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Kyei EF, Zhang L. Exploring the Link: Health Insurance Coverage and Historical Substance Use Patterns Among U.S. Adults-A NHANES-Based Analysis. Policy Polit Nurs Pract 2024; 25:103-109. [PMID: 38410001 DOI: 10.1177/15271544241232588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This study analyzed the NHANES database (2016-2018), investigating substance use patterns among 6,108 U.S. adults (18-64 years), with a focus on health insurance, race/ethnicity, age, gender, and socioeconomic status. Among participants, 1,063 reported a history of substance use. A key finding was the correlation between health insurance coverage and substance use history; notably, 80% of those with a history of substance use were insured. Non-Hispanic Whites represented a significant proportion (76%) of substance users, exceeding their population representation. Age and gender differences were prominent, with older adults (50-64 years) comprising 41% of substance users, and males accounting for 61%. The study's reliance on self-reported substance use history from NHANES may introduce measurement bias. Such bias necessitates careful interpretation of the data, considering variations across demographic and socioeconomic variables. Logistic regression analysis revealed that lacking health insurance increased the odds of a history of substance use (OR = 1.43, p < .01). The interaction between insurance coverage and race/ethnicity was not significant. These findings underscore the multifaceted nature of substance use, highlighting the need for comprehensive public health strategies to address the diverse factors influencing substance use behaviors.
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Affiliation(s)
- Evans F Kyei
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Lingling Zhang
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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2
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Altman CE, Hamilton C, Dondero M. The Intersection of State-Level Immigrant Policy Climates and Medicaid Expansion: an Examination Among Immigrants. J Racial Ethn Health Disparities 2023; 10:2195-2206. [PMID: 36036841 DOI: 10.1007/s40615-022-01399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
States have broad discretion over the implementation of policies like Medicaid expansion and other policies that impact the well-being and integration of immigrants. While numerous studies document Medicaid expansion on immigrants' health insurance coverage and the role of state immigrant policy climates on immigrants' well-being, no research to date has studied whether the association between a state's Medicaid expansion on immigrants' health insurance coverage varies based on the inclusiveness or exclusiveness of a state's immigrant policy climate. We combine nationally representative data from the 2014-2018 American Community Survey (ACS) with state policy data and estimate multivariate regression models. The results reveal a state immigrant policy climate gradient whereby ACA Medicaid expansion on noncitizens is negative and most severe in exclusionary climates. This study highlights how state policies intersect as important structural forces that influence immigrant health and well-being.
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Affiliation(s)
- Claire E Altman
- Department of Health Sciences and Truman School of Government and Public Affairs, University of Missouri, 304 Clark Hall, Columbia, MO, 65211, USA.
| | - Christal Hamilton
- Center on Poverty and Social Policy, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Molly Dondero
- Department of Sociology, American University, 4400 Massachusetts Avenue NW, Washington D.C., 20016, USA
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Sharareh N, Seligman HK, Adesoba TP, Wallace AS, Hess R, Wilson FA. Food Insecurity Disparities Among Immigrants in the U.S. AJPM FOCUS 2023; 2:100113. [PMID: 37790670 PMCID: PMC10546596 DOI: 10.1016/j.focus.2023.100113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Food insecurity negatively impacts public health and costs the U.S. healthcare system $53 billion annually. Immigrants are at higher risk of food insecurity. We sought to (1) characterize the prevalence of food insecurity among immigrants (i.e., noncitizens and naturalized citizens) and U.S.-born citizens and (2) determine whether Supplemental Nutrition Assistance Program utilization and income-poverty ratio levels impact the relationship between immigration status and food insecurity. Methods Multivariable logistic regression models were used to determine the odds of food insecurity (dependent variables) using nationally representative data from the 2019-2020 National Health Interview Survey. Independent variables included immigration status, Supplemental Nutrition Assistance Program utilization, income-poverty ratio, and other important demographics. AORs with their 95% CIs are reported. Analysis was conducted in 2022. Results After controlling for independent variables, noncitizens had 1.28 (95% CI=1.02, 1.61) times higher odds of food insecurity than U.S.-born citizens. There was no food insecurity disparity between naturalized citizens and U.S.-born citizens. However, the association between immigration status and food insecurity varied significantly at different levels of Supplemental Nutrition Assistance Program utilization and income-poverty ratio. There were no food insecurity disparities between immigrants and U.S.-born citizens when they utilized the Supplemental Nutrition Assistance Program and when they had an income below 200% federal poverty level. Noncitizens who did not utilize the Supplemental Nutrition Assistance Program or those with an income above 200% federal poverty level were more likely to report food insecurity than their U.S.-born counterparts (AOR=1.32, 95% CI=1.01, 1.73 and AOR=1.88, 95% CI=1.24, 2.86, respectively). Moreover, naturalized citizens with an income above 200% federal poverty level were also more likely to report food insecurity than their U.S.-born counterparts (AOR=1.61, 95% CI=1.21, 2.14). Conclusions Supplemental Nutrition Assistance Program utilization may likely eliminate food insecurity disparities among immigrants and U.S.-born citizens. However, among non-Supplemental Nutrition Assistance Program utilizers, significant food insecurity disparities remained between noncitizens and U.S.-born citizens after adjusting for independent variables. In addition, among individuals with incomes above 200% federal poverty level, significant food insecurity disparities were observed between immigrants and U.S.-born citizens. More research is needed to further understand the role that fear of deportation, ineligibility or lack of awareness about eligibility for the Supplemental Nutrition Assistance Program, and other factors such as structural racism play in food insecurity disparities between immigrants and U.S.-born citizens.
