according to U.S. Customs and Border Protection. That is over two and a half times the number just four years ago, overwhelming the ability of governmental bodies — border patrol, immigration courts, human services agencies — to manage the flow.

Migrants wait to be processed by the U.S. Customs and Border Patrol after they crossed the Rio Grande and entered the U.S. from Mexico.

Eric Gay/Associated Press

The continued escalation of the crisis has allowed Republicans to leverage the issue in exchange for more aid for Ukraine and Israel, which in turn has pushed a bipartisan group of senators and White House officials into marathon negotiations.

Broadly speaking, Democrats want more money to process the backlog while Republicans want to substantially narrow the grounds on which migrants would be permitted to remain in the United States (along with building more of the wall that Donald Trump has been urging). We need lots of the former and a bit of the latter.

Immigration court backlog

3 million pending cases

The backlog has doubled since 2021, increasing caseloads to around 4,500 per judge .

Source: Transactional Records Access Clearinghouse

Note: Data of November 2023. December 2023 is projected.

The Democratic push for more funding is correct. The country’s immediate need is to unclog the immigration court system that has allowed millions of asylum seekers to float around the country, unable to work for the first six months after entry and then potentially remain in limbo for years. During the 2023 fiscal year, just 670,000 cases were resolved in the courts.

So, yes to money for more border agents, processing staff, asylum review officers and judges.

But that’s not enough. We must reduce the flow to the border, which will require making immigrating into the U.S. by such means more difficult. As Republicans have long demanded and Democrats are coming to see as necessary, our obligation under international law to provide asylum need not create chaos.

Percentage of immigration court cases resolved per year

In the 2012 fiscal year, 207,000 immigration cases were resolved, or 39 percent of all cases.

By 2023, the government managed to resolve 670,000 cases, yet because of the surge in its backlog, this represented only 19 percent of all cases.

30% of cases

Fiscal year

For starters, we should require asylum seekers to apply in Mexico or other countries, including their home countries, before they reach the U.S., reducing the incentive to travel here to gain entry during drawn-out proceedings. Both Mr. Trump and Mr. Biden have tried to accomplish this, but these changes have been mired in legal challenges and strained negotiations with Latin American countries. For this to succeed, the United States needs to work with Mexico to make conditions there safe for asylum seekers in waiting.

Next, we need to tighten the asylum criteria.

For example, we should make a greater distinction in the asylum process between those who followed established procedures and entered the country through an established port of entry and those who crossed along our border between ports of entry.

Mr. Biden has already started down this path, with a new federal rule requiring migrants to obtain appointments at ports of entry (or show they’ve been denied asylum in another country) to be eligible for the standard path to asylum. Others will face far tougher criteria to gain relief.

This rule is being challenged in the courts, and it needs to be codified by Congress as part of the current negotiations.

Average time to complete a case in the immigration court system

The average time to resolve an immigration case spiked during the pandemic, peaking in 2022 at over three years.

While recognizing the need for due process, we should raise the legal standard for consideration for asylum from a “significant possibility” that asylum would be granted to something closer to the standard used for final decisions in immigration court, reducing the number of duplicative hearings and administrative delays.

We may also need to further limit the use of humanitarian parole, a program expanded by the Biden administration that allows more migrants from places like Venezuela and Nicaragua to temporarily enter the country and apply for relief. As heartbreaking as it may be, we simply cannot take every refugee from every failed state.

Of course, the most humane way to reduce the flow to our border would be to help improve conditions in the countries from which many of the new arrivals emanate. But we chose differently: Over the past 10 years, our aid spending has dropped to a paltry 0.2 percent of our gross domestic product, from 0.3 percent.

In the long run, we need to come to a national consensus on how many immigrants we want to accept and the bases for determining who is chosen. That includes balancing the two principal objectives of immigration policy: to meet our legal and moral humanitarian obligations to persecuted individuals and to bolster our workforce.

A group of migrants cross the Rio Grande river into the U.S. near the Paso Del Norte international bridge in Juarez, Chihuahua, Mexico.

Ivan Pierre Aguirre for The New York Times

Without immigration, our population would begin to decline in 2037, according to United Nations projections. Even continuing to admit a million legal immigrants a year would leave our population flatlining within half a century. Maintaining our historical population growth rate of 1 percent would suggest admitting nearly four million individuals a year.

While that may be more than today’s politics can withstand, we should care about keeping the number of Americans growing at a reasonable rate. Immigration is our defense against the challenges of an aging society. Fewer workers supporting more retirees makes it harder to adequately fund Social Security and Medicare.

Given that unemployment is at 3.7 percent, near the all-time low, no one can sensibly argue that these additions to the labor force would cost Americans jobs. Increasing legal pathways would also help reduce the illegal labor that endangers migrants and undercuts American workers.

Moreover, reshaping our immigration policies to prioritize skills that are in particularly short supply would be a win-win. At present, only 27 percent of green card recipients are chosen for their skills. And we still don’t automatically provide green cards to non-Americans who graduate from our universities. That is insane.

A better immigration system is possible. With the right policy, resources and political will, we can live up to our country’s ideals and still maintain a safe and orderly southern border.

Methodology

The analysis reflects major processing pathways visible with the best data available to the public and are not completely exhaustive. “Non-border cases” reflects the difference between court notices delivered at the border, estimated court notices delivered through expedited removal referrals, and the total nation-wide new proceedings available in courts data. Fiscal year 2023 courts outcomes data scaled from published fourteen-month figures to twelve months.

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The Effects of Perceived Discrimination on Immigrant and Refugee Physical and Mental Health

Magdalena szaflarski.

Department of Sociology, University of Alabama at Birmingham, HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152

Shawn Bauldry

Department of Sociology, Purdue University, 700 W. State Street, Stone 326 B, West Lafayette, IN 47907

Associated Data

Discrimination has been identified as a major stressor and influence on immigrant health. This study examined the role of perceived discrimination in relation to other factors, in particular, acculturation, in physical and mental health of immigrants and refugees.

Methodology/approach

Data for US adults (18+ years) were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Mental and physical health was assessed with SF-12. Acculturation and perceived discrimination were assessed with multidimensional measures. Structural equation models were used to estimate the effects of acculturation, stressful life effects, perceived discrimination, and social support on health among immigrants and refugees.

Among first-generation immigrants, discrimination in health care had a negative association with physical health while discrimination in general had a negative association with mental health. Social support had positive associations with physical and mental health and mediated the association of discrimination to health. There were no significant associations between discrimination and health among refugees, but the direction and magnitude of associations were similar to those for first-generation immigrants.

Implications

Efforts aiming at reducing discrimination and enhancing integration/social support for immigrants are likely to help with maintaining and protecting immigrants’ health and well-being. Further research using larger samples of refugees and testing moderating effects of key social/psychosocial variables on immigrant health outcomes is warranted.

Originality/value

This study used multidimensional measures of health, perceived discrimination, and acculturation to examine the pathways between key social/psychosocial factors in health of immigrants and refugees at the national level. This study included possibly the largest national sample of refugees.

The US foreign-born population continues to grow and is becoming increasingly diverse. The number of immigrants reached a historic record high of 43.5 million in 2015, is currently at 44.5 million, and is estimated to grow to 78 million by 2065 ( Lopez & Bialik, 2017 ; Zong & Batalova, 2017 ). When most immigrants enter the United States, their health is generally better than that of US-natives. However, for many immigrants, the longer they stay in the US, the worse their health becomes ( National Academy of Sciences, 2015 ; G. Singh, Rodriguez-Lains, & Kogan, 2013 ; G. K. Singh & Miller, 2004 ). Refugees – people who have fled their native country because of persecution, war, or violence – have unique health problems over and beyond the general immigrant population. Common concerns among refugees include poor mental health, nutritional deficiencies, pain problems, and undiagnosed chronic conditions ( Eckstein, 2011 ; Mishori, Aleinikoff, & Davis, 2017 ). There are multiple challenges to optimal health status for immigrants and refugees in the US, such as linguistic and cultural barriers, socioeconomic limitations, access to health care, stress due to adaptation and everyday living, and social integration issues (e.g., isolation) ( National Academy of Sciences, 2015 ).

