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医疗保健的情况。该项目将评估移民证件身份如何造成获得保健服务的脆弱性，以及新移民和传统移民目的地社区的体制和社会政治背景如何可能减少保健障碍。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程序对医疗保健的获取和使用或父母和儿童的法律地位的影响知之甚少。本研究将利用1996年、2001年、2004年和2008年SIPP小组中四个具有全国代表性的队列的汇总纵向数据，并结合有关公共和学校卫生设施、经济条件以及很大程度上限制性的当地移民相关法律和政策的背景数据，解决这些研究差距。将按种族、族裔、出生地和法律地位，以及新移民目的地与传统移民目的地的情况，检查保险费率和保险类型、长期（如按年）保险缺口以及接受常规医疗和牙科护理的情况。拟议的分析将推动与卫生保健获取和利用相关的新目的地和传统目的地环境（即卫生和与工作相关的机构环境，移民接受环境）的多个维度的公共卫生学术研究。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证件状态的算法；倾向评分的发展，用于模型偏差的敏感性测试

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.