Use of Reproductive Health Care among Asian Immigrant Women

项目摘要/摘要 美国有2000多万亚洲人，其中60%是移民。到2055年，这一人口结构是 预计将超过西班牙裔，成为美国最大的移民群体。其中包括150万 无证件的亚洲人，他们比有证件的同龄人面临更大的准入障碍。尽管如此 在这一趋势下，国家卫生统计数据往往将亚洲人归为“其他”类别，或将他们完全排除在外。对于亚洲人 移民女性，她们报告意外怀孕的几率更大，不太可能使用性爱和 生殖健康(SRH)保健与美国出生的同行相比，详细的SRH数据占了 他们的社会、经济和政治经验的多样性对于解决其 不断壮大的社区。此外，过去的研究将移民身份视为二元(有记录/无记录) 和静态变量；然而，越来越多的人认识到存在状态和该状态的层次结构 会在移民的一生中发生改变。在PI过去处理亚洲移民工作的基础上，目标是 这项研究将在迄今为止最多样化的亚洲移民女性样本中提供关键的SRH数据。 我们建议建立第一个多城市、序贯混合方法的亚洲妇女SRH研究。 跨多个种族和移民身份，包括入籍公民，合法永久居民， 临时工和学生、DACA接受者和非法移民。在社会的引导下 生态模型和生命过程视角，这项研究将评估多水平的因素，中介和 移民身份和SRH护理使用之间的适度关联。我们首先进行48个质化生命 历史访谈，考察移民身份的社会政治经历如何成为SRH的障碍 长期小心使用(目标1)。接下来，使用一种新的海星采样方法来招募隐藏的种群， 我们将招募2000名年龄在18-49岁的亚洲移民女性，包括对四个最大的 无证亚裔(印度人、中国人、菲律宾人和韩国人)人数最多的城市 亚洲移民(洛杉矶、纽约市、休斯顿和亚特兰大)。利用定量调查数据，我们将 1)研究移民身份如何与使用最近的SRH服务相关联；2)探索 移民状况并评估敏感时期(如童年、 青春期、成年期)(目标2)；3)审查调解人和主持人(目标3)。为了改善这一状况 在我们研究的质量、相关性和可及性方面，我们将与全美亚太裔美国人协会合作 妇女论坛是亚洲第一个全国性生殖正义组织，其分会位于 在我们感兴趣的每个城市。此外，我们还将密切关注以下方面的知识、专业知识和敏感性 加利福尼亚州、纽约州、德克萨斯州和佐治亚州的当地社区组织。我们的短期计划 目标是确定和告知多层次的SRH外展和干预努力，这将帮助我们实现我们的 改善移民、家庭和社区的SRH公平性的长期目标。

Project Summary/Abstract There are over 20 million Asians in the US, 60% of whom are immigrants. By 2055, this demographic is expected to surpass Hispanics to become the largest immigrant group in the country. This includes 1.5 million undocumented Asians, who experience greater barriers to access than their documented peers. Despite these trends, national health statistics often lump Asians into an “other” category or exclude them entirely. For Asian immigrant women, who report greater odds of unintended pregnancies and are less likely to use sexual and reproductive health (SRH) care compared to their US-born counterparts, detailed SRH data accounting for their diversity of social, economic, and political experiences is critical to addressing SRH inequities in their growing community. Moreover, past studies treat immigration status as a binary (documented/undocumented) and static variable; however, there is increasing recognition that there is a hierarchy of statuses and that status can change across the life of an immigrant. Building on the PI’s past work with Asian immigrants, the goal of this study is to provide critical SRH data among the most diverse sample of Asian immigrant women to date. We propose to establish the first multi-city, sequential mixed-methods study of the SRH of Asian women across multiple ethnicities and immigration statuses, including naturalized citizens, lawful permanent residents, temporary workers and students, DACA recipients, and undocumented immigrants. Guided by the social ecological model and life course perspective, this study will assess multilevel factors that mediate and moderate associations between immigration status and SRH care use. We first conduct 48 qualitative life history interviews to examine how sociopolitical experiences of immigration statuses act as barriers to SRH care use over time (Aim 1). Next, using a novel starfish sampling method used to recruit hidden populations, we will recruit 2,000 Asian immigrant women aged 18-49 years, including an oversampling of the four largest undocumented Asian ethnicities (Indian, Chinese, Filipinos, and Koreans) in cities with the highest numbers of Asian immigrants (Los Angeles, New York City, Houston, and Atlanta). Using quantitative survey data, we will 1) examine how immigration status is associated with use of recent SRH services; 2) explore histories of immigration statuses and assess cumulative risks on SRH care use during sensitive periods (e.g. childhood, adolescence, adulthood) (Aim 2); 3) and examine mediators and moderators (Aim 3). In order to improve the quality, relevance, and accessibility of our research, we will partner with the National Asian Pacific American Women’s Forum (NAPAWF), the first national Asian reproductive justice organization, and its chapters located in each of our cities of interest. In addition, we will closely engage the knowledge, expertise, and sensitivities of local community-based organizations throughout California, New York, Texas, and Georgia. Our short-term goal is to identify and inform multi-level SRH outreach and intervention efforts, which will help us achieve our long-term goal to improve the SRH equity of immigrants, families, and communities.