One of the major stressors affecting the health of immigrants and refugees in the US, especially those from racial-ethnic minority backgrounds, is racism and discrimination ( Ayon, 2015 ; Pascoe & Smart Richman, 2009 ; Takeuchi, 2016 ; Williams, 2012 ). Racial discrimination, along with other forms of social disadvantage, has detrimental effects on health and contributes to existing health disparities ( Colen, Ramey, Cooksey, & Williams, 2017 ; Smedley, Stith, & Nelson, 2003 ; Williams, 2012 ). At the societal level, racism and discrimination operate through residential segregation and when individuals are unequally treated in accessing jobs, education, healthcare, social services, and so on, due to their foreign-born status, ethnic origin, and/or race ( Ayon, 2015 ; Williams, 2012 ). At the individual level, discrimination “gets under the skin” as an acute and chronic stressor that activates physiological responses, such as elevated blood pressure, heart rate, and cortisol secretions, that trigger declines in mental and physical health ( Clark, Anderson, Clark, & Williams, 1999 ; Williams, 1999 ). Perceived discrimination, defined as a behavioral manifestation of a negative attitude, judgment, or unfair treatment toward members of a group ( Williams, 1999 ), has been associated with poor mental and physical health ( Paradies, 2006 ; Pascoe & Smart Richman, 2009 ; Williams, 2012 ; Williams & Mohammed, 2009 ; Williams, Neighbors, & Jackson, 2003 ). Routine discrimination, in particular, may erode an individual’s protective resources and increase vulnerability to physical illness through over- or underactivity of allostatic systems ( Seeman, Singer, Rowe, Horwitz, & McEwen, 1997 ).

Racial/ethnic minority immigrants have been suggested to experience discrimination differently from their US-born counterparts ( Gee, Ryan, Laflamme, & Holt, 2006 ). Immigrants acquire minority status within the US society after arrival. The longer immigrants stay, their reported levels of discrimination tend to increase ( Finch, Frank, & Hummer, 2000 ; Goto, Gee, & Takeuchi, 2002 ). In addition, foreign-born status may interact with racial/ethnic background; for example, Black immigrants may be treated better than their US-born counterparts initially, but this advantage is likely to disappear over time ( Read & Emerson, 2005 ; Waters, 2000 ). Furthermore, skin tone and English-language proficiency influence immigrants’ experiences of discrimination, with darker skin tones and lower language proficiency being linked to greater levels of discrimination ( Ayon, 2015 ; Frank, 2010 ).

Immigrants experience discrimination in work places (e.g., exploitation, immigration raids), housing (e.g., residential segregation), and access to and quality of health care ( Ayon, 2015 ). One of the major way in which opportunities and discrimination operate among immigrants and refugees is through US citizenship. Citizenship grants immigrants similar rights and protections as US natives. Naturalized citizens do better than the non-citizens on some socioeconomic and mobility measures (education, jobs) and access to quality neighborhood living ( Aguirre & Saenz, 2006 ; Bloemraad, 2000 ). In terms of health care, unauthorized immigrants and recent arrivals are often prevented from accessing public benefits such as Medicaid ( Fortuny & Chaudry, 2011 ), and they are less likely than native-born and other immigrants to have a usual source of care, visit a medical professional in an outpatient setting, use mental health services, or receive dental care ( Derose, Bahney, Lurie, & Escarce, 2009 ; Pourat, Wallace, Hadler, & Ponce, 2014 ; Rodriguez, Bustamante, & Ang, 2009 ). Even refugees, who are entitled to resettlement support including Medicaid, have problems with access and quality care because of long waits for or disruption in benefits, gaps in follow-up, and significant linguistic and cultural barriers ( McNeely & Morland, 2016 ; Mishori et al., 2017 ; Philbrick, Wicks, Harris, Shaft, & Van Vooren, 2017 ). The foreign-born and non-English speakers are also less satisfied with their health care and report more discrimination ( Derose et al., 2009 ).

There are growing concerns about the well-being of immigrants and refugees due to rising anti-immigrant sentiments ( Gostin, 2017 ; Philbrick et al., 2017 ). In addition to a long-standing battle for immigration control and immigration reform, the issue of refugees, mainly Muslims, became a controversial topic during the 2016 US presidential election and continues today. During the campaign, derogatory language was used to describe immigrants from Mexico, and shortly after winning the election, President Donald Trump issued an executive order barring Syrian refugees indefinitely, other refugees for 120 days, and travel from seven Muslim-majority countries for 90 days, claiming the need for America to protect itself against terrorism. Many perceived this move as racist and discriminatory. The initial ban caused disruption of immigrant lives, separated families, stranded travelers, and prevented students, skilled workers, sick patients to enter the US, and the ban continues to be challenged in courts ( Gostin, 2017 ).

Furthermore, protections for immigrants who came to the US as children and their families, the Deferred Action for Childhood Arrivals (DACA) program introduced by the Obama administration in 2012, are currently being dismantled. The issue has caused a stand-off in Congress and a government shut-down while Democrats and Republicans are negotiating DACA. Just when research is beginning to show favorable effects of DACA on immigrant physical and mental health ( Venkataramani, Shah, O’Brien, Kawachi, & Tsai, 2017 ), anti-immigrant policies and continuing rise of racism and discrimination pose a real health threat to immigrants and refugees ( Almeida, Biello, Pedraza, Wintner, & Viruell-Fuentes, 2016 ).

Considering the challenges that immigrants and refugees face in American society and gaps in knowledge regarding discrimination and refugee health, this study posed the following questions: (1) How does perceived discrimination -- overall and specifically in health care -- affect immigrant health and well-being? and (2) How does perceived discrimination affect the health and well-being of refugees, whose experiences and needs tend to differ from those of other immigrants? To answer these questions, this study used nationally representative data for US adults (18+ years) to estimate the direct, indirect, and total effects of perceived discrimination, acculturation, stressful life events, and social support on immigrant and refugee physical and mental health using structural equation models.

PROFILE OF US IMMIGRANT AND REFUGEE POPULATIONS

According to data from the US Census Bureau, 13.4 percent of the US population (44.5 million) in 2015 was foreign-born ( Lopez & Bialik, 2017 ). This is the highest percentage of the foreign-born population in 94 years. A total of 18.7 million of new immigrants (legal and illegal) came to the US between 2000 and 2014, including 7.9 million who arrived between 2008 and mid-2014, during the Great Recession ( Camarota & Zeigler, 2016 ). The majority of foreign-born are from Latin America (28% from Mexico and 24% from other Latin American countries) and Asia (26%, including 6% Chinese and 5% Indian); fewer immigrants have come from Europe and Canada (14%) and other countries (8%) ( Pew Research Center, 2015 ). States with the largest increases of immigrants include North Dakota, Wyoming, Montana, Kentucky, New Hampshire, Minnesota, and West Virginia.

Many immigrants, especially those from Mexico/Latin America, have modest levels of education and limited skills. As a result, they often occupy low-paying jobs in the service sector; for example, 49 percent of maids, 47% of taxi drivers, and 35 percent of construction workers are foreign-born. This group of immigrants is more likely to live in poverty, lack health insurance, and have lower rates of home ownership than US natives ( Camarota & Zeigler, 2016 ). However, the distribution of the immigrant population is socioeconomically bi-modal, and 40–51% of immigrants from South and East Asia, Middle East, Europe/Canada, and South America have college degrees. Thus, the overall rates of completed college education for the native and foreign-born population are actually similar (31% and 30%, respectively) ( Lopez & Bialik, 2017 ).

Although the US has the largest immigrant population in the world, Americans’ views of immigrants are mixed. In 2014, 41% of Americans said that immigrants are a burden to American society because they take jobs, housing, and health care ( Pew Research Center, 2015 ) and in 2015, 34% Americans believed that immigrants represent a threat to American customs and values ( Cooper, Cox, Lienesch, & Jones, 2016 ). However, the current attitudes are actually more positive than a decade earlier, when 63% of Americans in 1994 called immigrants a burden. A little more than half (51%) of American today say immigrant make America stronger, an increase from 31% in 1994 ( Pew Research Center, 2015 ). Attitudes toward immigrants also vary strikingly by age group, race, ethnicity, religious and political party affiliations, and region/state ( Cooper et al., 2016 ). A total of 68% of people ages 18–29 and 53% of people ages 30–49 think that immigrants strengthen American society, compared with 42% and 36% of people ages 50–64 and 65+, respectively. This likely represents cohort change in attitudes. Also, not surprisingly, large majorities of Asian-Pacific Islanders (70%) and Hispanic Americans (67%) believe that immigrants are a benefit to American society compared with a minority (45%) of whites.