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Affiliation(s)
- Nasser Sharareh
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah
| | - Hilary K. Seligman
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California
| | - Taiwo P. Adesoba
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Andrea S. Wallace
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Rachel Hess
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah
| | - Fernando A. Wilson
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah
- Matheson Center for Health Care Studies, The University of Utah, Salt Lake City, Utah
- Department of Economics, College of Social & Behavioral Science, University of Utah, Salt Lake City, Utah
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Chu J, Roby DH, Boudreaux MH. Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access. Health Serv Res 2022; 57 Suppl 2:315-325. [PMID: 36053731 PMCID: PMC9660422 DOI: 10.1111/1475-6773.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To estimate the effects of Children's Health Insurance Reauthorization Act (CHIPRA), a policy that provided states the option to extend Medicaid/CHIP eligibility to immigrant children who have not been legal residents for five years or more, on insurance coverage, access, utilization, and health outcomes among immigrant children. DATA SOURCES Restricted use 2000-2016 National Health Interview Survey (NHIS). STUDY DESIGN We used a difference-in-differences design that compared changes in CHIPRA expansion states to changes in non-expansion states. DATA COLLECTION Our sample included immigrant children who were born outside the US, aged 0-18 with family income below 300% of the Federal Poverty Level (FPL). Subgroup analyses were conducted across states that did and did not have a similar state-funded option prior to CHIPRA (state-funded vs. not state-funded), by the length of time in the US (5 years vs. 5-14 years), and global region of birth (Latin American vs. Asian countries). PRINCIPLE FINDINGS We found that CHIPRA was associated with a significant 6.35 percentage point decrease in uninsured rates (95% CI: -11.25, -1.45) and an 8.1 percentage point increase in public insurance enrollment for immigrant children (95% CI: 1.26, 14.98). However, the effects of CHIPRA became small and statistically not significant 3 years after adoption. Effects on public insurance coverage were significant in states without state-funded programs prior to CHIPRA (15.50 percentage points; 95% CI:8.05, 22.95) and for children born in Asian countries (12.80 percentage points; 95% CI: 1.04, 24.56). We found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA. CONCLUSIONS CHIPRA's eligibility expansion was associated with increases in public insurance coverage for low-income children, especially in states where CHIPRA represented a new source of coverage versus a substitute for state-funded coverage. However, we found evidence of crowd-out in certain subgroups and no effect of CHIPRA on access to care and health. Our results suggest that public coverage may be an important tool for promoting the well-being of immigrant children but other investments are still needed.
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Affiliation(s)
- Jun Chu
- Department of Sociology, Anthropology and Public HealthThe University of MarylandBaltimore County
| | - Dylan H. Roby
- Department of Health, Society, and Behavior, Public HealthUniversity of CaliforniaIrvineCaliforniaUSA
| | - Michel H. Boudreaux
- Department of Health Policy and Management, School of Public HealthUniversity of MarylandCollege ParkMarylandUSA
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5
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Young MEDT, Perez-Lua F, Sarnoff H, Plancarte V, Goldman-Mellor S, Payán DD. Working around safety net exclusions during the COVID-19 pandemic: A qualitative study of rural Latinx immigrants. Soc Sci Med 2022; 311:115352. [PMID: 36126474 PMCID: PMC9444313 DOI: 10.1016/j.socscimed.2022.115352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 06/07/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
Rural Latinx immigrants experienced disproportionately negative health and economic impacts during the COVID-19 pandemic. They contended with the pandemic at the intersection of legal status exclusions from the safety net and long-standing barriers to health care in rural regions. Yet, little is known about how rural Latinx immigrants navigated such exclusions. In this qualitative study, we examined how legal status stratification in rural contexts influenced Latinx immigrant families' access to the safety net. We conducted interviews with first- and second-generation Latinx immigrants (n = 39) and service providers (n = 20) in four rural California communities between July 2020 and April 2021. We examined personal and organizational strategies used to obtain economic, health, and other forms of support. We found that Latinx families navigated a limited safety net with significant exclusions. In response, they enacted short-term strategies and practices - workarounds - that met immediate, short-term needs. Workarounds, however, were enacted through individual efforts, allowing little recourse beyond immediate personal agency. Some took the form of strategic practices within the safety net, such as leveraging resources that did not require legal status verification; in other cases, they took the form of families opting to avoid the safety net altogether.
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Affiliation(s)
- Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA.
| | - Fabiola Perez-Lua
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Hannah Sarnoff
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA
| | | | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Denise Diaz Payán
- Department of Health, Society and Behavior, Program in Public Health, University of California, Irvine, CA, 92697, USA
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6
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Legal status and health disparities: An examination of health insurance coverage among the foreign-born. DEMOGRAPHIC RESEARCH 2022. [DOI: 10.4054/demres.2022.47.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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7
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Carrasco-Aguilar A, Galán JJ, Carrasco RA. Obamacare: A bibliometric perspective. Front Public Health 2022; 10:979064. [PMID: 36033824 PMCID: PMC9416003 DOI: 10.3389/fpubh.2022.979064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
Obamacare is the colloquial name given to the Affordable Care Act (ACA) signed into law by President Obama in the USA, which ultimately aims to provide universal access to health care services for US citizens. The aim of this paper is to provide an overview of the political-legal, economic, social, management (or administrative), and medical (or health) repercussions of this law, using a bibliometric methodology as a basis. In addition, the main contributors to research on ACA issues have been identified in terms of authors, organizations, journals, and countries. The downward trend in scientific production on this law has been noted, and it has been concluded that a balance has not yet been reached between the coexistence of private and public health care that guarantees broad social coverage without economic or other types of barriers. The law requires political consensus to be implemented in a definitive and global manner for the whole of the United States.
