Revisiting the Healthy Immigrant Effect: Nativity and Oral Health Disparities Among U.S. Adults in NHANES 2017–2018

Revisiting the Healthy Immigrant Effect: Nativity and Oral Health Disparities Among U.S. Adults in NHANES 2017–2018 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Revisiting the Healthy Immigrant Effect: Nativity and Oral Health Disparities Among U.S. Adults in NHANES 2017–2018 Mannat Tiwana, Gursimran Singh Walia, Tamanna Bhui This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6884137/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The "healthy immigrant effect" posits that foreign-born individuals often arrive in host countries with health profiles superior to those of native-born populations. However, the durability of this advantage in oral health remains poorly understood. This study investigates oral health disparities by nativity and duration of U.S. residence using nationally representative data. Methods We analyzed cross-sectional data from 5,856 adults (aged ≥ 18) in the 2017–2018 National Health and Nutrition Examination Survey (NHANES). Self-rated oral health and recency of dental visits were examined across nativity groups (U.S.-born vs. foreign-born) and by length of U.S. residency (< 10 vs. ≥10 years). Descriptive statistics, cross-tabulations, and chi-square tests were conducted with appropriate sample weights. Results Foreign-born individuals represented 30.5% of the sample. Compared to U.S.-born adults, a greater proportion of immigrants reported not having visited a dentist in over a year and rated their oral health as "fair" or "poor" (p < 0.001). Among foreign-born respondents, those who had lived in the U.S. for ≥ 10 years were significantly more likely to have had a dental visit within the past year and reported better self-rated oral health than those with < 10 years of residency. Conclusion Findings indicate that oral health advantages among immigrants diminish with time and are linked to reduced access and delayed utilization of dental care. Policy efforts should prioritize early integration of immigrants into preventive oral health systems to reduce long-term disparities. immigrant health oral health disparities NHANES health access dental visits acculturation Introduction Immigrants constitute a significant and growing segment of the U.S. population, contributing richly to its cultural and economic landscape. The "healthy immigrant effect," which suggests that immigrants often arrive healthier than their U.S.-born counterparts, has been widely documented across general health outcomes. However, oral health—a critical yet often overlooked dimension of well-being—has received limited attention in this context. Oral diseases such as caries and periodontal disease are among the most prevalent noncommunicable conditions globally. They affect quality of life, exacerbate systemic conditions like diabetes, and disproportionately burden low-income and minority communities. Access to dental care in the U.S. is highly stratified by socioeconomic status, insurance, and nativity, leaving immigrants especially vulnerable to poor oral health outcomes. While existing literature has explored the healthy immigrant effect in the context of cardiovascular and metabolic health, relatively few studies have examined how this paradigm applies to oral health, particularly using nationally representative datasets. Moreover, even fewer have investigated how oral health outcomes shift with duration of residence in the U.S. This study aims to fill that gap. Methods Data Source We used data from the 2017–2018 cycle of the NHANES, a nationally representative cross-sectional survey conducted by the CDC. Our analytic sample included 5,856 adults aged 18 and older who completed both the demographic and oral health components. Key Variables: Nativity : Defined using the variable DMDBORN4 (1 = U.S.-born, 2 = Foreign-born). Years in U.S. : DMDYRUSZ was recoded into two groups: <10 years (recent immigrants) and ≥ 10 years (long-term immigrants). Oral Health Outcomes : Self-rated oral health (OHQ830: 1 = Excellent to 5 = Poor) and time since last dental visit (OHQ845: 1 = < 6 months to 3 = ≥ 1 year). Statistical Analysis All analyses were conducted in SPSS using complex sample weights (WTMEC2YR). Frequencies and cross-tabulations were generated for oral health outcomes by nativity and duration of residence. Chi-square tests assessed statistical significance at p < 0.05. Results Among the 5,856 adults analyzed, 30.5% were foreign-born. Self-rated oral health revealed significant disparities: 33.3% of foreign-born adults rated their oral health as "good," and 34.1% as "fair," compared to 28.3% and 22.6% respectively among U.S.-born adults. Poor oral health ratings were higher among U.S.