A refugee is a person who has been forced to flee is their country. War and ethnic, tribal, and religious violence are the leading causes of refugees fleeing their countries (USA for UNHCR: The UN Refugee Agency). Approximately 3 million refugees have been resettled in the US since Congress passed the Refugee Act of 1980 ( Krogstad & Radford, 2017 ). The origins of refugees to the US have changed over time. In the late 1970s, there was an influx of refugees from Vietnam, and many refugees from Asia continued coming to the US through the mid-1990s. Relatively few refugees came from Latin America and Africa during those decades. In the 1980s and 1990s, Europe joined Asia as the second largest region of origin of the refugee population; during that time, many refugees from the Soviet Union and the former Yugoslavia came over. Through the 2000s, the numbers of refugees from Europe have been dropping, with most refugees coming from Asia and Africa, and some from Latin America. The geographic distribution of the most recent refugee population in the US has been uneven. In 2016, California, Texas, and New York resettled nearly a quarter of all refugees.

Over the years, large segments of the US population have opposed admitting refugees and has not welcomed refugees from specific countries or regions ( Krogstad & Radford, 2017 ). For example, in 1958, 55% of Americans disapproved of Hungarian refugees; in 1979, 62% disapproved of Indochinese refugees; and, in 1980, 71% disapproved of Cuban refugees. A third of Americans in 1999 also opposed admitting ethnic Albanians from Kosovo. The resistance toward refugees from countries where people are fleeing war and oppression has been growing in the recent years. Notably, 54% of registered voters in 2016 said that the US does not have responsibility to accept refugees from Syria. As noted earlier, these attitudes shaped the 2016 presidential election campaign and lead to the eventual ban efforts by President Trump and his administration.

WHAT DO WE KNOW ABOUT IMMIGRANT AND REFUGEE HEALTH?

There is a growing literature addressing immigrant health, especially mental health, in the contemporary US context. Research shows that despite a relative socioeconomic and cultural (e.g., linguistic) disadvantage, many immigrants have better health than their ethnic US-born counterparts ( G. K. Singh & Miller, 2004 ). This phenomenon has been labeled as an “immigrant health paradox” ( Tamara Dubowitz, Bates, & Acevedo-Garcia, 2010 ; Markides & Coreil, 1986 ). In this section, we briefly review evidence regarding physical and mental health of immigrants and refugees in the US, highlighting the differences between refugees and other immigrants.

Physical Health

Research examining eight national datasets (e.g., American Community Survey, National Health Interview Survey) has shown that immigrants have better infant, child, and adult health outcomes than their native ethnic counterparts and natives in general ( Colen et al., 2017 ; National Academy of Sciences, 2015 ; G. Singh et al., 2013 ). Compared to natives, immigrants have a lower incidence of all cancers combined, fewer chronic health problems and functional limitations, and lower rates of infant mortality, obesity, and overweight status ( G. Singh et al., 2013 ). This study also showed that immigrants had a 3.4 years higher life expectancy than natives. There were, however, conditions that were more common among immigrants from some ethnic backgrounds, compared to native counterparts. For example, deaths from stomach and liver cancers were more common among immigrants than natives. Also, Asian Indian, Chinese, Mexican, Cuban, Central American, and South American immigrants reported higher levels of poor or fair health compared with their native counterparts.

Few studies have considered both mental and physical health of immigrants. Jerant, Arellanes, and Franks ( Jerant, Arellanes, & Franks, 2008 ) compared four Hispanic groups (Mexicans, Cubans, Puerto, Ricans, and Dominicans), both US- and foreign-born, on self-rated health and mental health using the SF-12 assessment. Mexicans had better outcomes than Whites and other Hispanic groups regardless of nativity, but nativity was associated with worse physical and mental health among Mexican Americans and better health/mental health among Cuban Americans. Furthermore, Cuban immigrants had the lowest mental health score of all groups while migrants from Puerto Rico had the lowest physical health score, after adjusting for socioeconomic status and sociodemographics.

Refugees are an exception compared with the general immigrant population, in that they tend to have poorer physical health and some unique health problems and needs. Common health issues among refugees include nutritional deficiencies, chronic pain and musculoskeletal symptoms, and undiagnosed chronic conditions (e.g., asthma, diabetes mellitus, or hypertension) ( Mishori et al., 2017 ). In addition, some refugees have higher risks of tropical and infectious diseases (e.g., tuberculosis and sexually transmitted infections). Poor oral health is also a big problem due dietary issues and limited or no access to dental services pre-, peri-, and post-immigration.

Primary care physicians are advised to assess refugees’ circumstances – preflight, during flight/in camp/pre-departure, and at arrival/post-arrival ( Mishori et al., 2017 ). Preflight health risks include low social position in the country of origin; exposure to violence, threats, torture, sexual violence, or imprisonment; or, limited access to age-appropriate preventive services. Women are also screened for female genital mutilation. Flight-related health risks include, again, traumatic experiences (e.g., loss of family members), limited access to food/shelter and other basic necessities, prolonged hiding and/or refugee camp stay, and lack of or limited health screenings and treatments during flight. Health screenings and treatments on arrival/post-arrival are also considered, along with the individual’s current health status and access to health and social services and benefits (e.g., health insurance, case management, literacy).

Mental Health

Social epidemiological research using large national surveys (e.g., the National Survey of American Life or the National Latino and Asian American Studies) show that immigrants from minority racial-ethnic backgrounds have lower rates of mental disorders than their US-born counterparts ( Szaflarski et al., 2016 ; Szaflarski, Cubbins, & Meganathan, 2017 ; Takeuchi, 2016 ). Most community studies that comprise both treated and untreated cases of mental disorders also tend to find lower rates of mental health problems among immigrants compared with US natives. However, rates of mental disorders among immigrants tend to increase over time in the US. For example, research has shown that third generation of Latinos has higher rates of psychiatric disorders than first and second generation ( Alegria, Shrout, et al., 2007 ) while second and third generation of Asians ( Takeuchi, Alegria, Jackson, & Williams, 2007 ) and Caribbean blacks ( Williams et al., 2007 ) have higher rates of mental disorders than their respective first generation immigrants.

Refugees are again an exception to the general pattern of mental health advantage among immigrants, as they tend to have significant mental health problems. For example, refugees have relatively high rates of depression, anxiety, posttraumatic stress disorder (PTSD), and suicide ( Eckstein, 2011 ; Fazel, Wheeler, & Danesh, 2005 ; National Academy of Sciences, 2015 ). Refugees experience unique pre-and peri-immigration stressors compared to other immigrants, such as trauma of war, torture, terrorism, natural disasters, famine, and refugee camp living. These experiences combined with stresses of post-immigration make this group particularly vulnerable in terms of psychological well-being ( Eckstein, 2011 ; Mishori et al., 2017 ; Pumariega, Rothe, & Pumariega, 2005 ). Refugees are known to present in medical practice with somatic symptoms, sleep disorders, fatigue, paranoia, and suicidal thoughts ( Donnelly et al., 2011 ).

However, some research shows that refugees were significantly less likely than US-natives or non-refugee immigrants to report involvement in any non-violent or violent antisocial behavior ( Vaughn, Salas-Wright, Zhengmin, & Wang, 2015 ), though multiple years of living as a refugee were associated with higher likelihood of reporting involvement in violence. This research suggests that the immigrant health paradox may apply to some mental health issues among refugees.

WHAT DO WE KNOW ABOUT FACTORS SHAPING IMMIGRANT AND REFUGEE HEALTH?

Several explanations have been offered for the immigrant health advantage, including immigrant selection, home country’s lower disease risks, unhealthy American lifestyles, and changes in somatization of psychological and mental problems ( National Academy of Sciences, 2015 ; Takeuchi, 2016 ). Early research focused on the role of assimilation and acculturation to explain declines in immigrants’ health over time (e.g., ( Berry, 1992 )), but the focus has now been shifting to social structural conditions (racism, residential segregation) and social psychological factors such as discrimination experiences ( Almeida et al., 2016 ; Takeuchi, 2016 ; Williams, 2012 ). We lay out our conceptual framework for the study ( Fig. 1 ) by considering the immigrant assimilation and acculturation perspectives first, as it is the experience of being an immigrant or a refugee that creates conditions for experiences with discrimination (see the causal path from acculturation to discrimination in Fig. 1 ).