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State-Level Immigrant Policy Climates and Health Care Among U.S. Children of Immigrants. POPULATION RESEARCH AND POLICY REVIEW 2022. [DOI: 10.1007/s11113-022-09726-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Jain T, LaHote J, Samari G, Garbers S. Publicly-Funded Services Providing Sexual, Reproductive, and Maternal Healthcare to Immigrant Women in the United States: A Systematic Review. J Immigr Minor Health 2022; 24:759-778. [PMID: 34697702 PMCID: PMC10373793 DOI: 10.1007/s10903-021-01289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/24/2022]
Abstract
Sexual, reproductive, and maternal health (SRMH) care in the US is highly politicized, with restrictions that impede immigrant women's health. This review describes SRMH outcomes among immigrant women accessing publicly-funded services. We examined articles published from December 2007 to August 2020 in PubMed, PsycINFO, and Web of Science databases, following PRISMA guidelines. Included articles (n = 9) consisted of predominantly Latina immigrant samples. The majority included a subsample of women classified as vulnerable due to low income, low educational attainment, and/or documentation status. Our search strategy included a range of SRMH outcomes; however, the majority of articles focused on prenatal care (PNC). Over half of the articles revealed that underserved immigrant women with access to Medicaid/CHIP during expansion had higher rates of PNC adequacy compared to those without access. There is a need for more research on the impact of publicly-funded services other than Medicaid on outcomes beyond PNC.
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Affiliation(s)
- Tanvi Jain
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Jessica LaHote
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA.
| | - Goleen Samari
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Samantha Garbers
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
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10
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Amen TB, Chavez TJ, Dee EC, Varady NH, Yao JS, Paguio JA, Chen AF. Disparities in psychological distress and access to mental health services among immigrants with rheumatologic disease. Clin Rheumatol 2022; 41:2205-2211. [PMID: 35260950 DOI: 10.1007/s10067-022-06074-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Patients with rheumatologic disease experience higher rates of comorbid mental health diseases than those without. Although mental health services (MHS) can improve musculoskeletal functional outcomes, access to MHS has been limited among vulnerable populations in the United States (US). The purpose of this study was to investigate contemporary patterns of severe psychological distress and receipt of MHS among immigrant populations with rheumatologic disease in the US. METHODS The National Health Interview Survey was queried for patients with rheumatologic disease from 2009 to 2018. Patient demographics, severe psychological distress, and receipt of MHS were collected and/or calculated. Multivariable logistic regressions assessed for factors associated with decreased receipt of MHS and severe psychological distress. RESULTS Immigrant patients with rheumatologic disease had higher rates of severe psychological distress than US-born patients (7.7% vs. 6.5%, p < 0.001), but were less likely to access MHS (8.3% vs. 11.0%, p < 0.001). Among immigrant patients, factors associated with lower MHS receipt included being Black (AOR 0.50, 95% CI 0.32-0.77, p = 0.002), Hispanic (AOR 0.80, 95% CI 0.30-1.00, p = 0.050), Asian (AOR 0.44, 95% CI 0.31-0.63, p < 0.001), older (p < 0.001), uninsured (p < 0.001), and having self-reported poor health (p < 0.001). DISCUSSION Immigrant patients with rheumatologic disease in the US had higher rates of severe psychological distress yet were less likely to receive MHS compared to US-born patients. Immigrants with rheumatologic illness were less likely to receive MHS if they were male, Black, Hispanic, Asian, older, lower income, or uninsured. This lack of MHS receipt may contribute to disparities in functional outcomes seen in immigrant minorities with musculoskeletal disease. Key Points • Immigrant patients with rheumatologic disease in the US had higher rates of severe psychological distress yet were less likely to receive MHS compared to US-born patients between 2009 and 2018 • Immigrants with rheumatologic illness were less likely to receive MHS if they were Black, Hispanic, Asian, older, lower income, or uninsured • Future efforts to carefully screen for mental health diseases in these vulnerable patient populations should be made while exploring patient-specific cultural considerations of MHS receipt.
