Estimating the effects of Arizona-style omnibus immigration policies on Latino children???s access to health care

 描述（由申请人提供）：拉丁裔儿童有任何美国公民儿童最差的医疗保健访问1，2限制性的国家移民政策可能会进一步加剧差距。综合移民政策旨在加强移民执法，限制无证移民获得服务，并对无证移民进行刑事处罚。定性研究6-10表明，综合政策减少了拉丁美洲儿童的医疗保健服务，无论父母的移民身份。然而，现有的几项定量研究的结果是混合的，这些研究的研究设计薄弱，样本不具有代表性。6，8，9没有研究检查医疗保健获取的哪些方面受到最大的影响，影响持续多久，或者影响是否因个人或社区特征而异。这项研究假设：（1）综合移民政策减少了美国公民拉丁裔儿童获得医疗保健的机会，其影响会随着时间的推移而下降，但不会消失;（2）移民儿童的影响大于美国出生的父母的儿童; (3)生活在一个拉丁美洲人比例高的县会减弱影响。本研究将采用比较中断时间序列（CITS）设计，以估计综合移民政策对拉丁裔美国公民儿童获得医疗保健的影响，政策通过后长达四年。当随机对照试验不可行时，CITS是评估卫生政策效果的最严格设计。11数据将来自全国健康访谈调查，将包括所有50个州超过98，000名公民拉丁裔儿童，时间超过14年（2001-2014）。结果措施将包括以下保健服务获得情况指标：牙科和医疗保险覆盖率、预防保健的使用、未满足的保健需求以及经常性的保健来源。模型将估计政策通过对卫生保健获取的直接和长期影响。交互作用项将被添加到模型中，以测试父母的移民身份或县拉丁裔人口是否会调节效应。如果样本量允许，分析将按拉丁美洲人种亚组分层。研究结果将具有重要的政策意义。12面对移民改革的压力越来越大，了解移民政策如何影响公民儿童至关重要，既要以保护儿童的方式引导政策，又要为公共卫生工作提供信息，以减轻影响。

 DESCRIPTION (provided by applicant): Latino children have the worst health care access of any US citizen children1, 2 Restrictive state immigration policies may further exacerbate disparities. Omnibus immigration policies seek to increase immigration enforcement, restrict undocumented immigrants' access to services, and create criminal penalties for undocumented immigration.3, 4 Although these policies had immediate, drastic effects on communities,5 little is known about their effects on health care access for Latino children. Qualitative studies 6-10 indicate that omnibus policies reduce Latino children's health care access, regardless of parents' immigration status. Findings from the few quantitative studies that exist are mixed, however, and these studies suffer from weak study designs and non-representative samples.6,8,9 No studies have examined which aspects of health care access are most affected, how long effects last, or whether effects vary by individual or community characteristics. This study hypothesizes that (1) omnibus immigration policies reduce health care access for U.S. citizen Latino children, with effects that decline but do not disappear over time; (2) effects are greater for children of immigrants than for children of US- born parents; and (3) living in a county with a high proportion of Latinos attenuates effects. This study will use a comparative interrupted time series (CITS) design to estimate the effects of omnibus immigration policies on health care access for US citizen children of Latino descent up to four years after policies were passed. CITS is the most rigorous designs for evaluating health policy effects when a randomized controlled trial is not feasible.11 Data will come from the National Health Interview Survey and will include over 98,000 citizen Latino children in all 50 states over 14 year (2001-2014). The outcome measures will include the following indicators of health care access: dental and medical insurance coverage, use of preventive care, unmet health care needs, and regular source of care. Models will estimate immediate and long-term effects of policy passage on health care access. Interaction terms will be added to the models to test whether effects are moderated by parents' immigration status or by county Latino population. If sample sizes permit, analyses will be stratified by Latino national origin subgroup. Findings will have important policy implications. State immigration policies drive and set the course of immigration policy discussions at the federal level, and many state-level policies are eventually replicated at the national level.12 In the face of mounting pressure for immigration reform, it is critical to understand how immigration policies affect citizen children-both to steer policy in ways that protect children and to inform public health efforts to alleviate effects.