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Venkataramani AS, Cook E, O’Brien RL, Kawachi I, Jena AB, Tsai AC. College affirmative action bans and smoking and alcohol use among underrepresented minority adolescents in the United States: A difference-in-differences study. PLoS Med 2019; 16:e1002821. [PMID: 31211777 PMCID: PMC6581254 DOI: 10.1371/journal.pmed.1002821] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND College affirmative action programs seek to expand socioeconomic opportunities for underrepresented minorities. Between 1996 and 2013, 9 US states-including California, Texas, and Michigan-banned race-based affirmative action in college admissions. Because economic opportunity is known to motivate health behavior, banning affirmative action policies may have important adverse spillover effects on health risk behaviors. We used a quasi-experimental research design to evaluate the association between college affirmative action bans and health risk behaviors among underrepresented minority (Black, Hispanic, and Native American) adolescents. METHODS AND FINDINGS We conducted a difference-in-differences analysis using data from the 1991-2015 US national Youth Risk Behavior Survey (YRBS). We compared changes in self-reported cigarette smoking and alcohol use in the 30 days prior to survey among underrepresented minority 11th and 12th graders in states implementing college affirmative action bans (Arizona, California, Florida, Michigan, Nebraska, New Hampshire, Oklahoma, Texas, and Washington) versus outcomes among those residing in states not implementing bans (n = 35 control states). We also assessed whether underrepresented minority adults surveyed in the 1992-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who were exposed to affirmative action bans during their late high school years continued to smoke cigarettes between the ages of 19 and 30 years. Models adjusted for individual demographic characteristics, state and year fixed effects, and state-specific secular trends. In the YRBS (n = 34,988 to 36,268, depending on the outcome), cigarette smoking in the past 30 days among underrepresented minority 11th-12th graders increased by 3.8 percentage points after exposure to an affirmative action ban (95% CI: 2.0, 5.7; p < 0.001). In addition, there were also apparent increases in past-30-day alcohol use, by 5.9 percentage points (95% CI: 0.3, 12.2; p = 0.041), and past-30-day binge drinking, by 3.5 percentage points (95% CI: -0.1, 7.2, p = 0.058), among underrepresented minority 11th-12th graders, though in both cases adjustment for multiple comparisons resulted in failure to reject the null hypothesis (adjusted p = 0.083 for both outcomes). Underrepresented minority adults in the TUS-CPS (n = 71,575) exposed to bans during their late high school years were also 1.8 percentage points more likely to report current smoking (95% CI: 0.1, 3.6; p = 0.037). Event study analyses revealed a discrete break for all health behaviors timed with policy discussion and implementation. No substantive or statistically significant effects were found for non-Hispanic White adolescents, and the findings were robust to a number of additional specification checks. The limitations of the study include the continued potential for residual confounding from unmeasured time-varying factors and the potential for recall bias due to the self-reported nature of the health risk behavior outcomes. CONCLUSIONS In this study, we found evidence that some health risk behaviors increased among underrepresented minority adolescents after exposure to state-level college affirmative action bans. These findings suggest that social policies that shift socioeconomic opportunities could have meaningful population health consequences.
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Affiliation(s)
- Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Erin Cook
- Analysis Group, Boston, Massachusetts, United States of America
| | - Rourke L. O’Brien
- La Follette School of Public Affairs, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
| | - Ichiro Kawachi
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alexander C. Tsai
- Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Khullar D, Chokshi DA. Challenges for immigrant health in the USA-the road to crisis. Lancet 2019; 393:2168-2174. [PMID: 30981536 DOI: 10.1016/s0140-6736(19)30035-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/16/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022]
Abstract
The USA is home to more immigrants than any other country-about 46 million, just less than a fifth of the world's immigrants. Immigrant health and access to health care in the USA varies widely by ethnicity, citizenship, and legal status. In recent decades, several policy and regulatory changes have worsened health-care quality and access for immigrant populations. These changes include restrictions on access to public health insurance programmes, rhetoric discouraging the use of social services, aggressive immigration enforcement activities, intimidation within health-care settings, decreased caps on the number of admitted refugees, and rescission of protections from deportation. A receding of ethical norms has created an environment favourable for moral and public health crises, as evident in the separation of children from their parents at the southern US border. Given the polarising immigration rhetoric at the national level, individual states rather than the country as a whole might be better positioned to address the barriers to improved health and health care for immigrants in the USA.
