Beyond Eligibility: Access to Federal Public Benefit Programs for Immigrant Families in the United States

Effect of citizenship status on access to pediatric liver and kidney transplantation

Transplantation of non-US citizen residents remains controversial. We evaluate national trends in transplant activity among pediatric noncitizen residents (PNCR). Pediatric liver and kidney transplant data were obtained from the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients. Data on transplanted organs, region, waitlist additions, procedures, and citizenship status were analyzed from 2012-2022. Rates of PNCR transplantation activity were compared with population rates from the US Census Bureau. On average, 713 ± 47 pediatric liver and 1039 ± 51 kidney patients were added to the waitlist, with 544 ± 32 liver and 742 ± 33 kidney transplants performed annually. Of these, PNCR comprised 1.5% and 3.3% of liver and kidney waitlist additions and 1.5% and 2.9% of liver and kidney transplant procedures, respectively. There were no significant changes in waitlist or transplant activity nationwide over the study period. There was a significant geographic variation in the percentage of waitlist additions and transplants across the United Network for Organ Sharing regions among the PNCR for liver and kidney transplantation. This is the first study to evaluate national trends in transplantation activity among PNCRs. The significant regional variation in transplantation activity for PNCR may suggest multilevel structural and systemic barriers to transplant accessibility.

Family Matters: Modeling Naturalization Propensities in the United States

Despite the benefits of gaining citizenship, many eligible immigrants in the United States are not naturalizing. In this article, we examine factors that lead to naturalization in the United States, finding that immigrants’ pathways to citizenship are simultaneously shaped by individual characteristics, place-based attributes, and family dynamics. Of notable significance, and largely omitted from previous empirical work on naturalization, we find that having a naturalized spouse prior to one’s own naturalization is associated with a higher probability of naturalization, whereas being married to an undocumented immigrant reduces the probability of naturalization. Similarly, having a naturalized adult in the family other than a spouse improves the odds of naturalization, but having an undocumented family member other than a spouse reduces the odds. These findings suggest that while eligible immigrants with naturalized family members are more likely to improve their access to naturalization through pooled resources and increased information sharing, eligible immigrants with undocumented family members are more likely to avoid the naturalization process entirely, likely due to chilling effects from immigrant enforcement and policies that target close ties with liminal legality. These findings suggest that immigrants’ access to citizenship could be improved by (1) reaching immigrants who are the first in their families to naturalize and (2) improving the context of reception for undocumented immigrants and mixed-status families. More broadly, while individual factors play a role in naturalization, complex contextual factors, including place and family, shape immigrants’ pathways to citizenship and provide opportunities for new policies to promote immigrant integration.

Structural Inequities and Barriers to Accessing Kidney Healthcare Services in the United States: A Focus on Uninsured and Undocumented Children and Young Adults

The population of children living in poverty and lacking healthcare insurance has increased in the United States of America in the last decade. Several factors have been responsible for this trend including illegal immigration, socioeconomic deprivation, young age, racial segregation, environmental degradation, and discriminatory housing policies. These systemic barriers have contributed to the exclusion of families from essential healthcare services. They are also contributory to the development of chronic illnesses (such as dialysis-dependent kidney disease) that are debilitating and frequently require considerable therapeutic resources. This unfortunate scenario creates a never-ending vicious cycle of poverty and diseases in a segment of society. For pediatric nephrologists, the challenges of caring for uninsured children with chronic kidney disease are all too familiar. Federally funded healthcare programs do not cover this patient population, leaving them the option of seeking care in emergency healthcare settings. Presentation with a critical illness often necessitates urgent placement of vascular catheters and the choice of acute hemodialysis. Adverse social environment influences the need for protracted chronic hemodialysis and a delay in kidney transplantation. Consequently, there is greater comorbidity, recurrent hospitalization, and a higher mortality rate. New policies should address the deficit in health insurance coverage while promoting social programs that will remove structural barriers to health care resources for undocumented children and young adults.

Latino-to-Latino: Promotores' Beliefs on Engaging Latino Participants in Autism Research

BACKGROUND

In Latino(a) communities, promotores de salud (i.e., community health workers; promotores) are becoming critical participants in prevention, health promotion, and the delivery of health care. Although involving culturally diverse participants in research is a national priority, recruitment and retention of research participants from these groups is challenging. Therefore, there is an increased need to identify strategies for successful recruitment of participants from underrepresented minority backgrounds. Our overall study purpose was to gain promotores' perspectives on recruiting Latino(a) immigrant community members for an intervention study on autism spectrum disorders (ASD). The goal of this paper is to explore insider promotores' views on the barriers and facilitators to research participation in the Latino(a) community and learn strategies for recruiting Latino(a) participants in a nontraditional destination city.

METHODS

We conducted qualitative focus groups with an established group of promotores known as Latinos Unidos por la Salud (LU-Salud), who were members of a community-academic research team. Fifteen LU-Salud promotores participated in the focus groups. Focus group interviews were analyzed by using Leininger's data analysis enabler. These results will inform our partnerships with promotores and Latino(a) neighborhood agencies to increase recruitment for community-based research on promoting awareness of ASD among Latino(a) families.

RESULTS

Promotores were credible community members able to gain community trust and committed to improving the health and well-being of their Latino(a) community, including involving them in research. Latino(a) research involvement meant facilitating community members' engagement to overcome barriers of distrust around legal and health care systems. Challenges included legal uncertainties, language and literacy barriers, health knowledge, and economic hardship. Promotores also voiced the diversity of cultural practices (subcultures) within the Latino(a) culture that influenced: (1) research engagement, (2) guidance from promotores, (3) immersion in the Latino(a) community, and (4) health and well-being. Experienced promotores, who are living in a nontraditional migration area, believe the primary facilitator to increasing research involvement is Latino(a)-to-Latino(a) recruitment.

CONCLUSIONS

These findings will aid in building partnerships to recruit participants for future studies that promote early recognition of ASD in the Latino(a) community.

Screening for Immigration-Related Health Concerns in a Federally Qualified Health Center Serving a Diverse Latinx Community: A Mixed Methods Study

Immigration-related concerns can impact health and are an important consideration while caring for a multinational Latinx immigrant community. Patients and caregivers waiting for a non-urgent clinic appointment were randomly screened with one of two social risk screening tools. One tool included a question about "any health or stability concerns related to immigration status." The other tool did not include an immigration health question. Immediately following, respondents were invited to participate in a semi-structured interview regarding their social risk screening experience. 201 screens were completed, and 20 patients agreed to an interview. There were no significant sociodemographic differences between groups. Of those screened for immigration, 11% reported a concern. In both arms, interviewees felt that social risk screening was acceptable in a clinic setting. Questions about immigration are timely, important, and relevant, and can be considered when implementing social assessments in communities where there are high levels of trust in providers.