-born adults (10.5%) but must be interpreted in context of access and utilization patterns. Regarding dental visits, 71.0% of U.S.-born respondents had visited a dentist in the last year, compared to 66.6% of foreign-born respondents. Among foreign-born adults, those who had been in the U.S. for ≥ 10 years were significantly more likely to have had a dental visit within the last year (p < 0.001). Chi-square tests confirmed statistically significant differences in both self-rated oral health and dental care utilization by nativity and duration of U.S. residence (p < 0.001). Discussion This study extends the healthy immigrant effect framework to oral health, revealing complex patterns. Although immigrants may arrive with relatively good oral health behaviors or resilience, the structural barriers they face in the U.S.—including lack of insurance, limited dental coverage under Medicaid, language barriers, and systemic discrimination—may erode these initial advantages over time. Notably, longer U.S. residence was associated with greater dental service use, suggesting acculturation and systemic integration improve access. However, the decline in self-rated oral health among long-term immigrants may reflect cumulative exposure to U.S. health system inequalities. These findings underscore the need for targeted, early interventions such as community-based oral health outreach, mobile dental clinics, and immigrant-friendly insurance navigation programs. Additionally, integrating oral health education into existing migrant health services could strengthen preventive practices and reduce reliance on emergency care. Conclusion Oral health disparities between U.S.-born and foreign-born adults persist and evolve with time spent in the host country. As the U.S. continues to grow more diverse, policymakers and health systems must prioritize early, equitable integration of immigrants into oral health systems. This approach is essential to preventing long-term disparities and promoting a truly inclusive public health agenda. Declarations Ethics approval and consent to participate NHANES data are publicly available and de-identified. Ethical approval for NHANES protocols is provided by the National Center for Health Statistics Research Ethics Review Board. Consent for publication Not applicable. Availability of data and materials The datasets analyzed during the current study are available from the NHANES website: https://www.cdc.gov/nchs/nhanes/index.htm Competing interests The author declares no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions MT conceived the study and conducted the analysis, GSW and TB interpreted the results, and drafted the manuscript. Acknowledgements The author thanks the Centers for Disease Control and Prevention for providing public access to the NHANES data. References Centers for Disease Control and Prevention (CDC). National Health and Nutrition Examination Survey: NHANES 2017–2018. Available from: https://www.cdc.gov/nchs/nhanes/index.htm Alegría M, Sribney W, Woo M, Torres M, Guarnaccia P. Looking beyond nativity: the relation of age of immigration, length of residence, and birth cohorts to the risk of onset of psychiatric disorders for Latinos. Res Hum Dev. 2007;4(1–2):19–47. Bastani R, Garza MA, Glenn BA, et al. Exploring the healthy immigrant effect in oral health among Mexican immigrants in the United States. J Immigr Minor Health. 2007;9(4):255–63. Patrick DL, Lee RSY, Nucci M, Grembowski D, Jolles CZ, Milgrom P. Reducing oral health disparities: a focus on social and cultural determinants. BMC Oral Health. 2006;6(Suppl 1):S4. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104. Cruz GD, Chen Y, Salazar CR, Le Geros RZ, Tavares M. The association of immigration and acculturation attributes with oral health among immigrants in New York City. Am J Public Health. 2009;99(Suppl 2):S474–80. Flores G, Lin H. Trends in racial/ethnic disparities in medical and oral health, access to care, and use of services in US children: has anything changed over the years? Int J Equity Health. 2013;12:10. Dye BA, Li X, Thornton-Evans G. Oral health disparities as determined by selected healthy people 2020 oral health objectives for the United States, 2009–2010. NCHS Data Brief. 2012;104:1–8. Fisher-Owens SA, Isong IA, Soobader MJ, et al. An examination of racial/ethnic disparities in children’s oral health in the United States. J Public Health Dent. 2013;73(2):166–74. Wu B, Tran TV, Khatutsky G. The health status of older Chinese in the United States: findings from the 1997–1999 National Health Interview Survey. J Aging Health. 2005;17(5):754–76. Lukes SM, Simon B. Dental services for migrant and seasonal farmworkers in the United States. J Health Care Poor Underserved. 