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Affiliation(s)
- Dhruv Khullar
- Department of Healthcare Policy and Research and Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Dave A Chokshi
- New York City Health and Hospitals Corporation, New York, NY, USA; Departments of Population Health and Medicine, New York University Langone Health, New York, NY, USA
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Patler C, Hamilton E, Meagher K, Savinar R. Uncertainty About DACA May Undermine Its Positive Impact On Health For Recipients And Their Children. Health Aff (Millwood) 2019; 38:738-745. [DOI: 10.1377/hlthaff.2018.05495] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Caitlin Patler
- Caitlin Patler is an assistant professor of sociology at the University of California Davis
| | - Erin Hamilton
- Erin Hamilton is an associate professor of sociology at the University of California Davis
| | - Kelsey Meagher
- Kelsey Meagher is a PhD candidate in sociology at the University of California Davis
| | - Robin Savinar
- Robin Savinar is a postdoctoral fellow in sociology at the University of California Davis
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Abstract
Public policies play a crucial role in shaping how immigrants adapt to life in the United States. Federal, state, and local laws and administrative practices impact immigrants' access to education, health insurance and medical care, cash assistance, food assistance, and other vital services. Additionally, immigration enforcement activities have substantial effects on immigrants' health and participation in public programs, as well as effects on immigrants' families. This review summarizes the growing literature on the consequences of public policies for immigrants' health. Some policies are inclusive and promote immigrants' adaptation to the United States, whereas other policies are exclusionary and restrict immigrants' access to public programs as well as educational and economic opportunities. We explore the strategies that researchers have employed to tease out these effects, the methodological challenges of undertaking such studies, their varying impacts on immigrant health, and steps that can be undertaken to improve the health of immigrants and their families.
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Affiliation(s)
- Krista M Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA;
| | - Juan M Pedroza
- Department of Sociology, University of California, Santa Cruz, California 95064, USA;
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55
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Juárez SP, Honkaniemi H, Dunlavy AC, Aldridge RW, Barreto ML, Katikireddi SV, Rostila M. Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis. Lancet Glob Health 2019; 7:e420-e435. [PMID: 30852188 PMCID: PMC6418177 DOI: 10.1016/s2214-109x(18)30560-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/20/2018] [Accepted: 12/06/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Government policies can strongly influence migrants' health. Using a Health in All Policies approach, we systematically reviewed evidence on the impact of public policies outside of the health-care system on migrant health. METHODS We searched the PubMed, Embase, and Web of Science databases from Jan 1, 2000, to Sept 1, 2017, for quantitative studies comparing the health effects of non-health-targeted public policies on migrants with those on a relevant comparison population. We searched for articles written in English, Swedish, Danish, Norwegian, Finnish, French, Spanish, or Portuguese. Qualitative studies and grey literature were excluded. We evaluated policy effects by migration stage (entry, integration, and exit) and by health outcome using narrative synthesis (all included studies) and random-effects meta-analysis (all studies whose results were amenable to statistical pooling). We summarised meta-analysis outcomes as standardised mean difference (SMD, 95% CI) or odds ratio (OR, 95% CI). To assess certainty, we created tables containing a summary of the findings according to the Grading of Recommendations Assessment, Development, and Evaluation. Our study was registered with PROSPERO, number CRD42017076104. FINDINGS We identified 43 243 potentially eligible records. 46 articles were narratively synthesised and 19 contributed to the meta-analysis. All studies were published in high-income countries and examined policies of entry (nine articles) and integration (37 articles). Restrictive entry policies (eg, temporary visa status, detention) were associated with poor mental health (SMD 0·44, 95% CI 0·13-0·75; I2=92·1%). In the integration phase, restrictive policies in general, and specifically regarding welfare eligibility and documentation requirements, were found to increase odds of poor self-rated health (OR 1·67, 95% CI 1·35-1·98; I2=82·0%) and mortality (1·38, 1·10-1·65; I2=98·9%). Restricted eligibility for welfare support decreased the odds of general health-care service use (0·92, 0·85-0·98; I2=0·0%), but did not reduce public health insurance coverage (0·89, 0·71-1·07; I2=99·4%), nor markedly affect proportions of people without health insurance (1·06, 0·90-1·21; I2=54·9%). INTERPRETATION Restrictive entry and integration policies are linked to poor migrant health outcomes in high-income countries. Efforts to improve the health of migrants would benefit from adopting a Health in All Policies perspective. FUNDING Swedish Council for Health, Working Life, and Social Research; UK Medical Research Council; Scottish Government Chief Scientist Office.
