One in four children in the United States lives in an immigrant family (i.e., with at least one immigrant parent in the household), and at least one in twenty lives in a mixed-immigration status family (i.e., variability in immigration status). While several studies have demonstrated the importance of a family?s immigration status as a social determinant of child health ? few have analyzed the role of immigration policy (including national, state and local immigration policies) in shaping child health outcomes. Historically, such analyses have been challenging because of the limited availability of nationwide data sets containing the requisite measures of immigration status, and the use of insufficiently-rigorous analytic techniques that are unable to go beyond statistical associations. Our interdisciplinary group has shown its capacity to overcome these issues in a recent study using state Medicaid data and innovative analytic techniques to examine the impact of immigration policy on infant, child, and maternal health. For this proposal, our overarching goal is to extend this capacity nationwide by using Medicaid data to assess the impact of public policy on health care access, health-service utilization, and health outcomes for US-born children of first-generation immigrant parents. Specifically, we will fulfill the following aims.
Aim 1 : we will build a national, longitudinal, linked Medicaid data set to examine the effect of immigration policies on children?s health.
Aim 2 : using this national database, we will examine the impact of national immigration policy on child health (e.g., mental health) and health care use (e.g., primary-care access, hospital utilization).
Aim 3 : we will examine state and local immigration policies to determine the differential impact of various policies on immigrant parents and their US-born children. We use eligibility requirements for Medicaid to identify immigrant mothers and their US-born children, and then use probabilistic matching (via household billing identification systems and birth records) to link family units. To conduct the analyses in Aims 2-3, we will use causal inference research designs (such as difference-in-difference) to explore the impact of external public policy changes ? taking advantage of ?natural experiments? in policy implementation over time and across geographic areas. This includes federal and state immigration policies (e.g., immigration laws, regulations that include or exclude immigrants from particular services), state and local immigration actions (e.g., workplace-level and community-level enforcement), and federal and state health policies (e.g., federal Medicaid legislation, regulation or guidance specific to prenatal care, pediatric care) that may differentially impact first- generation immigrant parents and their US-born children. We hypothesize that these policies will have important intergenerational impacts on the health and wellbeing of US-born children of immigrants. Answering these specific aims is essential to inform decision-making by policymakers, public health leaders, and medical professionals who are committed to addressing health disparities and improving health trajectories for children in immigrant families, one of the most rapidly growing child population groups.

Public Health Relevance

Immigrant families confront an increasingly complex array of local, state, and federal health- and immigration- focused policies with important implications for access to health care as well as direct short- and long-term consequences for well-being. Although current research points to a strong relationship between immigration status, health access, and health outcomes, we have yet to develop systematic evidence on the policy levers that have the potential to impact such a large number of immigrants? lives. We propose to rigorously assess, using an innovative data-linking approach and quasi-experimental methods, the intergenerational impact of immigration policies at the local, state, and federal levels.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Social Sciences and Population Studies B Study Section (SSPB)
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Dagher, Rada Kamil
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Stanford University
Social Sciences
Schools of Arts and Sciences
United States
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