Conceptualized Effects of Discrimination, Acculturation, Stress, and Social Support on Health among Immigrants and Refugees

Acculturation and Acculturative Stress

Acculturation, the process of learning and adapting to the host country’s culture while maintaining the values, norms, beliefs, language, etc. of the country of origin, has received much attention ( Berry, 1992 , 2001 ). Acculturation has been found to have complex and mixed effects on health of US immigrants ( Lara, Gamboa, Kahramanian, Morales, & Bautista, 2005 ). For example, acculturation has been associated with some negative health behaviors and outcomes, such as substance abuse, poor dietary habits, and preterm births. However, acculturation is also associated with higher health care use and self-perceptions of health, as well as with higher satisfaction with health care and less discrimination ( Derose et al., 2009 ; Lara et al., 2005 )

One explanation for these mixed findings is that acculturation is not a linear or unidimensional process. In fact, different acculturation models exist ( Lara et al., 2005 ). Generally, the acculturation mode that involves both adapting to the new culture and retaining and maintaining elements of the old culture (bi-culturalism) leads to more positive health outcomes for immigrants ( Berry, 1992 , 2001 ). Acculturation modes may vary at the individual or family level, but also at the group level. For example, some ethnic groups may follow one acculturation mode more likely than others. There is also an intricate relationship between acculturation, socioeconomic status, ethnicity, and health. Acculturation can be associated with socioeconomic gains such as educational achievement. Education has been viewed as a major causal factor in higher/improved health status ( Mirowsky & Ross, 2003 ), but these gains are uneven across racial and ethnic groups. For example, the relationship between education and health has been weaker for Latino and Asian immigrants than non-Hispanic whites ( Acevedo-Garcia, Soobader, & Berkman, 2007 ; Goldman, Kimbro, Turra, & Pebley, 2006 ).

One aspect of acculturation often examined is the time spent in the US, but its influence on health outcomes is mixed. Research has shown that health problems such as hypertension, chronic illness, smoking, diabetes, and heavy alcohol use increase with US tenure ( Alegria, Mulvaney-Day, et al., 2007 ; Jackson et al., 2007 ; National Academy of Sciences, 2015 ; O’Brien, Alos, Davey, Bueno, & Whitaker, 2014 ; Ro, 2014 ; G. Singh et al., 2013 ; Takeuchi et al., 2007 ). However, continued interactions with members of the host-dominant society also expose immigrants to stress in the form of prejudice and discrimination, as well heightened aspirations ( Finch & Vega, 2003 ; McKeever & Klineberg, 1999 ), which are often harmful to health. Research shows that the accumulated stress from discrimination, poor working conditions, undocumented legal status, and limited English proficiency are linked with negative health outcomes, including self-reported health and mental health problems ( Finch & Vega, 2003 ; Yoo, Gee, & Takeuchi, 2009 ).

Another aspect of acculturation is the ability to speak English. Language proficiency helps immigrants to gain access to jobs, education, and social and health services, and it has been strongly associated with health among Asian, black, and Latino immigrants ( Gee, Walsemann, & Takeuchi, 2010 ; Kimbro, Bzostek, Goldman, & Rodriguez, 2008 ; Okafor, Carter-Pokras, Picot, & Zhan, 2013 ). However, being bilingual – speaking both English and one’s ethnic language – is also linked with positive health outcomes. Bilingual proficiency has been shown to provide access to resources and create opportunities for social mobility ( Chen, Benet-Martinez, & Bond, 2008 ).

Discrimination

While acculturation has been central to sociocultural explanations for immigrant health, its measures have been debated and it diverts attention from the historical, political, and economic contexts of migration (T. Dubowitz et al., 2007 ). In particular, discrimination has been identified as one of the mechanisms preventing successful integration of immigrants, and resulting in poor health outcomes ( Takeuchi, 2016 ; Williams, 2012 ). Racial and ethnic discrimination has been proposed as a key explanation for health disparities in the US ( Ayon, 2015 ; National Academy of Sciences, 2015 ). Individual and institutional measures of racial discrimination have associations with minority and immigrant health, even after controlling for a range of social and psychosocial factors, including acculturation ( Gee, 2008 ).

Perceived discrimination is a type of stressor that can cause wear and tear on the body and spirit and lead to premature illness and death ( Williams & Mohammed, 2009 ). Perceived discrimination has been associated with a wide range of health behaviors and outcomes such as smoking, alcohol use, obesity, hypertension, breast cancer, depression, anxiety, psychological, distress, substance use, and self-reported health across ethnoracial groups ( Gee, Ro, Shariff-Marco, & Chae, 2009 ; Paradies, 2006 ; Pascoe & Smart Richman, 2009 ; Williams, 2012 ; Williams & Mohammed, 2009 ; Williams et al., 2003 ), as well as physical health problems including hypertension, self-reported health, and breast cancer, as well as health risk factors, such obesity, high blood pressure, and substance abuse ( Colen et al., 2017 ; Pascoe & Smart Richman, 2009 ; G. Singh et al., 2013 ; Williams & Mohammed, 2009 ). A meta-analytic review showed consistent associations between perceived discrimination and various mental and physical health outcomes, although evidence regarding physical health was more limited ( Pascoe & Smart Richman, 2009 ). The review also identified potential mechanisms underlying these relationships including stress response, health behaviors, social support, personal coping, and group identification, but significant gaps in this knowledge remain.

Discrimination may vary by race, ethnicity, and nativity. For example, most studies find that discrimination is associated with poorer health among Asian Americans, though there is more evidence for mental health than for physical health ( Gee et al., 2009 ). Also, Caribbean Blacks appear to have fewer experiences with discrimination than their native counterparts, and their health is also relatively better ( Williams, 2012 ; Williams et al., 2007 ). However, with time in the US, Caribbean Blacks experience more discrimination, and the protective effects of foreign birth on health is likely to decrease or disappear. Also, few studies have focused on discrimination among immigrants specifically, but the available research shows patterns similar to those reported for ethnoracial groups ( Gee et al., 2006 ; Ryan, Gee, & Laflamme, 2006 ; Yoo et al., 2009 ). For example, Yoo and colleagues ( Yoo et al., 2009 ) have found that perceived language-related discrimination had a strong association with health among Asian immigrants living in the US 10 years or longer.

More and more research suggests that discrimination is intertwined with acculturation as an acculturation stressor ( Williams, 2012 ). Discrimination, legal status, and language conflict have been identified as some of the acculturation stressors that affect Latino immigrants’ health and well-being. Finch and Vega ( Finch & Vega, 2003 ) found these stressors to be linked with fair/poor health ratings (positive gross effect). In their study fair/poor health ratings also decreased with social support, including religious support, and social support moderated effects of discrimination on health. Other literature also points to an important role of social support in buffering the effects of discrimination on health, but the evidence is uneven and further studies are needed to clarify these relationships ( Pascoe & Smart Richman, 2009 ), especially among immigrants and refugees, for whom little contemporary data are available.

Other Social Stress/Stressors

Stress is a multifaceted, multilevel concept. In biological terms, stress is a physiological response of the body in the presence of stressors, “conditions of threat, challenge, demands, or structural constraints (p. 300) ( Blair Wheaton, Young, Montazer, & Sttuart-Lahman, 2013 ). Stress is a major factor in racial/ethnic and socioeconomic disparities ( R. Jay Turner, 2013 ). Acculturation stress and discrimination are two dimensions of social stress experienced by immigrants and refugees. These stressors tend to persist and contribute to chronic stress. A more acute type of stress often results from stressful life events, such as death of a loved one, losing a job, or experiences of violence ( B Wheaton, 1999 ). It is not entirely clear if events stress is experienced in the same way across race, ethnicity, and nativity groups. For example, some researchers have reported racial-ethnic differences in responses to stressors, but the differences were small ( R. J. Turner, Taylor, & Van Gundy, 2004 ). In another study, the impact of stressors, including stressful life events, on depression was lower for Cuban Americans and African Americans compared to non-Hispanic whites and other Hispanics, but the impact of immigration was not considered ( R. Jay Turner & Lloyd, 2004 ). Little is also known about events stress shapes health and wellbeing of refugees. Refugees are more likely than other populations to experience traumatic events, which can turn into chronic and be even more detrimental to health ( Blair Wheaton et al., 2013 ).

Social Support

There is long-standing evidence of the importance of social relationships in people’s lives. Social support has become the key phrase to refer to the beneficial effects of social relationships (their presence and quality) to health ( J. B. Turner & Turner, 2013 ). Although much of the literature focuses on social support as buffering stress, with less attention given to its main effects on health, a review of literature indicates that the buffering effects are actually less consistent than the direct effects ( Thoits, 2011 ; J. B. Turner & Turner, 2013 ).

Social support is an important factor shaping immigrant and refugee health. Finch and Vega ( Finch & Vega, 2003 ) found social support, including religious support, to be associated with lower levels of fair/poor health ratings among immigrants, but to social support also buffered the effects of discrimination on health. Other literature also points to an important role of social support in buffering the effects of discrimination on health, but the evidence is uneven ( Pascoe & Smart Richman, 2009 ). Among immigrants, maintaining ties with one’s own racial-ethnic group seems to protect against poor mental health ( Banchevska, 1981 ; Koranyi, 1981 ). However, evidence of living in ethnic enclaves (effects of ethnic density) on immigrant health has been mixed, both positive and negative effects noted ( Liechty & Lee, 2013 ; National Academy of Sciences, 2015 ). Others have noted that the effects of ethnic density may depend on nativity, developmental state, health outcomes, and the history of the group in the community ( Osypuk et al., 2012 ). Earlier research found that crossing racial-ethnic lines in social relations may promote psychological well-being, especially among immigrants ( Quizumbing, 1982 ). Having native friends may also help with navigating the health care system and, through care, lead to better health outcomes ( Lara et al., 2005 ).

