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

项目III采用纵向研究设计，分析墨西哥移民子女获得和利用医疗保健的情况。该项目将评估移民身份如何造成卫生保健获取的脆弱性，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卫生保健障碍。虽然近三分之一(29%)的墨西哥儿童没有医疗保险，估计有16%的儿童没有定期体检，但人们对移民和定居程序对医疗保健获得和使用的影响或父母和儿童的法律地位知之甚少。这项研究将利用1996年、2001年、2004年和2008年SIPP小组的四个具有全国代表性的队列的纵向数据，结合公共和学校医疗设施、经济状况以及与移民相关的大部分限制性当地法律和政策的背景数据，来解决这些研究差距。将按种族、出生地和法律地位以及新移民和传统移民目的地背景对保险覆盖率和类型、覆盖范围随时间的差距(例如按年)以及常规医疗和牙科护理的接受情况进行审查。拟议的分析将促进公共卫生学术研究，涉及与卫生保健获取和利用有关的新的和传统目的地背景的多个层面(即，与健康和工作有关的机构背景、移民接受度背景)。方法论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证件状况的算法；开发用于模型偏差敏感性测试的倾向分数 由于被选入新的/传统的目的地社区并用于创建移民调整的权重；对移民接受度“气候”的多来源衡量，包括当地颁布的与移民有关的法律和政策以及媒体记录的与移民有关的社区社会行动。

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.