2006;17(4 Suppl):50–69. Quiñonez C, Gibson D, Jokovic A, Locker D. Emergency department visits for dental care of nontraumatic origin. Community Dent Oral Epidemiol. 2009;37(4):366–71. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6884137","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477334255,"identity":"2d34a4e0-2a74-402c-a916-ce8b98b370bf","order_by":0,"name":"Mannat Tiwana","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYBADHjD5oQJIMDM3EKEhwQCshXHGGZAWRuK0gClm3jawTvxadNvPHnvw88cfGYPjZw9+5p1XG83fDtTyo2IbTi1mZ/LSDXuADjM4k5csOXfb8dwZhxkbGHvO3Mat5UCOmQQPUAuQYSDxdtux3AagFmbGNjxazr8xk/wD0nL+jfEP3jnHcucT1HIjx0wabAuQIcnbUJO7gbCWN2bSMmnGPPZAhuWMYwdyNwK1HMTrl/NAw9/YyNlL9ucY3/hQU5c77/zhgw9+VODWgg4Og8kDRKsHgjpSFI+CUTAKRsEIAQBNTlwq+Uz2ygAAAABJRU5ErkJggg==","orcid":"","institution":"California State University","correspondingAuthor":true,"prefix":"","firstName":"Mannat","middleName":"","lastName":"Tiwana","suffix":""},{"id":477334256,"identity":"23dd6739-f002-4dd3-85e6-0baed93ebbd4","order_by":1,"name":"Gursimran Singh Walia","email":"","orcid":"","institution":"Luxmi Bai Institute of Dental Sciences and Hospital, Baba Farid University of Health Sciences and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gursimran","middleName":"Singh","lastName":"Walia","suffix":""},{"id":477334257,"identity":"85a3df01-7ed6-44ea-a75d-c077c46fad04","order_by":2,"name":"Tamanna Bhui","email":"","orcid":"","institution":"Luxmi Bai Institute of Dental Sciences and Hospital, Baba Farid University of Health Sciences and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tamanna","middleName":"","lastName":"Bhui","suffix":""}],"badges":[],"createdAt":"2025-06-13 03:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6884137/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6884137/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88753719,"identity":"031b143d-7c1b-4237-9b27-91d57f1a672f","added_by":"auto","created_at":"2025-08-11 06:54:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":356527,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6884137/v1/9e951f5b-cd44-40c5-8c32-5abc3a3f0a18.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Revisiting the Healthy Immigrant Effect: Nativity and Oral Health Disparities Among U.S. Adults in NHANES 2017–2018","fulltext":[{"header":"Introduction","content":"\u003cp\u003eImmigrants constitute a significant and growing segment of the U.S. population, contributing richly to its cultural and economic landscape. The \"healthy immigrant effect,\" which suggests that immigrants often arrive healthier than their U.S.-born counterparts, has been widely documented across general health outcomes. However, oral health\u0026mdash;a critical yet often overlooked dimension of well-being\u0026mdash;has received limited attention in this context.\u003c/p\u003e \u003cp\u003eOral diseases such as caries and periodontal disease are among the most prevalent noncommunicable conditions globally. They affect quality of life, exacerbate systemic conditions like diabetes, and disproportionately burden low-income and minority communities. Access to dental care in the U.S. is highly stratified by socioeconomic status, insurance, and nativity, leaving immigrants especially vulnerable to poor oral health outcomes.\u003c/p\u003e \u003cp\u003eWhile existing literature has explored the healthy immigrant effect in the context of cardiovascular and metabolic health, relatively few studies have examined how this paradigm applies to oral health, particularly using nationally representative datasets. Moreover, even fewer have investigated how oral health outcomes shift with duration of residence in the U.S. This study aims to fill that gap.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cstrong\u003eData Source\u003c/strong\u003e \u003cp\u003eWe used data from the 2017\u0026ndash;2018 cycle of the NHANES, a nationally representative cross-sectional survey conducted by the CDC. Our analytic sample included 5,856 adults aged 18 and older who completed both the demographic and oral health components.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eKey Variables:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eNativity\u003c/b\u003e: Defined using the variable DMDBORN4 (1\u0026thinsp;=\u0026thinsp;U.S.-born, 2\u0026thinsp;=\u0026thinsp;Foreign-born).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eYears in U.S.\u003c/b\u003e: DMDYRUSZ was recoded into two groups: \u0026lt;10 years (recent immigrants) and \u0026ge;\u0026thinsp;10 years (long-term immigrants).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eOral Health Outcomes\u003c/b\u003e: Self-rated oral health (OHQ830: 1\u0026thinsp;=\u0026thinsp;Excellent to 5\u0026thinsp;=\u0026thinsp;Poor) and time since last dental visit (OHQ845: 1\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;6 months to 3\u0026thinsp;=\u0026thinsp;\u0026ge;\u0026thinsp;1 year).