Adding Nativity, Citizenship, and Immigration Status to Health Monitoring and Survey Data

Immigration status and related policies have a significant impact on health outcomes. Yet major national health surveys currently provide little or no information about immigration status, rendering subgroups of noncitizens largely invisible. Even measures of citizenship, nativity, country of birth, and years in the United States, which provide critical information about immigration history, are not consistently included in national data sets. The main objections to asking directly about immigration status are that (1) such questions are too stigmatizing, risking lower response rates and inaccurate responses; and (2) answering the questions may expose respondents to possible immigration or criminal consequences. Our analysis shows that these objections are unfounded or can be mitigated. National health surveys have evolved over the past decades to include questions about mental health, substance use, sexual orientation, and gender identity-topics once assumed to be too stigmatizing to ask about, with possible negative legal consequences. We argue that the time has come to obtain more detailed information about immigration status as well as to consistently include the measures of immigration history mentioned so that we can better evaluate the health consequences of immigrant-related policy choices. (Am J Public Health. 2025;115(1):75-82. https://doi.org/10.2105/AJPH.2024.307867).