Study Aim and Hypotheses

Drawing on past theory and research, we tested a conceptual model ( Fig. 1 ) of perceived discrimination and other influences on physical and mental health of first-generation immigrants and refugees. We hypothesized that perceived discrimination would be directly linked with lower levels of physical and mental health and that perceived discrimination would mediate the effects of immigrant background and acculturation measures. We expected that the effects of discrimination may be greater for refugees immigrants, considering the current political climate. We also hypothesized that stressful life events would have negative effects on health, independent of discrimination, and possibly have greater effects in refugees, who are more likely than other immigrants to have experienced traumatic events. Furthermore, social support was expected to have a direct positive effect on health, and also mediate the effects of discrimination on health.

Data for US adults (18+ years) were derived from Wave 1 (2001–2002; n=43,093) and Wave 2 (2004–2005; n=34,653) of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC; see http://pubs.niaaa.nih.gov/publications/arh29-2/74-78.htm ). The NESARC data include detailed measures of immigrant background, acculturation, discrimination, other social and psychosocial factors, and physical and mental health. Wave 1 of the NESARC (2001–2002; n=43,093; 81% response) was conducted with one randomly selected person from each household/group quarter in a face-to-face, computer-assisted personal interview (CAPI). A total of 34,653 (80.4%) cases were re-interviewed at Wave 2 (2004–2005). NESARC sampling procedures included over-sampling of non-Hispanic Black and Hispanic households, and within households it over-sampled 18 to 24 year olds. The NESARC provides sample weights to adjust for its complex sampling design and non-response at the household- and person-level.

Most of the measures used in this study were included in both Wave 1 and Wave 2 of the NESARC. The exceptions are refugee status, acculturation, perceived discrimination, and social support, which were only assessed at Wave 2.

Mental health and physical health were assessed using scales based on the SF-12v2 summary measures ( Ware, Kosinski, Turner Bowker, & Gandek, 2002 ) that have been shown to be reliable and valid measures in a variety of populations. Health is a multidimensional concept that recognizes more than simply the absence of disease and includes well-being across physical, mental, and social domains. It is quite possible to be “healthy” in one domain and not others and to have different determinants of health across domains. Thus, it is valuable to analyze more than one domain of health in keeping with this broad WHO-based definition of health ( World Health Organization, 1946/1948 ).

The SF-12v2 measure has two component scores: the Mental Component Summary (MC12) and the Physical Component Summary (PCS12), which represent the latent concepts of mental and physical health. The PCS12 assesses participants’ general overall health; limitations in mobility, work, and other physical activities; and, limitations due to pain. The MCS12 assesses participants’ limitations in social activity, emotional state, and level of distraction. In this study, we used the MCS12 and PCS12 obtained from Wave 2 of the NESARC.

Perceived racial-ethnic discrimination was assessed by asking respondents about how often they experienced discrimination related to their race or ethnicity in a variety of situations during the last 12 months. These include experiencing discrimination in their ability to obtain health care or health insurance; in how they are treated when they got health care; in public, (on the street, in stores, or in restaurants); in any other situation (jobs, school or training program, in courts or with police, or obtaining housing); being called a racist name because of their race-ethnicity; and, being made fun of, picked on, pushed, shoved, hit or threatened with harm because of their race-ethnicity. Factor analysis was used to generate two factors indicating perceived discrimination related to health care (Cronbach’s alpha = 0.75) and other aspects of life (e.g., in jobs, schooling, housing, in businesses, or by police; Cronbach’s alpha = 0.73).

First-generation immigrant was defined as born outside of the United States versus US-born. Refugee status was assessed with the item: “Were you ever a refugee – that is, did you flee your home to a foreign country or place to escape danger or persecution?” (yes/no). Racial-ethnic origin was categorized as: African, Asian/Pacific Islander, Hispanic, European, and other.

Indicators of acculturation included language preference, racial-ethnic social preference, and racial-ethnic orientation. Measures of language preference and racial-ethnic social preference were constructed based on the Brief Acculturation Rating Scale II (ARSMA-II) ( Coronado, Thompson, McLerran, Schwartz, & Koepsell, 2005 ; Cuellar & Roberts, 1997 ; Deyo, Diehl, Hazoda, & Stern, 1985 ; Solis, Marks, Garcia, & Shelton, 1990 ) and the East Asian Acculturation Measure ( Barry, 2001 ). Seven questions on language preference asked respondents about which language they generally read and speak; spoke as a child; usually speak at home; usually think in; usually speak with friends; and, watch/listen in TV/radio programming. Response categories used a 5-point scale and were: only non-English language; more non-English language than English; both equally; more English than non-English language; and, only English. The average of the seven items was calculated as a scale for language preference with higher values indicating greater acculturation (Cronbach’s alpha = 0.96).

The NESARC questions on racial–ethnic social preference asked respondents about the race–ethnicity of their close friends; people at the social gatherings and parties they prefer to attend; the people they visit with; and, their children’s friends if they could choose. The pattern of possible responses was coded as: all from my racial–ethnic group; more from my racial–ethnic group than other racial–ethnic groups; about half and half; more from other racial–ethnic groups than from my racial–ethnic group; and, all from other racial–ethnic groups. The average of the four items was calculated as a scale for social preference with higher values indicating greater acculturation (Cronbach’s alpha = 0.85).

For racial-ethnic orientation we used questions in the NESARC that were adapted from other scales of racial-ethnic identity ( Barry, 2002 ; Phinney, 1990 ; Rahim-Williams et al., 2007 ). Respondents were asked how strongly they agreed or disagreed that they have a strong sense of self as a member of their racial-ethnic group; identify with other people from their racial-ethnic group; racial-ethnic heritage is important in their life; and, are proud of their racial-ethnic heritage. The average of the four items was calculated as a scale for racial/ethnic identity with higher values indicating greater acculturation (Cronbach’s alpha = 0.87). Data on acculturation were collected for all respondents regardless of nativity.

Stressful life events was the total number of the following 12 events that respondents reported experiencing in the 12 months prior to the interview: any family member or close friend died; any family or close friend had serious illness or injury; moved/anyone new came to live with you; fired or laid off from a job; unemployed and looking for a job for more than a month; trouble with their boss or a coworker; changed job, job responsibilities, or work hours; marital separation or divorce or breakup of a steady relationship; had problems with neighbor, friend, or relative; financial crisis, declaration of bankruptcy, or being unable to pay their bills; respondent or family member had serious trouble with the police or law; and, respondent or family member being crime victim.

Social support was assessed by using the Interpersonal Support Evaluation List (ISEL12; ( Cohen & Hoberman, 1983 ; Cohen, Mermelstein, Kamarck, & Hoberson, 1985 ) which had six questions on how true it is respondents could find someone to help them or join them in a variety of situations, including: help with daily chores if sick, seek advice about handling problems with family, go to a movie, deal with personal problems, have lunch, and get ride if stranded 10 miles from home. The average of the six items was calculated as a scale for social support with higher values indicating greater social support (Cronbach’s alpha = 0.79).

Several socioeconomic factors were also assessed. Education was defined as the highest grade level completed. Work status was divided into three categories: not working, working part-time, and working full-time. NESARC assessed household income by using 21 categories. We created a continuous income variable by recoding the income categories to their midpoint values (divided by $10,000); the top category was determined by a Pareto approximation (Hout, 2004). Sociodemographic variables included age, gender, US region, and community type (center Metropolitan Statistical Area [MSA], not center MSA, and not MSA).

Procedure of Analysis

The analysis relied on structural equation models (SEMs) to estimate the various associations among the covariates depicted in Figure 1 separately for first-generation immigrants and refugees ( Bollen, 1989 ). In addition to the pathways included in Figure 1 , the model specifications permitted correlations among the error terms for the two discrimination measures and the two health measures respectively. These correlations account for the possibility that there are common unmeasured factors that influence each of these domains (e.g., variables not included in the model that affect both discrimination measures). Finally, a SEM approach also facilitates the decomposition of the total effects of the two measures of discrimination on physical and mental health into direct and indirect effects.