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e \u003cp\u003eAll analyses were conducted in SPSS using complex sample weights (WTMEC2YR). Frequencies and cross-tabulations were generated for oral health outcomes by nativity and duration of residence. Chi-square tests assessed statistical significance at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 5,856 adults analyzed, 30.5% were foreign-born. Self-rated oral health revealed significant disparities: 33.3% of foreign-born adults rated their oral health as \"good,\" and 34.1% as \"fair,\" compared to 28.3% and 22.6% respectively among U.S.-born adults. Poor oral health ratings were higher among U.S.-born adults (10.5%) but must be interpreted in context of access and utilization patterns.\u003c/p\u003e \u003cp\u003eRegarding dental visits, 71.0% of U.S.-born respondents had visited a dentist in the last year, compared to 66.6% of foreign-born respondents. Among foreign-born adults, those who had been in the U.S. for \u0026ge;\u0026thinsp;10 years were significantly more likely to have had a dental visit within the last year (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eChi-square tests confirmed statistically significant differences in both self-rated oral health and dental care utilization by nativity and duration of U.S. residence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study extends the healthy immigrant effect framework to oral health, revealing complex patterns. Although immigrants may arrive with relatively good oral health behaviors or resilience, the structural barriers they face in the U.S.\u0026mdash;including lack of insurance, limited dental coverage under Medicaid, language barriers, and systemic discrimination\u0026mdash;may erode these initial advantages over time.\u003c/p\u003e \u003cp\u003eNotably, longer U.S. residence was associated with greater dental service use, suggesting acculturation and systemic integration improve access. However, the decline in self-rated oral health among long-term immigrants may reflect cumulative exposure to U.S. health system inequalities.\u003c/p\u003e \u003cp\u003eThese findings underscore the need for targeted, early interventions such as community-based oral health outreach, mobile dental clinics, and immigrant-friendly insurance navigation programs. Additionally, integrating oral health education into existing migrant health services could strengthen preventive practices and reduce reliance on emergency care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOral health disparities between U.S.-born and foreign-born adults persist and evolve with time spent in the host country. As the U.S. continues to grow more diverse, policymakers and health systems must prioritize early, equitable integration of immigrants into oral health systems. This approach is essential to preventing long-term disparities and promoting a truly inclusive public health agenda.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e NHANES data are publicly available and de-identified. Ethical approval for NHANES protocols is provided by the National Center for Health Statistics Research Ethics Review Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e The datasets analyzed during the current study are available from the NHANES website:\u0026nbsp;https://www.cdc.gov/nchs/nhanes/index.htm\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The author declares no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e MT conceived the study and conducted the analysis, GSW and TB interpreted the results, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e The author thanks the Centers for Disease Control and Prevention for providing public access to the NHANES data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention (CDC). National Health and Nutrition Examination Survey: NHANES 2017\u0026ndash;2018. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchs/nhanes/index.htm\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchs/nhanes/index.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlegr\u0026iacute;a M, Sribney W, Woo M, Torres M, Guarnaccia P. Looking beyond nativity: the relation of age of immigration, length of residence, and birth cohorts to the risk of onset of psychiatric disorders for Latinos. Res Hum Dev. 2007;4(1\u0026ndash;2):19\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBastani R, Garza MA, Glenn BA, et al. Exploring the healthy immigrant effect in oral health among Mexican immigrants in the United States. J Immigr Minor Health. 