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Affiliation(s)
- Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St., New York City, NY, 10021, USA.
| | - Tyler J Chavez
- Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, f1275 York Avenue, New York, NY, 10065, USA
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St., New York City, NY, 10021, USA
| | - Jasper Seth Yao
- Department of Medicine, Albert Einstein Medical Center Philadelphia, 5501 Old York Rd., Philadelphia, PA, 19141, USA
| | - Joseph Alexander Paguio
- Department of Medicine, Albert Einstein Medical Center Philadelphia, 5501 Old York Rd., Philadelphia, PA, 19141, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Barbieri PN, Nguyen HM. When in America, do as the Americans? The evolution of health behaviors and outcomes across immigrant cohorts. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101063. [PMID: 34547713 DOI: 10.1016/j.ehb.2021.101063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/13/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
This study seeks to understand US immigrants' health-related behaviors and outcomes across arrival cohorts. We simultaneously examine risky consumption choices (smoking and drinking) and physical health conditions (asthma, diabetes, vision problems, and coronary heart diseases) using data from the National Health Interview Surveys (1989-2018). We incorporate cohort fixed-effects and the interactions between cohort effects and years since immigration into our empirical framework to capture the dynamics of immigrant health over time. For all health indicators, we find that there are important differences between arriving immigrants and natives. Despite some heterogeneity in the dynamics of unhealthy behaviors, this heterogeneity seems to dissipate as we explore longer-term health outcomes. Overall, our findings provide an interesting outlook on how the integration into the host society affects American immigrants' health. We contribute new results to the immigrant assimilation literature, which has primarily focused on obesity and wages.
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Affiliation(s)
- Paolo Nicola Barbieri
- Centre for Health Economics, University of Gothenburg, Sweden & Department of Economic Research and Analysis, Prometeia, Italy
| | - Hieu M Nguyen
- Department of Economics, Illinois Wesleyan University, 1402 Park Street, SFH 320, Bloomington, IL 61702, USA.
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12
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Ortega AN, Bustamante AV, Roby DH. New Directions for Public Health Research on the Health and Health Care of Undocumented Immigrants. Am J Public Health 2021; 111:1910-1912. [PMID: 34678052 PMCID: PMC8607342 DOI: 10.2105/ajph.2021.306506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Alexander N Ortega
- Alexander N. Ortega is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Dylan H. Roby is with the Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
| | - Arturo Vargas Bustamante
- Alexander N. Ortega is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Dylan H. Roby is with the Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
| | - Dylan H Roby
- Alexander N. Ortega is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Dylan H. Roby is with the Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
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13
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Pre-COVID-19 Social Determinants of Health Among Mexican Migrants in Los Angeles and New York City and Their Increased Vulnerability to Unfavorable Health Outcomes During the COVID-19 Pandemic. J Immigr Minor Health 2021; 24:65-77. [PMID: 34596830 PMCID: PMC8485317 DOI: 10.1007/s10903-021-01283-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 12/24/2022]
Abstract
COVID-19 has disproportionally affected underrepresented minorities (URM) and low-income immigrants in the United States. The aim of the study is to examine the underlying vulnerabilities of Mexican immigrants in New York City (NYC) and Los Angeles (LA), its correspondence with area-level COVID-19 morbidity and mortality, and to document the role of trusted and culturally sensitive services offered during the pandemic through the Ventanillas de Salud (i.e. VDS, Health Windows) program. The study uses a mixed-methods approach including a cross-sectional survey of Mexican immigrants in LA and NYC collected in the Mexican Consulates at the onset of the pandemic, complemented with a georeferencing analysis and key informant interviews. Data suggested an increased vulnerability to COVID-19 given participants reported health status, health care profile and place of residence, which coincided with the georeferencing analysis. The key informant interviews confirmed the vulnerability of this population and the supporting role of VDS in helping immigrants navigate health systems and disseminate health information. Mexican immigrants had an increased vulnerability to COVID-19 at the individual, geographic and systemic levels. Trusted and culturally sensitive services are needed to overcome some of the barriers and risk factors that increase the vulnerability of URM and immigrant populations to COVID-19.
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14
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Chu J, Ortega AN, Park S, Vargas-Bustamante A, Roby DH. The Affordable Care Act and Health Care Access and Utilization Among White, Asian, and Latino Immigrants in California. Med Care 2021; 59:762-767. [PMID: 34081680 DOI: 10.1097/mlr.0000000000001586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to examine changes in health care access and utilization for White, Asian, and Latino immigrants associated with the implementation of the Patient Protection and Affordable Care Act (ACA) in California. STUDY DESIGN Using the 2011-2013 and 2015-2017 California Health Interview Survey, we examined changes in 2 health care access and 2 utilization measures among 3 immigrant racial/ethnic groups. We estimated the unadjusted and adjusted percentage point changes in the pre-ACA and post-ACA periods. Adjusted estimates were obtained using linear probability models controlling for predisposing, enabling, and need factors. RESULTS After the ACA was nationally implemented in 2014, rates of insurance increased for non-Latino (NL) White, NL Asian, and Latino immigrant groups in California. Latino immigrants had the largest increase in insurance coverage (14.3 percentage points), followed by NL Asian immigrants (9.9 percentage points) and NL White immigrants (9.2 percentage points). Despite benefitting from the largest increase in insurance coverage, the proportion of insured Latino immigrants was still lower than that of NL White and NL Asian immigrants. Latino immigrants reported a small but significant decrease in the usual source of care (-2.8 percentage points) and an increase in emergency department utilization (2.9 percentage points) after the ACA. No significant changes were found after the ACA in health care access and utilization among NL White and NL Asian immigrants. CONCLUSIONS Insurance coverage increased significantly for these 3 immigrant groups after the ACA. While Latino immigrants had the largest gain in insurance coverage, the proportion of Latino immigrants with insurance remained the lowest among the 3 immigrant racial/ethnic groups.