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Affiliation(s)
- Sol Pía Juárez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Helena Honkaniemi
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden.
| | - Andrea C Dunlavy
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
| | | | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
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Gómez S, Castañeda H. "Recognize Our Humanity": Immigrant Youth Voices on Health Care in Arizona's Restrictive Political Environment. QUALITATIVE HEALTH RESEARCH 2019; 29:498-509. [PMID: 29448885 DOI: 10.1177/1049732318755580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The "DACAmented Voices in Healthcare" project examined the intersection of restrictive immigration policies and health care via photovoice, a participatory action research approach, with immigrant youth living in Arizona, who were recipients of the Deferred Action for Childhood Arrivals (DACA) program. These "DACAmented" youth took part in nine photovoice sessions exploring their health care experiences and accessibility to care using documentary photography and narratives. They poignantly illustrated their experiences through images identifying their main health concerns and strengths, facilitating the development of health policy recommendations. This article illustrates the thematic findings and discusses policy recommendations and lessons learned from presentations to policy makers and health care providers. Findings suggest that immigrant youth are knowledgeable of their family's health care needs and hold a unique and important position within mixed-status households. Health care providers can benefit from the proposed recommendations by building bridges to care to address health equity in immigrant communities.
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Affiliation(s)
- Sofía Gómez
- The University of Arizona, Tucson, Arizona, USA
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Ginot L, Kirschen B, Laporte A, Riou F, Devys C. [Establishing a public policy for migrant health]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2019; 30:611-616. [PMID: 30767477 DOI: 10.3917/spub.186.0611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Based on nursing reports and interviews, a public health program was set up in the Paris region in order to respond to the health needs of thousands of refugees with the goal of steering them, if necessary toward medical care. Elaborated gradually and interfacing with refugee social policies, this organization seems effective. Although subject to certain conditions, this experience provides lessons that could be generalized to other areas of public health and other populations.
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Getrich CM, Rapport K, Burdette A, Ortez-Rivera A, Umanzor D. Navigating a fragmented health care landscape: DACA recipients' shifting access to health care. Soc Sci Med 2019; 223:8-15. [PMID: 30685567 DOI: 10.1016/j.socscimed.2019.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
Deferred Action for Childhood Arrivals (DACA) recipients face an uncertain fate as their future in the United States is being debated. Yet even before the program was introduced in June 2012 and became endangered in September 2017, they encountered challenges in navigating a fragmented health care landscape throughout the United States. This paper focuses on DACA recipients' experiences in accessing health care throughout their lives, both before and after receiving DACA. We conducted semi-structured interviews and questionnaires with 30 DACA recipients living in Maryland between April-December 2016. Participants represented 13 countries of origin and ranged in age between 18 and 28. Results demonstrate that DACA recipients have had punctuated coverage throughout their lives and continue to face constrained access despite temporary gains in status. Health care access is further stratified within their mixed-status families. Participants have also experienced shifts in their health care coverage due to moving between jurisdictions with variable eligibility and changing life circumstances related to family, school, and employment. This article underscores the importance of examining young adult immigrants' access to care over time as they weather changes in the broader policy context and in highly variable contexts of reception nationwide, shaped by state, but also county and city policies and programs. The challenges and gaps in coverage DACA recipients face also underscore the need for both health care and immigration reform.
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Affiliation(s)
- Christina M Getrich
- University of Maryland, College Park, Department of Anthropology, 1111 Woods Halls, 4302 Chapel Lane, College Park, MD, 20742, USA.
| | - Kaelin Rapport
- Northwestern University, Department of Anthropology, 1810 Hinman Avenue, Evanston, IL, 60208, USA.
| | - Alaska Burdette
- University of Maryland, College Park, Department of Anthropology, 1111 Woods Halls, 4302 Chapel Lane, College Park, MD, 20742, USA.
| | - Ana Ortez-Rivera
- University of Maryland, College Park, Department of Anthropology, 1111 Woods Halls, 4302 Chapel Lane, College Park, MD, 20742, USA.
| | - Delmis Umanzor
- University of Maryland, College Park, Department of Anthropology, 1111 Woods Halls, 4302 Chapel Lane, College Park, MD, 20742, USA.
