Social and Political Determinants of Health and Health Services Use of US Immigrant Children Restricted; Files Only
Kim, Ye Ji (Spring 2023)
Published
Abstract
Immigrant families’ children make up about one in four children in the United States. Yet, our understanding of social and political determinants that influence the access and use of health services is limited within this vital group of our society. The overall goal of this dissertation was to evaluate and examine the relationships between social determinants at multiple levels – including the individual level, neighborhood level, and state policy level – with the health and health services use of US immigrant children.
In Aim 1, I conduct multiple group path analyses to estimate the mechanism of children’s immigration status and multi-year prevalence of health services use by household socioeconomic status. There was an indirect association between household generation status and healthcare services use through uninsured status, among children in 1stgeneration families compared to non-immigrant families, particularly for children of low SES.
In Aim 2, I evaluate the impact of the state-level removal of the 5-year eligibility bar for federally funded programs on health indicators among foreign-born children from low-income households. Using difference-in-differences design, the removal of the 5-year bar increased the risk of poor health status and poor teeth condition and decreased the risk of asthma, though estimates were small. Further adjustment for political party of the state’s governor, a proxy for the state-level immigrant climate context, did not meaningfully change the impact of the 5-year bar removal on health indicators.
In Aim 3, I define four ethnic structures of residence among foreign-born children – ethnic enclave, low-income ethnoburb, high-income ethnoburb, and other. I use generalized linear mixed models to estimate the association between ethnic structures of residence and odds of preventive healthcare services use over time, testing for differences by insurance type. I use median odds ratios to estimate the variation between neighborhoods. Majority of our study sample of foreign-born children lived in ethnic enclaves. Second, there was no evidence of an association between the ethnic structure of residence and use of preventive health services. Neighborhood level income inequality and unemployment rates explained much of the variance in children’s use of preventive services between neighborhoods.
This dissertation contributes to the growing body of work demonstrating the need for insurance coverage and understanding of the neighborhood context among immigrant children. In addition, disparities in the health and use of health services persist despite state-level changes to broaden public program eligibilities. Future work should explore longer term effects of the 5-year bar on clinically diagnosed health conditions and differences across these sociopolitical factors of health services use and health conditions by documentation status.
Table of Contents
Abstract 2
Acknowledgements 4
Introduction 1
Aim 1. Immigration Status and Use of Health Services Among Children: Multiple Samples Path Analyses of National Survey of Children’s Health 2016-2017 6
Background 6
Methods 8
Results 15
Discussion 25
Supplement 28
Aim 2. Effects of Removing the 5-Year Eligibility Restrictions of Public Benefits on Immigrant Children’s Health 45
Background 45
Methods 46
Results 52
Discussion 58
Supplement 62
Aim 3. Ethnic Structure of Residence and Health Services Use of US Immigrant Children 63
Background 63
Method 65
Results 68
Discussion 77
Conclusion and Future Directions 80
Bibliography 83
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File download under embargo until 22 May 2025 | 2023-02-27 13:16:12 -0500 | File download under embargo until 22 May 2025 |
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