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Affiliation(s)
- Jun Chu
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD
| | - Alexander N Ortega
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Sungchul Park
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Arturo Vargas-Bustamante
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Dylan H Roby
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
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15
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Allen CD, Perreira KM. Commentary on the Affordable Care Act and Health Care Access and Utilization Among White, Asian, and Latino Immigrants in California. Med Care 2021; 59:759-761. [PMID: 34425582 DOI: 10.1097/mlr.0000000000001620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chenoa D Allen
- Department of Health Sciences, University of Missouri School of Health Professions, Columbia, MO
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina Medical School, Chapel Hill, NC
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Bustamante AV, Chen J, Félix Beltrán L, Ortega AN. Health Policy Challenges Posed By Shifting Demographics And Health Trends Among Immigrants To The United States. Health Aff (Millwood) 2021; 40:1028-1037. [PMID: 34228519 DOI: 10.1377/hlthaff.2021.00037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Since the 1960s the immigrant population in the United States has increased fourfold, reaching 44.7 million, or 13.7 percent of the US population, in 2018. The shifting immigrant demography presents several challenges for US health policy makers. We examine recent trends in immigrant health and health care after the Great Recession and the nationwide implementation of the Affordable Care Act. Recent immigrants are more likely to have lower incidence of chronic health conditions than other groups in the US, although these differences vary along the citizenship and documentation status continuum. Health care inequities among immigrants and US-born residents increased after the Great Recession and later diminished after the Affordable Care Act took effect. Unremitting inequities remain, however, particularly among noncitizen immigrants. The number of aging immigrants is growing, which will present a challenge to the expansion of coverage to this population. Health care and immigration policy changes are needed to integrate immigrants successfully into the US health care system.
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Affiliation(s)
- Arturo Vargas Bustamante
- Arturo Vargas Bustamante is a professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health, and faculty director of research at the UCLA Latino Policy and Politics Initiative, University of California Los Angeles, in Los Angeles, California
| | - Jie Chen
- Jie Chen is a professor in the Department of Health Policy and Management, School of Public Health, University of Maryland, in College Park, Maryland
| | - Lucía Félix Beltrán
- Lucía Félix Beltrán is a research assistant in the Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Alexander N Ortega
- Alexander N. Ortega is a professor in the Department of Health Management and Policy, Drexel University Dornsife School of Public Health, in Philadelphia, Pennsylvania
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17
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Hoekstra E. "Not a free version of a broken system:" Medical humanitarianism and immigrant health justice in the United States. Soc Sci Med 2021; 285:114287. [PMID: 34364157 DOI: 10.1016/j.socscimed.2021.114287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/27/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
Medical humanitarian organizations are increasingly the primary healthcare providers for unauthorized migrants in high-income countries. Existing studies of medical humanitarianism in the Global North reveal tensions between principles of traditionally apolitical humanitarianism and human rights. In practice, these tensions translate into organizational debates about prioritizing direct service provision to meet immediate needs or advocacy to effect long-term systemic change. Informed by these debates, this paper asserts the importance of immigration and health policy contexts as central to shaping the relationship between healthcare provision and political advocacy within medical humanitarian NGOs. Drawing from twelve months of fieldwork with medical humanitarian NGOs in Arizona, I analyze data from ethnographic participant observation and interviews with volunteer healthcare providers at a medical humanitarian organization I call Community Clinic of Phoenix (CCP), a free clinic for uninsured, undocumented immigrants. I find that, in the context of Arizona's anti-immigrant rhetoric and policies, CCP employs medical humanitarianism as both a discourse and a model of care to challenge immigrants' exclusion from health coverage and criminalization through immigration enforcement. The clinic's emphasis on immigrant health justice shapes their critiques of the structural failures of U.S. immigration and health systems, their approach to providing equitable access to quality healthcare for uninsured immigrants, and their work to create broad social change for immigrant rights and health justice. Driven by their mission of "not replicating a free version of a broken system," the clinic's healthcare provision amid a climate inhospitable to immigrants demonstrates the importance of both conceptualizing and practicing medical humanitarianism as healthcare advocacy.
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Affiliation(s)
- Erin Hoekstra
- Marquette University, USA; Department of Social and Cultural Sciences, Lalumiere Hall, 340, 1310 W. Clybourn St., Milwaukee, WI, 53233, USA.
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18
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Li Y, Toseef MU, Jensen GA, Ortiz K, González HM, Tarraf W. Gains in insurance coverage following the affordable care act and change in preventive services use among non-elderly US immigrants. Prev Med 2021; 148:106546. [PMID: 33838157 DOI: 10.1016/j.ypmed.2021.106546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/02/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
Immigrants have lower and disproportionate use of preventive care. We use longitudinal panel data to examine how the 2014 full implementation of the ACA mandates affected change in preventive services (PS) use among immigrants that gained insurance. We used data on Foreign-Born (FB) and US-Born (USB) adults, ages 26-64 years, from the 2013/16 Medical Expenditures Panel Survey longitudinal files to examine within-person change in yearly utilization of age/sex specific United States Preventive Services Task Force (USPSTF) recommended services. We included five primary care (e.g., influenza immunization), three behavioral (e.g., diet), and seven cancer screening (e.g., mammography) measures. We used generalized estimating equations and difference-in-differences tests to assess the effects of insurance gain on: (1) change in PS utilization, and (2) reduction in utilization disparities between USB and FB adults, adjusting for predisposing, health enabling, and health needs factors. Our results showed that newly-insured FB adults substantially increased their use of all primary care checks, and exercise and diet advice. We also found improvements in use of endoscopies, two modalities of colon cancer screening, and prostate cancer screening, but not in receipt of mammography and clinical breast exams. Newly-insured FB PS use remained lower than use among continuously-insured USB adults, but some of the differences were explained by adjustment to enabling and health needs factors. Briefly, health insurance gains among immigrants translated into substantial improvements in use of recommended PS. Still, notable disparities persist among the newly-insured FB, and more so among the 1 in 5 that remain continuously uninsured.