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Szaflarski M, Bauldry S. The Effects of Perceived Discrimination on Immigrant and Refugee Physical and Mental Health. ACTA ACUST UNITED AC 2019; 19:173-204. [PMID: 31178652 DOI: 10.1108/s1057-629020190000019009] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose Discrimination has been identified as a major stressor and influence on immigrant health. This study examined the role of perceived discrimination in relation to other factors, in particular, acculturation, in physical and mental health of immigrants and refugees. Methodology/approach Data for US adults (18+ years) were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Mental and physical health was assessed with SF-12. Acculturation and perceived discrimination were assessed with multidimensional measures. Structural equation models were used to estimate the effects of acculturation, stressful life effects, perceived discrimination, and social support on health among immigrants and refugees. Findings Among first-generation immigrants, discrimination in health care had a negative association with physical health while discrimination in general had a negative association with mental health. Social support had positive associations with physical and mental health and mediated the association of discrimination to health. There were no significant associations between discrimination and health among refugees, but the direction and magnitude of associations were similar to those for first-generation immigrants. Implications Efforts aiming at reducing discrimination and enhancing integration/social support for immigrants are likely to help with maintaining and protecting immigrants' health and well-being. Further research using larger samples of refugees and testing moderating effects of key social/psychosocial variables on immigrant health outcomes is warranted. Originality/value This study used multidimensional measures of health, perceived discrimination, and acculturation to examine the pathways between key social/psychosocial factors in health of immigrants and refugees at the national level. This study included possibly the largest national sample of refugees.
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Affiliation(s)
- Magdalena Szaflarski
- Department of Sociology, University of Alabama at Birmingham, HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152
| | - Shawn Bauldry
- Department of Sociology, Purdue University, 700 W. State Street, Stone 326 B, West Lafayette, IN 47907
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Social Determinants of Health and Health Disparities Among Immigrants and their Children. Curr Probl Pediatr Adolesc Health Care 2019; 49:23-30. [PMID: 30595524 DOI: 10.1016/j.cppeds.2018.11.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In 2017, the United States (U.S.) foreign-born population was estimated to be 44.5 million, the highest share since 1910. It is unclear how many undocumented immigrants live in the U.S., but estimates in 2014 determined that there were at least 12.1 million. The immigrant population, particularly undocumented immigrants, has consistently been affected negatively by social determinants of health such as poverty, food and housing insecurity, lack of educational attainment, and challenges with health care access. Additionally, they face stigma and marginalization, difficulties with acculturation, and fear of deportation. Given these challenges that immigrants and their children face, physicians have a responsibility of assessing these social determinants of health and providing comprehensive care for this population.
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Statement on the Effects of Deportation and Forced Separation on Immigrants, their Families, and Communities. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 62:3-12. [PMID: 30066405 DOI: 10.1002/ajcp.12256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Venkataramani M, Pollack CE, DeCamp LR, Leifheit KM, Berger ZD, Venkataramani AS. Association of Maternal Eligibility for the Deferred Action for Childhood Arrivals Program With Citizen Children's Participation in the Women, Infants, and Children Program. JAMA Pediatr 2018; 172:699-701. [PMID: 29813154 PMCID: PMC6137505 DOI: 10.1001/jamapediatrics.2018.0775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines the association of maternal eligibility for Deferred Action for Childhood Arrivals (DACA) immigration program with participation of citizen children in the Women, Infants, and Children (WIC) health care and supplemental nutrition program.
