摘要：Objectives. We investigated whether the conventional Spanish translation of the self-rated health survey question helps explain why Latinos' self-rated health is worse than Whites' despite more objective health measures showing them to be as healthy as or healthier than are Whites. Methods. We analyzed the relationship between language of interview and self-rated health in the Chicago Community Adult Health Study (2001–2003) and the 2003 Behavioral Risk Factor Surveillance System. Results. Being interviewed in Spanish was associated with significantly higher odds of rating health as fair or poor in both data sets. Moreover, adjusting for language of interview substantially reduced the gap between Whites and Latinos. Spanish-language interviewees were more likely to rate their health as fair ( regular in Spanish) than as any other choice, and this preference was strongest when compared with categories representing better health (good, very good, and excellent). Conclusions. Our findings suggest that translation of the English word “fair” to regular induces Spanish-language respondents to report poorer health than they would in English. Self-rated health should be interpreted with caution, especially in racial/ethnic comparisons, and research should explore alternative translations. For more than 2 decades, researchers have been intrigued by studies indicating that Latinos experience health outcomes that are equal to or better than those of Whites, despite having lower socioeconomic status. 1 – 8 One important exception to this apparent Latino health advantage is self-rated health; that is, Latinos’ assessments of their overall health status are lower than those of Whites and below what would be expected from more objective measures. 8 – 15 Understanding this puzzling side of Latino population health is critical to advancing research on racial/ethnic disparities in health and addressing their root causes. 16 Some scholars hypothesize that Latinos’ relatively poor self-rated health reflects a cultural orientation to somatize psychosocial or emotional distress as physical health conditions or to avoid boasting about health. 11 , 12 , 17 , 18 Accordingly, some studies rely on measures of language use to tap into the cultural and cognitive factors that might explain Latinos’ perception of their own health. Such studies show that Latino respondents with greater proficiency in Spanish report lower levels of self-rated health than do Latinos with greater English proficiency 11 – 13 , 17 , 19 – 22 and that controlling for language use reduces Latino–White disparities in self-rated health. 11 – 13 , 19 The explanation for Latinos' relatively low levels of self-rated health may be that the usual Spanish translation of the response categories to the self-rated health question induces Spanish-language respondents to report poorer health than they would if they were responding to the question in English. Although this hypothesis does not preclude other explanations, it is a parsimonious and testable proposition. The response categories for the self-rated health question are conventionally translated into Spanish as excelente (excellent), muy buena (very good), buena (good), regular (fair), and mala (poor). Because the Spanish word regular connotes more positive meanings than fair does in English, the translation of this response option may downwardly bias estimates of Latino self-reported health status. Although other scholars have suggested similar explanations, 11 – 13 , 17 none, to our knowledge, have empirically examined how language of interview shapes answers to the fair response category.