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Affiliation(s)
- Yuyi Li
- Wayne State University, Institute of Gerontology, USA; Wayne State University, Department of Economics, USA; University of New Mexico, Department of Sociology, USA; University of California San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, USA; Wayne State University, Department of Healthcare Sciences, USA
| | - Mohammad Usama Toseef
- Wayne State University, Institute of Gerontology, USA; Wayne State University, Department of Economics, USA; University of New Mexico, Department of Sociology, USA; University of California San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, USA; Wayne State University, Department of Healthcare Sciences, USA
| | - Gail A Jensen
- Wayne State University, Institute of Gerontology, USA; Wayne State University, Department of Economics, USA; University of New Mexico, Department of Sociology, USA; University of California San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, USA; Wayne State University, Department of Healthcare Sciences, USA
| | - Kasim Ortiz
- Wayne State University, Institute of Gerontology, USA; Wayne State University, Department of Economics, USA; University of New Mexico, Department of Sociology, USA; University of California San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, USA; Wayne State University, Department of Healthcare Sciences, USA
| | - Hector M González
- Wayne State University, Institute of Gerontology, USA; Wayne State University, Department of Economics, USA; University of New Mexico, Department of Sociology, USA; University of California San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, USA; Wayne State University, Department of Healthcare Sciences, USA
| | - Wassim Tarraf
- Wayne State University, Institute of Gerontology, USA; Wayne State University, Department of Economics, USA; University of New Mexico, Department of Sociology, USA; University of California San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, USA; Wayne State University, Department of Healthcare Sciences, USA.
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19
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McBride K, Bacong AM, Reynoso A, Benjamin AE, Wallace SP, Kietzman KG. Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California. J Immigr Minor Health 2021; 22:494-502. [PMID: 31350680 DOI: 10.1007/s10903-019-00922-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To improve the coordination of long-term services and supports for dual-eligibles (those with both Medicare and Medicaid), California created Cal MediConnect (CMC), an Affordable Care Act-authorized managed care demonstration program. Beneficiaries were "passively enrolled" into CMC, meaning they were automatically enrolled unless they actively opted out. The aim of this study was to examine differences in factors influencing the enrollment decisions of U.S. born and immigrant dual-eligible beneficiaries. To explore differences in decision-making processes, we conducted in-depth interviews with dual-eligible consumers (39 native and 14 immigrant) in Los Angeles County. Interviews were analyzed using a constructivist grounded theory approach. Our findings illustrate a heightened sense of vulnerability and disempowerment experienced by immigrant participants. Immigrant participants also faced greater challenges in accessing healthcare and eliciting healthcare information compared to U.S.-born participants. Understanding the diverse perspectives of dual-eligible immigrant healthcare decision-making has implications for health care reform strategies aimed at ameliorating disparities for vulnerable immigrant populations.
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Affiliation(s)
- Kaitlyn McBride
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Campus Box 951772, Los Angeles, CA, 90095-1772, USA. .,UCLA Center for Health Policy Research, Los Angeles, CA, USA.
| | - Adrian M Bacong
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Ana Reynoso
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - A E Benjamin
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Steven P Wallace
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Kathryn G Kietzman
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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20
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Annan E, Stockbridge EL, Katz D, Mun EY, Miller TL. A cross-sectional study of latent tuberculosis infection, insurance coverage, and usual sources of health care among non-US-born persons in the United States. Medicine (Baltimore) 2021; 100:e24838. [PMID: 33607853 PMCID: PMC7899900 DOI: 10.1097/md.0000000000024838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons' access to, and ability to pay for, health care.To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011-2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries' high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.
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Affiliation(s)
- Esther Annan
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, TX
| | - Erica L. Stockbridge
- Department of Advanced Health Analytics & Solutions, Magellan Healthcare, Magellan Health, Inc., Scottsdale, AZ
| | - Dolly Katz
- Division of Tuberculosis Elimination, National Center for HIV/AIDs, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, GA
| | - Eun-Young Mun
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, TX
| | - Thaddeus L. Miller
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, TX
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21
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Porteny T, Ponce N, Sommers BD. Immigrants and the Affordable Care Act: Changes in Coverage and Access to Care by Documentation Status. J Immigr Minor Health 2020; 24:86-94. [DOI: 10.1007/s10903-020-01124-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
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22
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Modell SM, Fleming PJ, Lopez WD, Goltz HH. Work in Progress: Immigrant Health Care from the Vantage of Cancer Testing and Screening. J Immigr Minor Health 2020; 23:1-3. [PMID: 33231790 DOI: 10.1007/s10903-020-01129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
This letter offers a perspective from cancer testing and screening on the improvements in immigrant insurance coverage and care charted in Bustamante et al.'s April 2019 article in JOIH on "Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act." Supportive evidence for their data may be found in complementary literature drawing from both the National Health Interview Survey the authors use and the Medical Expenditure Panel Survey, while post-ACA surveys and state level information suggest disparities remain for lawfully present and undocumented immigrants ineligible for Medicaid and unable to secure insurance to pay medical costs. Existent options for cancer services are discussed. Further relevant reform depends on voter awareness and collaborative efforts between consumer advocates and legislators.