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Affiliation(s)
- Maya Venkataramani
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Craig Evan Pollack
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Ross DeCamp
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathryn M. Leifheit
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Zackary D. Berger
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Raifman J, Moscoe E, Austin SB, Hatzenbuehler ML, Galea S. Association of State Laws Permitting Denial of Services to Same-Sex Couples With Mental Distress in Sexual Minority Adults: A Difference-in-Difference-in-Differences Analysis. JAMA Psychiatry 2018; 75:671-677. [PMID: 29799924 PMCID: PMC6129969 DOI: 10.1001/jamapsychiatry.2018.0757] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Recent evidence suggests that state policies affecting sexual minorities are associated with health disparities. Twelve states have laws permitting the denial of services to same-sex couples, and the US Supreme Court is considering whether states can prohibit the denial of services to same-sex couples. OBJECTIVE We investigated whether state laws permitting individuals to refuse services to sexual minorities were associated with changes in the proportion of sexual minority adults reporting mental distress. DESIGN, SETTING, AND PARTICIPANTS This difference-in-difference-in-differences linear regression analysis with state fixed effects used Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 through 2016 from adults aged 18 to 64 years in 3 states that implemented laws permitting the denial of services to same-sex couples (Utah, Michigan, and North Carolina) and 6 nearby control states (Idaho and Nevada, Ohio and Indiana, and Virginia and Delaware, respectively). Sexual minority adults were defined as those who identified as gay, lesbian, bisexual, or not sure of their sexual orientation under a module on sexual orientation that BRFSS implemented in 2014 and each state could opt to include. Analysis controlled for year and individual-level sex, race, ethnicity, age group, educational attainment, income, employment, and marital status. A permutation test was conducted to precisely estimate statistical significance. EXPOSURES An interaction term indicating whether individuals identified as a sexual minority and lived in a state with a law permitting denial of services to same-sex couples in 2015. MAIN OUTCOMES AND MEASURES Mental distress, defined as poor mental health on 14 or more of the past 30 days. RESULTS Of 109 089 participants, 4656 (4.8%; all percentages incorporate survey weights) identified as sexual minorities, 86141 (72.1%) were non-Hispanic white, and ages were uniformly distributed between 18 and 64 years. In 2014, 2038 of 16637 heterosexual adults (12.6%) and 156 of 815 sexual minority adults (21.9%) in the 3 same-sex denial states reported mental distress. The proportion of sexual minority adults reporting mental distress increased by 10.1 percentage points (95% CI, 1.8 to 18.5 percentage points, permutation-adjusted P value = .046) between 2014 and 2016 in states that passed laws permitting denial of services to same-sex couples compared with control states, a 46% relative increase in sexual minority adults experiencing mental distress. Laws permitting denial of services to same-sex couples were not associated with significant changes in heterosexual adults experiencing mental distress (-0.36 percentage points, 95% CI, -1.73 to 1.01 percentage points). CONCLUSIONS AND RELEVANCE Laws permitting denial of services to same-sex couples, which exist in 12 states and are under consideration by the US Supreme Court, are associated with a 46% increase in sexual minority adults experiencing mental distress.
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Affiliation(s)
- Julia Raifman
- Boston University School of Public Health, Boston, Massachusetts
| | | | | | | | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts
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Hsin A, Ortega F. The Effects of Deferred Action for Childhood Arrivals on the Educational Outcomes of Undocumented Students. Demography 2018; 55:1487-1506. [PMID: 29943352 DOI: 10.1007/s13524-018-0691-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Deferred Action for Childhood Arrivals (DACA) is the first large-scale immigration policy to affect undocumented immigrants in the United States in decades and offers eligible undocumented youth temporary relief from deportation as well as renewable work permits. Although DACA has improved the economic conditions and mental health of undocumented immigrants, we do not know how DACA improves the social mobility of undocumented immigrants through its effect on educational attainment. We use administrative data on students attending a large public university to estimate the effect of DACA on undocumented students' educational outcomes. The data are unique because they accurately identify students' legal status, account for individual heterogeneity, and allow separate analysis of students attending community colleges versus four-year colleges. Results from difference-in-difference estimates demonstrate that as a temporary work permit program, DACA incentivizes work over educational investments but that the effect of DACA on educational investments depends on how easily colleges accommodate working students. At four-year colleges, DACA induces undocumented students to make binary choices between attending school full-time and dropping out of school to work. At community colleges, undocumented students have the flexibility to reduce course work to accommodate increased work hours. Overall, the results suggest that the precarious and temporary nature of DACA creates barriers to educational investments.
