Health Status and Health Service Access and Use Among Children in U.S. Immigrant Families

MBBS, Department of International Health-NHS, Georgetown University, St. Mary's Hall 215, Box 571107, 3700 Reservoir Rd NW, Washington, DC 20057, USA.
American Journal of Public Health (Impact Factor: 4.55). 05/2006; 96(4):634-40. DOI: 10.2105/AJPH.2004.049791
Source: PubMed

ABSTRACT We examined the health status and patterns of health care use of children in US immigrant families.
Data from the 1999 National Survey of America's Families were used to create 3 subgroups of immigrant children: US-born children with noncitizen parents, foreign-born children who were naturalized US citizens, and foreign-born children with noncitizen parents. Chi-square and logistic regression analyses were used to examine relationships between immigrant status and health access variables. Subgroup analyses were conducted with low-income families.
Foreign-born noncitizen children were 4 times more likely than children from native families to lack health insurance coverage and to have not visited a mental health specialist in the preceding year. They were 40% and 80% more likely to have not visited a doctor or dentist in the previous year and twice as likely to lack a usual source of care. US-born children with noncitizen parents were also at a disadvantage in many of these aspects of care.
We found that, overall, children from immigrant families were in worse physical health than children from non-immigrant families and used health care services at a significantly lower frequency.

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Available from: Rebecca Ledsky, Aug 20, 2015
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    • "Policies restricting or mystifying access have broad spillover effects on others in the same household. Despite U.S. citizen children's eligibility for benefits such as Medicaid and State Children's Health Insurance Program, those with undocumented parents access benefits at a lower rate (Hagan, Rodriguez, Capps, & Kabiri, 2003; Huang, Yu, & Ledsky, 2006; Perreira et al., 2012). Fear of deportation and avoidance of institutions leads some mixed-status families to limit or delay services for children (Abrego & Menjívar, 2011; Yoshikawa, 2012), or withdraw from programs altogether (Hagan et al., 2003; Xu & Brabeck, 2012). "
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    ABSTRACT: There are approximately 2.3 million mixed-status families in the United States, containing varied combinations of citizens, permanent legal residents, undocumented immigrants, and individuals in legal limbo. These families offer an opportunity to examine the functioning of the contemporary state and its penetration at the household level. For many Latino youth, experiences are framed not only by their own but other family members’ legal status. This article reports on health care seeking experiences of mixed-status families in the Lower Rio Grande Valley of South Texas and the impact of the recent health care reform (Affordable Care Act). We utilized qualitative ethnographic methods including 55 semistructured interviews with mixed- status families and 43 interviews with health care providers, caseworkers, and public health officials. Results indicate that changes accompanying the reform directly and indirectly affect mixed-status households’ ability to access care. We describe strategies in times of illness, including those unique to border communities. We conclude that, for successful implementation of policies associated with health care reform, broader issues related to immigration status must be addressed, especially anxieties regarding future chances of regularization. These uniquely affect mixed-status families, create a ripple effect on all household members, and result in unintended consequences for U.S. citizen children. Implications point to the need for a pathway to citizenship for parents as a basic step in improving well-being of children.
    American Behavioral Scientist 09/2014; 58(14). DOI:10.1177/0002764214550290 · 0.69 Impact Factor
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    • "In the present sample, having a non-Western immigrant background was associated with a significantly lower likelihood of having had CAPS contact in adolescents with both SA and NSSH. Previous studies from North America indicate that ethnic minority youths are less likely to receive mental health care [22,44,45], a finding that has been attributed to low income and insufficient health insurance among ethnic minority groups. Because all citizens in Norway are covered by universal health insurance, the low income in minority groups cannot fully explain the observed differences in CAPS contact in our sample. "
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    ABSTRACT: Studies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm report more mental health problems and other psychosocial problems than adolescents who report only one or none of these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report contact. Data on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk factors were collected in a cross-sectional sample (response rate = 92.7 %) of 11,440 adolescents aged 14-17 years who participated in a school survey in Oslo, Norway. Adolescents who reported any self-harm were more likely than other adolescents to have used child and adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and non-suicidal self-harm (OR = 9.3). This finding remained significant even when controlling for psychosocial variables. In adolescents with both suicide attempts and non-suicidal self-harm, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services, whereas a non-Western immigrant background was associated with a lower likelihood. In this study, adolescents who reported self-harm were significantly more likely than other adolescents to have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and adolescent psychiatric services, naturally reflecting the core tasks of the services, confirming that they represents an important area for interventions that aim to reduce self-harming behaviour. Such interventions should include systematic screening for early recognition of self-harming behaviours, and treatment programmes tailored to the needs of teenagers with a positive screen. Possible barriers to receive mental health services for adolescents with immigrant backgrounds should be further explored.
    Child and Adolescent Psychiatry and Mental Health 04/2014; 8(1):13. DOI:10.1186/1753-2000-8-13
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    • "It was not within the scope of this research to examine financial and legal access barriers (particularly renowned in countries such as the USA [16]) or to trace disease patterns associated with various migrant groups. "
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    ABSTRACT: The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Paediatric care can be complex, usually involving both the patient and the patient's family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families.
    BMC Health Services Research 10/2013; 13(1):389. DOI:10.1186/1472-6963-13-389 · 1.71 Impact Factor
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