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Affiliation(s)
- Stephen M Modell
- Department of Epidemiology, Center for Public Health and Community Genomics, University of Michigan School of Public Health, M5049 SPH II, 1415 Washington Hts., Ann Arbor, MI, 48109-2029, USA.
| | - Paul J Fleming
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - William D Lopez
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Heather Honore' Goltz
- Social Work Program, College of Public Service, University of Houston-Downtown, Houston, TX, USA
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23
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Martinez-Cardoso A, Jang W, Baig AA. Moving Diabetes Upstream: the Social Determinants of Diabetes Management and Control Among Immigrants in the US. Curr Diab Rep 2020; 20:48. [PMID: 32857197 PMCID: PMC9328159 DOI: 10.1007/s11892-020-01332-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Relative to the US-born population, immigrants are less likely to successfully manage and control their diabetes, leading to a host of diabetes-related complications. This review draws on the social determinants of health framework (SDoH) to summarize the multilevel factors that shape diabetes care and management among immigrants in the USA. RECENT FINDINGS While the diabetes literature is replete with research on individual-level risk factors and health behaviors, empirical literature linking the SDoH to diabetes management among immigrants is limited. However, housing precarity, food insecurity, poverty, uninsurance and underinsurance, and limited support for immigrants in healthcare systems are consistently shown to deter diabetes management and care. Immigrants with diabetes face a multitude of structural constraints to managing their diabetes. More research that theorizes the role of SDoH in diabetes management along with empirical qualitative and quantitative studies are needed. Interventions to address diabetes also require a more upstream approach in order to mitigate the drivers of diabetes disparities among immigrants.
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Affiliation(s)
- Aresha Martinez-Cardoso
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Ave, MC 2000, Chicago, IL, 60637, USA.
| | - Woorin Jang
- The College, University of Chicago, Chicago, IL, USA
| | - Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, IL, USA
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24
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Dondero M, Altman CE. Immigrant policies as health policies: State immigrant policy climates and health provider visits among U.S. immigrants. SSM Popul Health 2020; 10:100559. [PMID: 32181320 PMCID: PMC7063137 DOI: 10.1016/j.ssmph.2020.100559] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/26/2020] [Accepted: 02/15/2020] [Indexed: 12/24/2022] Open
Abstract
The geographic dispersion of the U.S. immigrant population has occurred alongside a dramatic increase in state-level immigration laws that has unfolded unevenly across states, creating markedly different state immigrant policy climates. Although not all such laws are health-related, they have potential implications for immigrants' health care utilization. Using data from the 2014 Survey of Income and Program Participation, we leverage the geographic variation in the restrictiveness of state immigrant policy climates to examine the association between state-level immigrant policies and health provider visits—a fundamental indicator of health care utilization—among immigrant adults. Results indicate that restrictive immigrant policy climates exacerbate nativity gaps in health provider visits among working-age adults and, to a lesser extent, among older adults. Our findings suggest that even immigrant policies not directly related to health have consequences for immigrants’ health care utilization. We model the association between state immigrant policy climates and health provider visits among U.S. adults. More restrictive policy climates are associated with lower odds of health provider visits for working-age immigrant adults. Nativity disparities in health provider visits among working-age adults are larger in more restrictive policy climates. A small nativity gap exists for older adults in restrictive climates, with immigrants less likely to visit a health provider.
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Affiliation(s)
- Molly Dondero
- Department of Sociology, American University, 4400 Massachusetts Avenue NW, Washington D.C., 20016, USA
| | - Claire E Altman
- Department of Health Sciences and Truman School of Public Affairs, University of Missouri, 501 Clark Hall, Columbia, MO 65211, USA
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25
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State of the Art: the Not-So-Great Wall of America. Curr Hypertens Rep 2019; 21:97. [PMID: 31853658 DOI: 10.1007/s11906-019-1004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW This paper aims to review the literature regarding the impact of Donald Trump's candidacy and presidency on the health of immigrants in America. RECENT FINDINGS The increase in detentions of alleged undocumented immigrants under the Trump presidency, especially his administration's attempts to detain children apart from their families, have placed thousands into conditions that can have long-lasting physical and mental health effects. Similarly, the Trump administration's efforts to increase deportations and restrict legal immigration has lead to immigrants' seeking fewer health-care resources for fear of jeopardizing their or their loved ones' chances of remaining in this country. The rhetoric used and policies pursued by Donald Trump have had a measurable adverse impact on the health of documented and undocumented immigrants in America.
