PROJECT 3: HEALTH CARE ACCESS & UTILIZATION AMONG MEXICAN CHILDREN OF IMMIGRANTS

项目三采用纵向研究设计，分析墨西哥移民子女获得和使用卫生保健的情况。该项目将评估移民证件身份如何造成获得医疗保健的脆弱性，以及新的和传统的移民目的地社区的体制和社会政治背景如何减少医疗保健障碍。虽然近三分之一（29%）的墨西哥儿童缺乏医疗保险，估计有16%的儿童没有定期体检，但人们对移民和定居过程或父母和子女的法律的地位对医疗保健的获得和使用的影响知之甚少。本研究将解决这些研究差距，使用汇总的纵向数据从四个全国代表性的队列从1996年，2001年，2004年和2008年面板的SIPP合并上下文数据的公共和学校为基础的卫生设施，经济条件，并在很大程度上限制当地的移民相关的法律和政策。保险覆盖率和类型，覆盖范围随时间的变化（例如，将按种族、出生地和法律的地位，以及新移民目的地与传统移民目的地的不同情况，对接受常规医疗和牙科护理的情况进行审查。拟议的分析将推进公共卫生奖学金，涉及与卫生保健获得和利用有关的新的和传统的目的地环境的多个方面（即，健康和工作相关的制度背景，移民接受背景）。方法创新解决了移民人口研究中固有的几个挑战，包括开发和验证估计移民文件状态的算法;开发用于模型偏差敏感性测试的倾向分数; 由于选择进入新的/传统的目的地社区而产生的估计数，用于建立移民调整权重;以及对移民接受“气候”的多来源测量，包括当地颁布的移民相关法律和政策以及媒体记录的移民相关社区社会行动记录。

Project III uses a longitudinal research design to analyze Mexican children of immigrants' access to and use of health care. The project will evaluate how immigrant documentation status creates health care access vulnerabilities and how institutional and sociopolitical contexts in new and traditional immigrant destination communities may reduce health care barriers. While nearly one-third (29%) of Mexican children lack health insurance and an estimated 16% do not get regular medical checkups, little is known about the effects on health care access and use of the immigration and settlement process or the legal status of parents and children. This study will address these research gaps using pooled longitudinal data from four nationally representative cohorts from the 1996, 2001, 2004 and 2008 panels ofthe SIPP merged with contextual data on public and school-based health facilities, economic conditions, and largely restrictive local area immigration-related laws and policies. Rates and types of insurance coverage, gaps in coverage over time (e.g., by year), and receipt of routine medical and dental care will be examined by race-ethnicity, nativity, and legal status, and across new versus traditional immigrant destination contexts. The proposed analysis will advance public health scholarship regarding multiple dimensions of new and traditional destination contexts that are related to health care access and utilization (i.e., health- and work-related institutional contexts, the immigrant receptivity context). Methodological innovations address several challenges inherent in the study of immigrant populations, including the development and validation of an algorithm to estimate immigrant documentation status; development of propensity scores for use in sensitivity tests for bias in model estimates due to selection into new/traditional destination communities and for use in creating emigration adjusted weights; and the multi-source measurement of immigrant receptivity "climate," including local area enacted immigration-related laws and policies and media-documented records of immigration-related community social actions.