Examining associations between self-rated health and proficiency in literacy and numeracy among immigrants and U.S.-born adults: Evidence from the Program for the International Assessment of Adult Competencies (PIAAC)

This paper uses data from the Program for the International Assessment of Adult Competencies (PIAAC) to analyze the relationship between self-reported health (SRH) and literacy and numeracy proficiency for immigrants compared to U.S.-born respondents and for Hispanic versus Asian immigrants. The research questions were: (1) Are literacy and numeracy scores associated with adults' SRH? (2) Are associations between SRH and literacy and numeracy proficiency moderated by immigrant status? (3) Among immigrants, are literacy and numeracy scores more strongly associated with SRH for Hispanics versus Asians? Immigrants had significantly lower literacy and numeracy scores, yet reported better health than U.S.-born respondents. Ordinal logistic regression analyses showed that literacy and numeracy were both positively related to SRH for immigrants and U.S.-born adults, and should therefore be viewed as part of the growing evidence that literacy is an independent and significant social determinant of health. Second, U.S.-born and immigrant adults accrued similarly positive health benefits from stronger literacy and numeracy skills. Third, although Hispanic immigrants were more disadvantaged than Asian immigrants on almost all socioeconomic characteristics and had significantly lower literacy and numeracy scores and worse SRH than Asian immigrants, both Hispanic and Asian immigrants experienced similar positive health returns from literacy and numeracy proficiency. These findings underscore the potential health benefits of providing adult basic education instruction, particularly for immigrants with the least formal schooling and fewest socioeconomic resources.