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26
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Knipper SH, Rivers W, Goodman JM. Effects of citizenship status, Latino ethnicity, and household language on health insurance coverage for U.S. adolescents, 2007-2016. Health Serv Res 2019; 54:1166-1173. [PMID: 31385302 DOI: 10.1111/1475-6773.13198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE/STUDY QUESTION To examine changes in uninsurance rates among U.S. adolescents ages 12-17 and assess whether trends over time differed by citizenship status, Latino ethnicity, and household language. DATA SOURCES/STUDY SETTING 2007-2016 National Health Insurance Survey (NHIS). STUDY DESIGN Multivariable logistic regression and postestimation marginal effects were used to assess changes in the current uninsured rate. Logistic regression models were used to determine significant trends over time for each demographic group and compare them to trends in the broader adolescent population. Marginal effects were employed to calculate adjusted outcome probabilities for each year. PRINCIPAL FINDINGS Across all 12- to 17-year-olds, the unadjusted uninsured rate dropped significantly between 2007 and 2016, from 10.2 percent to 6.0 percent. For noncitizen youth, the probability of being uninsured increased from 26.6 percent in 2007 to 28.4 percent in 2016, after controlling for covariates. Latino youth and those in Spanish-speaking households saw declines in their adjusted uninsurance rate that was proportional to non-Latino and English-speaking youth. CONCLUSIONS Most adolescents saw significant improvements in health insurance coverage between 2007 and 2016; however, disparities remain among Spanish-speaking and Latino adolescents and no improvements were seen among noncitizen youth. This suggests a need for equity-focused eligibility, outreach, and enrollment policies that expand insurance options for these populations.
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27
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Stimpson JP, Wilson FA. Medicaid Expansion Improved Health Insurance Coverage For Immigrants, But Disparities Persist. Health Aff (Millwood) 2019; 37:1656-1662. [PMID: 30273021 DOI: 10.1377/hlthaff.2018.0181] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act's Medicaid expansion provisions have been credited with overall improvements in insurance coverage, access to care, and health. However, recent studies have found that racial and ethnic disparities in coverage have persisted in spite of these improvements. We used data for the period 2010-15 from the American Community Survey about adults ages 19-64 to study the impact of Medicaid expansion on insurance coverage among US natives, naturalized citizens and noncitizen immigrants. We found that uninsurance decreased among US natives, naturalized citizens, and noncitizen immigrants after 2013. The percentage of uninsured noncitizens decreased from 69.6 percent in 2010 to 53.5 percent in 2015. However, uninsurance rates remained high for noncitizens in 2015, with 44.9 percent of them uninsured in expansion states, compared to 16.3 percent of natives. A triple-differences analysis suggested that among natives and noncitizens, 5.6 percent and 5.0 percent, respectively, of the drop in uninsurance were attributable to Medicaid expansion. However, decreases in uninsurance among naturalized citizens could not be attributed to Medicaid expansion. Although health insurance coverage improved significantly for natives, naturalized citizens, and noncitizens, substantial disparities in insurance coverage persisted for noncitizen immigrants.
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Affiliation(s)
- Jim P Stimpson
- Jim P. Stimpson ( ) is a professor of health management and policy at the Dornsife School of Public Health, Drexel University, in Philadelphia, Pennsylvania
| | - Fernando A Wilson
- Fernando A. Wilson is an associate professor of health services research and administration at the College of Public Health, University of Nebraska Medical Center, in Omaha
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28
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Bustamante AV, McKenna RM, Viana J, Ortega AN, Chen J. Access-To-Care Differences Between Mexican-Heritage And Other Latinos In California After The Affordable Care Act. Health Aff (Millwood) 2019; 37:1400-1408. [PMID: 30179559 DOI: 10.1377/hlthaff.2018.0416] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We examined changes in health insurance coverage and access to and use of health care among adult (ages 18-64) Latinos in the US before (2007-13) and after (2014-16) implementation of the main provisions of the Affordable Care Act. Data from the California Health Interview Survey were used to compare respondents in the two periods. We used multivariable and decomposition regression analyses to investigate the role of documentation status in access disparities between Mexicans and other Latinos in California. Our findings show that after the implementation of these provisions in California, insurance coverage increased for US- and foreign-born Latinos, including undocumented Latinos. Our decomposition analyses show that after implementation, disparities between Mexicans and other Latinos declined with respect to having coverage and a usual source of care. Without the implementation of these provisions in 2014, these disparities would have been 5.76 percent and 0.31 percent larger, respectively. In contrast, legal documentation status was positively associated with disparities between Mexicans and other Latinos in having coverage and physician visits. If Mexican Latinos had had the same share of undocumented immigrants as other Latinos, disparities in health insurance coverage would have declined by 24.17 percent.
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Affiliation(s)
- Arturo Vargas Bustamante
- Arturo Vargas Bustamante ( ) is an associate professor of health policy and management at the Jonathan and Karin Fielding School of Public Health, University of California Los Angeles (UCLA)
| | - Ryan M McKenna
- Ryan M. McKenna is an assistant professor of health management and policy at the Drexel University Dornsife School of Public Health, in Philadelphia, Pennsylvania
| | - Joseph Viana
- Joseph Viana is a graduate student researcher at the Jonathan and Karin Fielding School of Public Health at UCLA
| | - Alexander N Ortega
- Alexander N. Ortega is a professor in and chair of the Department of Health Management and Policy, Drexel University Dornsife School of Public Health
| | - Jie Chen
- Jie Chen is an associate professor of health services administration at the University of Maryland, in College Park
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29
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Bojorquez GR, Fry-Bowers EK. Beyond Eligibility: Access to Federal Public Benefit Programs for Immigrant Families in the United States. J Pediatr Health Care 2019; 33:210-213. [PMID: 30660428 DOI: 10.1016/j.pedhc.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 10/29/2018] [Accepted: 11/13/2018] [Indexed: 11/16/2022]
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