Immigrant Families and Children's Health: The Intergenerational Health Impact of Federal and State Immigration Policy - ABSTRACT
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.