Stata 15 was used to prepare the data for analysis and estimate the parameters for the SEMs ( StataCorp, 2017 ). Stata’s survey suite of commands was used to address NESARC’s complex sampling design and to incorporate the sample weights into the analysis. Standard errors for indirect and total effects were obtained using the delta method. All of the Stata code for preparing the data and conducting the analysis is maintained at a publicly available repository (identifying link omitted).

The descriptive statistics for both analytic samples, first-generation immigrants and refugees are shown in Table 1 . SEM results are presented in Figures 2 – 3 (see Appendix Tables A1 and A2 for the full set of estimates).

Selected Estimates of Unstandardized Effects of Discrimination, Acculturation, Stress, and Social Support on Physical and Mental Health among Immigrants

Notes: Only statistically significant estimates at p < 0.05 are reported. All estimates are net of sociodemographic correlates. The estimates and standard errors are adjusted for the complex sample design and incorporate the sample weights. See Table A1 (Appendix) for complete set of parameter estimates including standard errors.

Selected Estimates of Unstandardized Effects of Discrimination, Acculturation, Stress, and Social Support on Physical and Mental Health among Refugees

Notes: Only statistically significant estimates at p < 0.05 are reported. All estimates are net of sociodemographic correlates. The estimates and standard errors are adjusted for the complex sample design and incorporate the sample weights. See Table A2 (Appendix) for complete set of parameter estimates including standard errors.

Descriptive statistics for two analytic samples.

Notes : Unweighted descriptive statistics.

First-Generation Immigrants

Figure 2 reports selected unstandardized regression coefficients from the SEM for first-generation immigrants. Beginning with experience stressful life events, there is a positive association with the language component of acculturation (b = 0.10). Turning to the two measures of discrimination, there is a negative association with the language component of acculturation and health care related discrimination (b = −0.02). With respect to discrimination in general, there are positive associations with the social component of acculturation and with stressful life events (b = 0.04 and b = 0.04 respectively) and a negative association with the racial/ethnic identify component of acculturation (b = −0.02). Further, discrimination in health and discrimination in general have negative associations with social support (b = −0.09 and b = −0.10, respectively). Finally, turning to health, discrimination in health care has a negative association with physical health (b = −0.97), while discrimination in general has a negative association with mental health (b = −1.63). It is worth noting that social support has positive associations with both physical (b = 1.07) and mental (b = 3.82) health. Given the relationships between both forms of discrimination and social support, this suggests that discrimination also has an indirect association with physical and mental health, which is explored in more detail below.

Figure 3 reports unstandardized regression coefficients from the SEM for refugees. Beginning with experience stressful life events, there is a negative association with the social component of acculturation (b = −0.33) and a positive association with the racial/ethnic identity component of acculturation (b = 0.37). Stressful life events, however, are unrelated to perceived discrimination with respect to health care and only modestly positively related to perceived discrimination in general (b = 0.05). Furthermore, none of the acculturation measures are related to either dimension of discrimination.

Similar to first-generation immigrants, among refugees discrimination in general has a negative association with social support (b = −0.26), but discrimination in health care does not have a significant association with social support. In addition, neither dimension of discrimination have significant associations with either dimension of health. It is notable, however, that the direction and magnitude of the associations are similar to those found for first-generation immigrants, which suggests that these associations might be observed as statistically significant in a larger sample of refugees. Finally, social support, on the other hand, has positive associations with both physical (b = 2.74) and mental (b = 4.53) health.

Effect Decomposition

Table 2 reports unstandardized estimates of the direct, indirect, and total effects for discrimination in health care and discrimination in general on both physical and mental health based on the models for first-generation immigrants and for refugees (also shown in Figures 2 and ​ and3, 3 , respectively). The estimates of the indirect effects and the comparisons with the direct effects provide measures of the extent to which social support mediates effects of discrimination on health.

Effect decomposition for discrimination measures.

First-generation immigrants

Among first-generation immigrants, there are significant indirect effects operating through social support for discrimination in health care (indirect b = −0.09 for physical health and indirect b = −0.33 for mental health) and discrimination in general (indirect b = −0.11 for physical health and indirect b = −0.39 for mental health) for both physical and mental health (see Table 2 ). This is consistent with the hypothesis that a reduction in social support is one mechanism through which discrimination can shape health (though we note the estimates are associations and not interpretable as causal effects).

Among refugees, there are significant indirect effects operating through social support of discrimination in general (indirect b = −0.72 for physical health and indirect b = −1.20 for mental health) on physical and mental health (see Table 2 ). The imprecision in the estimates, particularly from the direct effects, leaves the total effects as non-significant. Thus there is limited evidence that social support is an important pathway connecting discrimination and health refugees, though as noted above, the estimates are almost all in the expected direction and the lack of statistical significance may reflect the relatively small sample size.

This study tested a model of relationships between acculturation, perceived discrimination, stressful life events, social support, and physical and mental health among first-generation immigrants and refugees aged 18 years and older, while controlling for immigrant background characteristics, including race-ethnicity. Among first-generation immigrants, we found a negative association of perceived discrimination in health care with physical health and a negative association of perceived discrimination in general with mental health. In addition, we observed indirect associations of perceived discrimination in health care and in general to both mental and physical health through social support (i.e., lessened impact of discrimination on health). Also, higher English language use was associated with decreased health-care related perceived discrimination while stronger ethnic identity was associated with decreased perceived discrimination in general. However, acculturation measures (language, social preference, and ethnic group identity) typically had no direct associations with health. These findings suggest that perceived discrimination shapes immigrants’ health in two ways: it mediates the effect of acculturation on health, and it influences health directly and indirectly through social support (the direct effects depend on the dimension of discrimination and the health component).

Among refugees, we did not observe direct associations between either measure of discrimination and physical or mental health. We did, however, find that discrimination in general had a negative association with social support and social support had strong positive associations with both physical and mental health. These findings for refugees suggest that perceived discrimination has the potential to shape health through social support.

The strengths of this study include a large national sample, multidimensional measures, and the SEM analytic procedure. Specifically, the study used a large, nationally representative sample of immigrants, and possibly the largest available sample of refugees, aged 18 years and older. In addition, multiple dimensions of acculturation, perceived discrimination, and health were assessed. Health was based on a subjective assessment, which allowed for individual perceptions of their health and functioning to be considered (versus clinical diagnoses, for example). Finally, the SEM procedure allowed the examination of direct, indirect, and total effects of the hypothesized covariates on both physical and mental health.

The study also had some limitations. One limitation was testing a limited conceptual model to streamline the interpretation of findings from SEM, a complex analytic procedure. Additional potential variables, for example, health behaviors or other health outcomes (e.g., clinical diagnoses) can be tested in future studies. Furthermore, the analysis was cross-sectional because the key study variables -- perceived discrimination, acculturation, social support, and refugee status -- were assessed only at Wave 2 of the NESARC. Some of our key concepts and measures also were limited. For example, we measured two types of perceived discrimination and three acculturation components, and thus did not cover the full breadth of these concepts.

Despite these limitations, this study adds to the mounting evidence that perceived discrimination is bad for health outcomes among ethnic minorities and immigrants ( Pascoe and Richman 2009 ). Our study is unique compared to earlier studies of discrimination and immigrant health in that it used a comprehensive measure of subjective health including mental and physical health. Earlier research has focused on perceived discrimination in relation to mental health diagnoses or symptomology and/or physical health conditions or risks among ethnogroups and less often among immigrants specifically ( G. Singh et al., 2013 ; Takeuchi, 2016 ), and such data on refugees are largely lacking. Also, when subjective measures of health were used in prior studies, they were based on a single indicator (e.g., self-reported health) ( Finch & Vega, 2003 ). Our study extends the literature by documenting that two types of discrimination are negatively associated with subjective mental and physical health components either directly or indirectly through social support. These associations have previously been documented in many studies that used other health measures ( Pascoe & Smart Richman, 2009 ). Furthermore, we modelled these relationships for not only for immigrants in general but for refugees specifically, too. The findings for refugees are novel, but need to be treated with caution and examined further with larger sample sizes.