2007;9(4):255\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatrick DL, Lee RSY, Nucci M, Grembowski D, Jolles CZ, Milgrom P. Reducing oral health disparities: a focus on social and cultural determinants. BMC Oral Health. 2006;6(Suppl 1):S4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCruz GD, Chen Y, Salazar CR, Le Geros RZ, Tavares M. The association of immigration and acculturation attributes with oral health among immigrants in New York City. Am J Public Health. 2009;99(Suppl 2):S474\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlores G, Lin H. Trends in racial/ethnic disparities in medical and oral health, access to care, and use of services in US children: has anything changed over the years? Int J Equity Health. 2013;12:10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDye BA, Li X, Thornton-Evans G. Oral health disparities as determined by selected healthy people 2020 oral health objectives for the United States, 2009\u0026ndash;2010. NCHS Data Brief. 2012;104:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFisher-Owens SA, Isong IA, Soobader MJ, et al. An examination of racial/ethnic disparities in children\u0026rsquo;s oral health in the United States. J Public Health Dent. 2013;73(2):166\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu B, Tran TV, Khatutsky G. The health status of older Chinese in the United States: findings from the 1997\u0026ndash;1999 National Health Interview Survey. J Aging Health. 2005;17(5):754\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLukes SM, Simon B. Dental services for migrant and seasonal farmworkers in the United States. J Health Care Poor Underserved. 2006;17(4 Suppl):50\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQui\u0026ntilde;onez C, Gibson D, Jokovic A, Locker D. Emergency department visits for dental care of nontraumatic origin. Community Dent Oral Epidemiol. 2009;37(4):366\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"immigrant health, oral health disparities, NHANES, health access, dental visits, acculturation","lastPublishedDoi":"10.21203/rs.3.rs-6884137/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6884137/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe \"healthy immigrant effect\" posits that foreign-born individuals often arrive in host countries with health profiles superior to those of native-born populations. However, the durability of this advantage in oral health remains poorly understood. This study investigates oral health disparities by nativity and duration of U.S. residence using nationally representative data.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe analyzed cross-sectional data from 5,856 adults (aged\u0026thinsp;\u0026ge;\u0026thinsp;18) in the 2017\u0026ndash;2018 National Health and Nutrition Examination Survey (NHANES). Self-rated oral health and recency of dental visits were examined across nativity groups (U.S.-born vs. foreign-born) and by length of U.S. residency (\u0026lt;\u0026thinsp;10 vs. \u0026ge;10 years). Descriptive statistics, cross-tabulations, and chi-square tests were conducted with appropriate sample weights.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eForeign-born individuals represented 30.5% of the sample. Compared to U.S.-born adults, a greater proportion of immigrants reported not having visited a dentist in over a year and rated their oral health as \"fair\" or \"poor\" (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among foreign-born respondents, those who had lived in the U.S. for \u0026ge;\u0026thinsp;10 years were significantly more likely to have had a dental visit within the past year and reported better self-rated oral health than those with \u0026lt;\u0026thinsp;10 years of residency.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFindings indicate that oral health advantages among immigrants diminish with time and are linked to reduced access and delayed utilization of dental care. Policy efforts should prioritize early integration of immigrants into preventive oral health systems to reduce long-term disparities.\u003c/p\u003e","manuscriptTitle":"Revisiting the Healthy Immigrant Effect: Nativity and Oral Health Disparities Among U.S. Adults in NHANES 2017–2018","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-30 06:50:35","doi":"10.21203/rs.3.rs-6884137/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d177674d-f9a0-4857-8d9d-d3771183dfb1","owner":[],"postedDate":"June 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-11T06:54:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-30 06:50:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6884137","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6884137","identity":"rs-6884137","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}