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

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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.