In terms of associations between acculturation measures and perceived discrimination, we found that discrimination in general was positively associated with the social component of acculturation while it was negatively associated with racial-ethnic orientation. This finding suggests that the higher preference for socializing outside one’s ethnic group (greater acculturation) is associated with greater perceived discrimination. This may be due to more opportunities for immigrants to experience discrimination through socializing with natives, some of whom may have negative attitudes toward immigrants. In terms of racial-ethnic orientation, higher values on this measure indicated less identification with one’s own racial-ethnic group, reflecting greater acculturation and assimilation. So, in case of this variable, the results suggest that weakening of the feeling of belonging to an ethnic group is associated with lower perceived discrimination. This is in contrast to a previous study that reported that a strong ethnic identity among Filipino Asian Americans decreases perceived discrimination and buffers the positive association between discrimination and depressive symptoms ( Mossakowski, 2003 ). However, we found no direct association of the social preference or identity with mental or physical health in our sample first-generation immigrants. These relationships may differ for ethnic minorities and immigrants because immigrants have a relatively good health compared with other US populations, but more research is needed to reconcile these inconsistencies.

There are several recommendations for future research. First, longitudinal research is urgently needed to better understand the effect of discrimination on immigrant health over time. In this line of research, it will also be important to consider immigrant arrival-cohort effects. Hamilton and colleagues ( Hamilton, Palermo, & Green, 2015 ) have documented that omitting cohort effects may result in overestimates of the declines in self-reported health among Latino/Hispanic immigrants.

Furthermore, more data on refugees as well as on undocumented immigrants and non-citizens would be helpful. Previous studies have shown that the undocumented legal status of Hispanic immigrants is associated with high emotional distress, poor quality of health, and low healthcare access and utilization ( Bustamante et al., 2010 ; Cavazos-Rehg, Zayas, & Spitznagel, 2007 ; Derose et al., 2009 ; Wallace, Torrens, Nobari, & Brown, 2012 ). Other research suggests that psychological well-being of undocumented immigrants may suffer due to the stigma of their legal status and related stressors ( Gonzalez, Suarez-Orozco, & Dedios-Sanguineti, 2013 ; Sullivan & Rehm, 2005 ; Takeuchi, 2016 ; Yoshikawa, 2011 ). Thus, discrimination through unequal rights likely plays a role in shaping immigrant health outcomes. Naturalization status also deserves more attention because of certain rights and access to more resources that immigrants acquire with citizenship that may lead them to better health outcomes ( Derose et al., 2009 ; Logan, Oh, & Darrah, 2012 ; National Academy of Sciences, 2015 ).

Further testing of potential moderating relationships, including moderated mediation, between discrimination and health among immigrants and refugees is also warranted while considering other psychosocial factors, including social support and mastery (see, for example, ( Miller, Rote, & Keith, 2013 ). Finally, any of the above recommendations require more detailed data collection on race, ethnicity, language, and nativity. Stepping up these efforts in US public health surveillance and monitoring systems has been recognized as one key strategy ( Rodriguez-Lainz et al., 2018 )

This research is timely and important considering the historically high and still growing numbers of immigrants, special support for refugees as a human right issue, and the heightened anti-immigrant and anti-refugee attitudes. The study specifically draws attention to the effects of discrimination on immigrant and refugee well-being and could drive interventions to curb discrimination against and enhance supports for vulnerable immigrant groups. This work contributes to the overall effort to eliminate health disparities, a national goal per Healthy People 2020 (Healthy People 2020).

Supplementary Material

Acknowledgements.

This study was funded by grant# R01–1DA023615 from the National Institutes of Health.

Contributor Information

Magdalena Szaflarski, Department of Sociology, University of Alabama at Birmingham, HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152.

Shawn Bauldry, Department of Sociology, Purdue University, 700 W. State Street, Stone 326 B, West Lafayette, IN 47907.

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Key findings about u.s. immigrants.

View  interactive charts and  detailed tables  on U.S. immigrants.

Note: For our most recent estimates of unauthorized immigrants in the U.S.  click here .

The United States has more immigrants than any other country in the world . Today, more than 40 million people living in the U.S. were born in another country, accounting for about one-fifth of the world’s migrants. The population of immigrants is also very diverse, with just about every country in the world represented among U.S. immigrants.

Pew Research Center regularly publishes statistical portraits of the nation’s foreign-born population, which include historical trends since 1960 . Based on these portraits, here are answers to some key questions about the U.S. immigrant population.

How many people in the U.S. are immigrants?

The U.S. foreign-born population reached a record 44.8 million in 2018. Since 1965, when U.S. immigration laws replaced a national quota system , the number of immigrants living in the U.S. has more than quadrupled. Immigrants today account for 13.7% of the U.S. population, nearly triple the share (4.8%) in 1970. However, today’s immigrant share remains below the record 14.8% share in 1890, when 9.2 million immigrants lived in the U.S.

What is the legal status of immigrants in the U.S.?

Most immigrants (77%) are in the country legally, while almost a quarter are unauthorized, according to new Pew Research Center estimates based on census data adjusted for undercount . In 2017, 45% were naturalized U.S. citizens.

Some 27% of immigrants were permanent residents and 5% were temporary residents in 2017. Another 23% of all immigrants were unauthorized immigrants. From 1990 to 2007, the unauthorized immigrant population more than tripled in size – from 3.5 million to a record high of 12.2 million in 2007. By 2017, that number had declined by 1.7 million, or 14%. There were 10.5 million unauthorized immigrants in the U.S. in 2017, accounting for 3.2% of the nation’s population.

The decline in the unauthorized immigrant population is due largely to a fall in the number from Mexico – the single largest group of unauthorized immigrants in the U.S. Between 2007 and 2017, this group decreased by 2 million. Meanwhile, there was a rise in the number from Central America and Asia. 

Do all lawful immigrants choose to become U.S. citizens?

Not all lawful permanent residents choose to pursue U.S. citizenship. Those who wish to do so may apply after meeting certain requirements , including having lived in the U.S. for five years. In fiscal year 2019, about 800,000 immigrants applied for naturalization. The number of naturalization applications has climbed in recent years, though the annual totals remain below the 1.4 million applications filed in 2007.

Generally, most immigrants eligible for naturalization apply to become citizens. However, Mexican lawful immigrants have the lowest naturalization rate overall. Language and personal barriers, lack of interest and financial barriers are among the top reasons for choosing not to naturalize cited by Mexican-born green card holders, according to a 2015 Pew Research Center survey .

Where do immigrants come from?

Mexico is the top origin country of the U.S. immigrant population. In 2018, roughly 11.2 million immigrants living in the U.S. were from there, accounting for 25% of all U.S. immigrants. The next largest origin groups were those from China (6%), India (6%), the Philippines (4%) and El Salvador (3%).

By region of birth, immigrants from Asia combined accounted for 28% of all immigrants, close to the share of immigrants from Mexico (25%). Other regions make up smaller shares: Europe, Canada and other North America (13%), the Caribbean (10%), Central America (8%), South America (7%), the Middle East and North Africa (4%) and sub-Saharan Africa (5%).

Who is arriving today?

More than 1 million immigrants arrive in the U.S. each year. In 2018, the top country of origin for new immigrants coming into the U.S. was China, with 149,000 people, followed by India (129,000), Mexico (120,000) and the Philippines (46,000).

By race and ethnicity, more Asian immigrants than Hispanic immigrants have arrived in the U.S. in most years since 2009. Immigration from Latin America slowed following the Great Recession, particularly for Mexico, which has seen both decreasing flows into the United States and large flows back to Mexico in recent years.

Asians are projected to become the largest immigrant group in the U.S. by 2055, surpassing Hispanics. Pew Research Center estimates indicate that in 2065, those who identify as Asian will make up some 38% of all immigrants; as Hispanic, 31%; White, 20%; and Black, 9%.

Is the immigrant population growing?

New immigrant arrivals have fallen, mainly due to a decrease in the number of unauthorized immigrants coming to the U.S. The drop in the unauthorized immigrant population can primarily be attributed to more Mexican immigrants leaving the U.S. than coming in . 

Looking forward, immigrants and their descendants are projected to account for 88% of U.S. population growth through 2065 , assuming current immigration trends continue. In addition to new arrivals, U.S. births to immigrant parents will be important to future growth in the country’s population. In 2018, the percentage of women giving birth in the past year was higher among immigrants (7.5%) than among the U.S. born (5.7%). While U.S.-born women gave birth to more than 3 million children that year, immigrant women gave birth to about 760,000.

How many immigrants have come to the U.S. as refugees?

Since the creation of the federal Refugee Resettlement Program in 1980, about 3 million refugees have been resettled in the U.S. – more than any other country.

In fiscal 2019, a total of 30,000 refugees were resettled in the U.S. The largest origin group of refugees was the Democratic Republic of the Congo, followed by Burma (Myanmar), Ukraine, Eritrea and Afghanistan. Among all refugees admitted in fiscal year 2019, 4,900 are Muslims (16%) and 23,800 are Christians (79%). Texas, Washington, New York and California resettled more than a quarter of all refugees admitted in fiscal 2018.

Where do most U.S. immigrants live?

