Understanding health services utilization and health mechanism among U.S. immigrant children and adolescents

项目摘要移民家庭的孩子约占美国儿童总数的五分之一 各州。从历史上看，移民一直面临着获得医疗保健的障碍，而这反过来又会持续下去 对身心健康的影响。城市居民卫生服务利用的理论框架 移民被概念化为卫生服务使用行为模式的延伸。这个 移民卫生服务利用理论包括移民身份等移民特有因素。 然而，移民之间的卫生服务利用模式存在潜在的间接影响。 通过服务需求和保险地位的状况和儿童健康服务利用情况，以及 使能因素，仍未得到检验。影响移民健康的关键宏观结构因素 包括关于获得联邦资助福利的政策，如医疗补助和儿童健康保险 程序。1996年的福利改革对合法永久居民规定了五年的等待期 领取公共福利。2009年，各州获得了通过取消等待来扩大资格的选择 句号。这项拟议的研究项目的总体目标是解决我们在健康知识方面的差距 通过更好地了解移民机制，了解移民儿童的服务利用和健康 卫生服务利用状况和国家一级政策限制的影响。在目标1中，我们将估计 儿童移民状况对其卫生服务利用的间接影响 基于路径分析的外来人口卫生服务利用概念模型--以儿童需求为中心 使用父母报告的健康状况进行评估的医疗保健服务，其次是通过儿童的 保险地位，一种赋能资源。我们还将估计两国关系的总体影响 移民状况和卫生服务利用情况。在目标2中，我们将评估国家层面的影响 取消对50个州和华盛顿特区由联邦政府资助的儿童健康项目的限制 哥伦比亚，采用差分(DD)设计。DD设计提供了貌似合理的因果推断 取消5年等待期对移民儿童和青少年健康的影响。这 研究将使用两个来源的数据：全国儿童健康调查(目标1：2016-2018；目标2： 2007和2011/12)；以及亨利·J·凯泽家庭基金会关于该州取消5年的数据 等待期(两个目标)。了解移民状况对卫生服务利用的影响机制 宏观结构限制可能突出对医疗服务的具体需求和对健康的政策影响 更好地为所有公众需求，包括移民和混合身份家庭的需求量身定做卫生服务。这 奖学金将为我提供机会和培训，以丰富我对社会学理论的理解， 加强我在社会流行病学方面的研究基础，并与健康差距学者接触，以促进 我的长期目标是成为一名独立研究人员。

Project Summary/Abstract Immigrant families’ children make up about one in five children in the United States. Immigrants historically and persistently face barriers obtaining healthcare, which in turn have lasting physical and mental health consequences. A theoretical framework of health service utilization among immigrants have been conceptualized as an extension of the Behavioral Model of Health Services Use. The theory of immigrant health service utilization includes immigrant-specific factors such as immigration status. Yet, potential indirect effects posited in the immigrant health service utilization model between immigration status and children’s health service utilization through the need of services and through insurance status, an enabling factor, remain unexamined. A critical macrostructural factor that influences health of immigrants include policies on access to federally funded benefits such as Medicaid and Children’s Health Insurance Program. The welfare reform in 1996 imposed a five-year waiting period for legal permanent residents before receiving public benefits. In 2009, states were given the option to expand eligibility by removing the waiting period. The overall goal of this proposed research project is to address gaps in our knowledge of health service utilization and health of immigrant children by better understanding the mechanisms of immigration status on health service utilization and the effects of state-level policy restrictions. In Aim 1, we will estimate the indirect effects of children’s immigration status on their health service utilization through two hypotheses of a conceptual model of immigrants’ health services utilization using path analysis – first through children’s need of health care services, assessed using parent-reported health conditions, and second through children’s insurance status, an enabling resource. We will also estimate the total effect of the relationship between immigration status and health services utilization. In Aim 2, we will evaluate the impact of the state-level removal of restriction to federally funded programs on children’s health across 50 states and the District of Columbia, using difference-in-difference (DD) design. The DD design provides plausible causal inference of the impact of the removal of the 5-year waiting period on immigrant children and adolescent health. This research will use data from two sources: National Survey of Children’s Health (Aim 1: 2016 – 2018; Aim 2: 2007 and 2011/12); and the Henry J. Kaiser Family Foundation data on the year of state’s removal of 5-year waiting period (both Aims). Understanding mechanisms of immigration status on health service utilization and macrostructural restrictions may highlight specific needs for healthcare services and policy impacts on health to better tailor health services to all public needs, including those of immigrant and mixed-status families. This fellowship will afford me opportunities and training to enrich my understanding of sociological theories, strengthen my research foundation in social epidemiology, and engage with health disparities scholars to foster my long-term goal of becoming an independent researcher.