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Affiliation(s)
- Amy Hsin
- Department of Sociology, Queens College, City University of New York, Flushing, NY, 11367, USA.
| | - Francesc Ortega
- Department of Economics, Queens College, City University of New York, Flushing, NY, 11367, USA
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Rosenquist JN. The Opiates and the (Voting) Masses. JAMA Netw Open 2018; 1:e180451. [PMID: 30646076 DOI: 10.1001/jamanetworkopen.2018.0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- James Niels Rosenquist
- Center for Quantitative Health, Massachusetts General Hospital, Harvard Medical School, Boston
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Filion N, Fenelon A, Boudreaux M. Immigration, citizenship, and the mental health of adolescents. PLoS One 2018; 13:e0196859. [PMID: 29723297 PMCID: PMC5933703 DOI: 10.1371/journal.pone.0196859] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/20/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To examine the reported mental health outcomes of adolescent foreign-born non-citizens and adolescent foreign-born U.S. citizens compared to adolescent U.S.-born citizens. METHODS Using the Strengths and Difficulties Questionnaire in the National Health Interview Survey, we compared mental health status of U.S.-born adolescent citizens to foreign-born citizens and non-citizens in the years 2010-2015, and examined how differences in emotional difficulty changed based on time spent in the U.S. RESULTS Results suggest that non-citizen adolescents experience better mental health outcomes than U.S.-born citizens. However, the mental health status of foreign-born citizens is indistinguishable from that of the U.S.-born, after accounting for basic socio-demographic characteristics. The prevalence of emotional difficulty experienced by immigrant adolescents increased with a family's duration in the U.S. CONCLUSION Our findings are consistent with a broader health advantage for the foreign-born, but we present new evidence that the mental health advantage of foreign-born adolescents exists only for non-citizens.
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Affiliation(s)
- Nicole Filion
- Department of Health Services Administration, University of Maryland School of Public Health, College Park, Maryland, United States of America
| | - Andrew Fenelon
- Department of Health Services Administration, University of Maryland School of Public Health, College Park, Maryland, United States of America
| | - Michel Boudreaux
- Department of Health Services Administration, University of Maryland School of Public Health, College Park, Maryland, United States of America
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67
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Morey BN. Mechanisms by Which Anti-Immigrant Stigma Exacerbates Racial/Ethnic Health Disparities. Am J Public Health 2018; 108:460-463. [PMID: 29470116 PMCID: PMC5846442 DOI: 10.2105/ajph.2017.304266] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 11/04/2022]
Abstract
Anti-immigrant rhetoric and political actions gained prominence and public support before, during, and after the 2016 presidential election. This anti-immigrant political environment threatens to increase health disparities among undocumented persons, immigrant groups, and people of color. I discuss the mechanisms by which anti-immigrant stigma exacerbates racial/ethnic health disparities through increasing multilevel discrimination and stress, deportation and detention, and policies that limit health resources. I argue that the anti-immigrant sociopolitical context is a social determinant of health that affects mostly communities of color, both immigrants and nonimmigrants. Public health has a moral obligation to consider how immigration policy is health policy and to be prepared to respond to worsening health disparities as a result of anti-immigrant racism.
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Affiliation(s)
- Brittany N Morey
- Brittany N. Morey is with the School of Public Policy, University of California, Riverside
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68
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Racialized legal status as a social determinant of health. Soc Sci Med 2018; 199:19-28. [DOI: 10.1016/j.socscimed.2017.03.010] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 12/22/2022]
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69
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Kim SY, Schwartz SJ, Perreira KM, Juang LP. Culture's Influence on Stressors, Parental Socialization, and Developmental Processes in the Mental Health of Children of Immigrants. Annu Rev Clin Psychol 2018; 14:343-370. [PMID: 29401046 DOI: 10.1146/annurev-clinpsy-050817-084925] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Children of immigrants represent one in four children in the United States and will represent one in three children by 2050. Children of Asian and Latino immigrants together represent the majority of children of immigrants in the United States. Children of immigrants may be immigrants themselves, or they may have been born in the United States to foreign-born parents; their status may be legal or undocumented. We review transcultural and culture-specific factors that influence the various ways in which stressors are experienced; we also discuss the ways in which parental socialization and developmental processes function as risk factors or protective factors in their influence on the mental health of children of immigrants. Children of immigrants with elevated risk for mental health problems are more likely to be undocumented immigrants, refugees, or unaccompanied minors. We describe interventions and policies that show promise for reducing mental health problems among children of immigrants in the United States.