Nearly half (45%) of the nation’s immigrants live in just three states: California (24%), Texas (11%) and Florida (10%) . California had the largest immigrant population of any state in 2018, at 10.6 million. Texas, Florida and New York had more than 4 million immigrants each.

In terms of regions, about two-thirds of immigrants lived in the West (34%) and South (34%). Roughly one-fifth lived in the Northeast (21%) and 11% were in the Midwest.

In 2018, most immigrants lived in just 20 major metropolitan areas, with the largest populations in the New York, Los Angeles and Miami metro areas. These top 20 metro areas were home to 28.7 million immigrants, or 64% of the nation’s total foreign-born population. Most of the nation’s unauthorized immigrant population lived in these top metro areas as well.

How do immigrants compare with the U.S. population overall in education?

Immigrants in the U.S. as a whole have lower levels of education than the U.S.-born population. In 2018, immigrants were over three times as likely as the U.S. born to have not completed high school (27% vs. 8%). However, immigrants were just as likely as the U.S. born to have a bachelor’s degree or more (32% and 33%, respectively).

Educational attainment varies among the nation’s immigrant groups, particularly across immigrants from different regions of the world. Immigrants from Mexico and Central America are less likely to be high school graduates than the U.S. born (54% and 47%, respectively, do not have a high school diploma, vs. 8% of U.S. born). On the other hand, immigrants from every region except Mexico, the Caribbean and Central America were as likely as or more likely than U.S.-born residents to have a bachelor’s or advanced degree.

Among all immigrants, those from South Asia (71%) were the most likely to have a bachelor’s degree or more. Immigrants from Mexico (7%) and Central America (11%) were the least likely to have a bachelor’s or higher.

How many immigrants are working in the U.S.?

In 2017, about 29 million immigrants were working or looking for work in the U.S., making up some 17% of the total civilian labor force. Lawful immigrants made up the majority of the immigrant workforce, at 21.2 million. An additional 7.6 million immigrant workers are unauthorized immigrants , less than the total of the previous year and notably less than in 2007, when they were 8.2 million. They alone account for 4.6% of the civilian labor force, a dip from their peak of 5.4% in 2007. During the same period, the overall U.S. workforce grew, as did the number of U.S.-born workers and lawful immigrant workers.

Immigrants are projected to drive future growth in the U.S. working-age population through at least 2035. As the Baby Boom generation heads into retirement, immigrants and their children are expected to offset a decline in the working-age population by adding about 18 million people of working age between 2015 and 2035.

How well do immigrants speak English?

Among immigrants ages 5 and older in 2018, half (53%) are proficient English speakers – either speaking English very well (37%) or only speaking English at home (17%).

Immigrants from Mexico have the lowest rates of English proficiency (34%), followed by those from Central America (35%), East and Southeast Asia (50%) and South America (56%). Immigrants from Canada (96%), Oceania (82%), Europe (75%) and sub-Saharan Africa (74%) have the highest rates of English proficiency.  

The longer immigrants have lived in the U.S. , the greater the likelihood they are English proficient. Some 47% of immigrants living in the U.S. five years or less are proficient. By contrast, more than half (57%) of immigrants who have lived in the U.S. for 20 years or more are proficient English speakers.

Among immigrants ages 5 and older, Spanish is the most commonly spoken language . Some 42% of immigrants in the U.S. speak Spanish at home. The top five languages spoken at home among immigrants outside of Spanish are English only (17%), followed by Chinese (6%), Hindi (5%), Filipino/Tagalog (4%) and French (3%).

How many immigrants have been deported recently?

Around 337,000 immigrants were deported from the U.S. in fiscal 2018 , up since 2017. Overall, the Obama administration deported about 3 million immigrants between 2009 and 2016, a significantly higher number than the 2 million immigrants deported by the Bush administration between 2001 and 2008. In 2017, the Trump administration deported 295,000 immigrants, the lowest total since 2006.

Immigrants convicted of a crime made up the less than half of deportations in 2018, the most recent year for which statistics by criminal status are available. Of the 337,000 immigrants deported in 2018, some 44% had criminal convictions and 56% were not convicted of a crime. From 2001 to 2018, a majority (60%) of immigrants deported have not been convicted of a crime.

How many immigrant apprehensions take place at the U.S.-Mexico border?

The number of apprehensions at the U.S.-Mexico border has doubled from fiscal 2018 to fiscal 2019, from 396,579 in fiscal 2018 to 851,508 in fiscal 2019. Today, there are more apprehensions of non-Mexicans than Mexicans at the border. In fiscal 2019, apprehensions of Central Americans at the border exceeded those of Mexicans for the fourth consecutive year. The first time Mexicans did not make up the bulk of Border Patrol apprehensions was in 2014.

How do Americans view immigrants and immigration?

While immigration has been at the forefront of a national political debate, the U.S. public holds a range of views about immigrants living in the country. Overall, a majority of Americans have positive views about immigrants. About two-thirds of  Americans (66%) say immigrants strengthen the country “because of their hard work and talents,” while about a quarter (24%) say immigrants burden the country by taking jobs, housing and health care.

Yet these views vary starkly by political affiliation. Among Democrats and Democratic-leaning independents, 88% think immigrants strengthen the country with their hard work and talents, and just 8% say they are a burden. Among Republicans and Republican-leaning independents, 41% say immigrants strengthen the country, while 44% say they burden it.

Americans were divided on future levels of immigration. A quarter said legal immigration to the U.S. should be decreased (24%), while one-third (38%) said immigration should be kept at its present level and almost another third (32%) said immigration should be increased.

Note: This is an update of a post originally published May 3, 2017, and written by Gustavo López, a former research analyst focusing on Hispanics, immigration and demographics; and Kristen Bialik, a former research assistant.

CORRECTION (Sept. 21, 2020): An update to the methodology used to tabulate figures in the chart “Among new immigrant arrivals, Asians outnumber Hispanics” has changed all figures from 2001 and 2012. This new methodology has also allowed the inclusion of the figure from 2000. Furthermore, the earlier version of the chart incorrectly showed the  partial  year shares of Hispanic and Asian recent arrivals in 2015; the corrected  complete  year shares are 31% and 36%, respectively.

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Key facts about U.S. immigration policies and Biden’s proposed changes

Most latinos say u.s. immigration system needs big changes, facts on u.s. immigrants, 2018, most popular.

About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

Immigration: Complexities and Challenges

Duke researchers are informing the debates with factual data on why and how people immigrate to the U.S., what happens after they arrive and how immigration affects everyone involved.

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Regardless of who’s in charge, immigration and the U.S. government’s approach to it is a thorny topic. Researchers across Duke are informing the debates with factual data on why and how people immigrate to the U.S., what happens after they arrive and how immigration affects everyone involved.

HOW VIOLENCE AND CLIMATE CHANGE ARE DRIVING MIGRATION

Long-term solutions to the increasing number of migrants crossing the U.S. border with Mexico requires research into what drives migration.

Sarah Bermeo, director of graduate studies at the Duke Center for International Development, found immigration from Honduras – which jumped sharply in 2019 after years of steady increase – has resulted from persistent violence coupled with sharp increases in food insecurity linked to climate change.

WHAT HAPPENS WHEN MIGRANTS ARE SENT BACK

Scholars know little about what happens to people once they’re deported from the U.S., including whether they plan to return to the United States.

Political science Professor Erik Wibbels was one of a group of political scientists who studied the fates of immigrants deported to Guatemala, which receives the most U.S. deportees after Mexico.

DEPORTATION OVER MINOR CRIMES

In March, a divided U.S. Supreme Court ruled in a case involving whether an immigrant living in the country without authorization can seek relief from deportation for a minor crime.

Kate Evans, a clinical law professor who directs the Immigration Law Clinic at Duke Law School, explains how the ruling could have strict consequences for some non-citizens seeking deportation relief.

CROSSING THE DARIEN GAP

For most U.S.-bound migrants crossing the Colombian border with Panama, the only option is to find clandestine routes through the Darien Gap, an unforgiving jungle where they are left without guides, with little or no food to find along the way, and under the constant threat of robbery.

Piotr Plewa, a visiting research scholar at Duke who specializes in international migration, explains what migration trends through the Darien Gap mean for the region.

THE U.S./MEXICO RELATIONSHIP: COMPLEX, CHALLENGING AND UNIQUE 

As Mexican Ambassador to the U.S., one of Martha Bárcena Coqui’s biggest challenges is to make the American public understand how their own future is directly linked to Mexico and its people.

Coqui shared with a Duke audience how in the last 30 years, the two countries have gone from distant neighbors to essential partners.

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