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Affiliation(s)
- Su Yeong Kim
- Department of Human Development and Family Sciences, University of Texas, Austin, Texas 78712, USA;
| | - Seth J Schwartz
- Department of Epidemiology and Public Health, University of Miami, Miami, Florida 33136, USA;
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA;
| | - Linda P Juang
- Inclusive Education Group, College of Human Sciences, University of Potsdam, 14476 Potsdam, Germany;
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70
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Uwemedimo OT, Monterrey AC, Linton JM. A Dream Deferred: Ending DACA Threatens Children, Families, and Communities. Pediatrics 2017; 140:peds.2017-3089. [PMID: 28993446 DOI: 10.1542/peds.2017-3089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Omolara T Uwemedimo
- Departments of Pediatrics and Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York; .,GLOhBAL (Global Learning. Optimizing health. Building Alliances Locally) at Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Ana C Monterrey
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Julie M Linton
- Department of Pediatrics, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina; and.,Maya Angelou Center for Health Equity, Wake Forest Clinical and Translational Science Institute, Winston-Salem, North Carolina
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71
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Affiliation(s)
- Atheendar S Venkataramani
- From the Department of Medical Ethics and Health Policy, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (A.S.V.); and the Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, and the Harvard Center for Population and Development Studies, Cambridge - both in Massachusetts (A.C.T.)
| | - Alexander C Tsai
- From the Department of Medical Ethics and Health Policy, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (A.S.V.); and the Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, and the Harvard Center for Population and Development Studies, Cambridge - both in Massachusetts (A.C.T.)
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72
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Hainmueller J, Lawrence D, Martén L, Black B, Figueroa L, Hotard M, Jiménez TR, Mendoza F, Rodriguez MI, Swartz JJ, Laitin DD. Protecting unauthorized immigrant mothers improves their children's mental health. Science 2017; 357:1041-1044. [PMID: 28860206 DOI: 10.1126/science.aan5893] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/01/2017] [Indexed: 12/11/2022]
Abstract
The United States is embroiled in a debate about whether to protect or deport its estimated 11 million unauthorized immigrants, but the fact that these immigrants are also parents to more than 4 million U.S.-born children is often overlooked. We provide causal evidence of the impact of parents' unauthorized immigration status on the health of their U.S. citizen children. The Deferred Action for Childhood Arrivals (DACA) program granted temporary protection from deportation to more than 780,000 unauthorized immigrants. We used Medicaid claims data from Oregon and exploited the quasi-random assignment of DACA eligibility among mothers with birthdates close to the DACA age qualification cutoff. Mothers' DACA eligibility significantly decreased adjustment and anxiety disorder diagnoses among their children. Parents' unauthorized status is thus a substantial barrier to normal child development and perpetuates health inequalities through the intergenerational transmission of disadvantage.
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Affiliation(s)
- Jens Hainmueller
- Department of Political Science, Stanford University, Stanford, CA 94305, USA. .,Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA.,Graduate School of Business, Stanford University, Stanford, CA 94305, USA
| | - Duncan Lawrence
- Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA
| | - Linna Martén
- Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA.,Uppsala Center for Labor Studies, Uppsala University, Uppsala 75120, Sweden
| | - Bernard Black
- Pritzker Law School and Kellogg School of Management, Northwestern University, Chicago, IL 60611, USA
| | - Lucila Figueroa
- Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA.,Department of Politics, University of Virginia, Charlottesville, VA 22903, USA
| | - Michael Hotard
- Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA
| | - Tomás R Jiménez
- Department of Sociology, Stanford University, Stanford, CA 94305, USA
| | - Fernando Mendoza
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jonas J Swartz
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA
| | - David D Laitin
- Department of Political Science, Stanford University, Stanford, CA 94305, USA.,Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA
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73
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McKee M, Stuckler D. The Deferred Action for Childhood Arrivals programme: a quasi-experiment in giving hope to migrants. THE LANCET PUBLIC HEALTH 2017; 2:e160-e161. [DOI: 10.1016/s2468-2667(17)30050-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022] Open
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