Understanding health services utilization and health mechanism among U.S. immigrant children and adolescents

了解美国移民儿童青少年卫生服务利用及健康机制

• 批准号: 10830233
• 负责人: Ye Ji Kim
• 金额: $ 3.86万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-03 至 2023-10-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10830233
• 关键词: Address; Adolescent; Adult; Area; Authorization documentation; Behavioral Model; Caring; Categories; Child; Child Health; Child Health Services; Communities; Country; Data; District of Columbia; Eligibility Determination; Enabling Factors; Excision; Face; Family; Fellowship; Fostering; Foundations; Funding; Goals; Health; Health Insurance; Health Services; Health Services Accessibility; Health Status; Healthcare; Immigrant; Immigrant family; Immigration; Insurance Coverage; Knowledge; Legal; Link; Literature; Low income; Mediating; Medicaid; Mental Health; Modeling; Motivation; Parents; Pattern; Policies; Population; Predisposing Factor; Pregnant Women; Preventive service; Reporting; Research; Research Personnel; Research Project Grants; Resources; Risk Factors; Role; Services; Social Behavior; Social Environment; Societies; Sociology; Source; Surveys; Training; United States; Work; adolescent health; authority; design; health care service; health care service utilization; health disparity; health service use; high risk; improved; low socioeconomic status; physical conditioning; programs; residence; service utilization; social epidemiology; social structure; theories; welfare

Project Summary/Abstract Immigrant families’ children make up about one in five children in the United States. Immigrants historically and persistently face barriers obtaining healthcare, which in turn have lasting physical and mental health consequences. A theoretical framework of health service utilization among immigrants have been conceptualized as an extension of the Behavioral Model of Health Services Use. The theory of immigrant health service utilization includes immigrant-specific factors such as immigration status. Yet, potential indirect effects posited in the immigrant health service utilization model between immigration status and children’s health service utilization through the need of services and through insurance status, an enabling factor, remain unexamined. A critical macrostructural factor that influences health of immigrants include policies on access to federally funded benefits such as Medicaid and Children’s Health Insurance Program. The welfare reform in 1996 imposed a five-year waiting period for legal permanent residents before receiving public benefits. In 2009, states were given the option to expand eligibility by removing the waiting period. The overall goal of this proposed research project is to address gaps in our knowledge of health service utilization and health of immigrant children by better understanding the mechanisms of immigration status on health service utilization and the effects of state-level policy restrictions. In Aim 1, we will estimate the indirect effects of children’s immigration status on their health service utilization through two hypotheses of a conceptual model of immigrants’ health services utilization using path analysis – first through children’s need of health care services, assessed using parent-reported health conditions, and second through children’s insurance status, an enabling resource. We will also estimate the total effect of the relationship between immigration status and health services utilization. In Aim 2, we will evaluate the impact of the state-level removal of restriction to federally funded programs on children’s health across 50 states and the District of Columbia, using difference-in-difference (DD) design. The DD design provides plausible causal inference of the impact of the removal of the 5-year waiting period on immigrant children and adolescent health. This research will use data from two sources: National Survey of Children’s Health (Aim 1: 2016 – 2018; Aim 2: 2007 and 2011/12); and the Henry J. Kaiser Family Foundation data on the year of state’s removal of 5-year waiting period (both Aims). Understanding mechanisms of immigration status on health service utilization and macrostructural restrictions may highlight specific needs for healthcare services and policy impacts on health to better tailor health services to all public needs, including those of immigrant and mixed-status families. This fellowship will afford me opportunities and training to enrich my understanding of sociological theories, strengthen my research foundation in social epidemiology, and engage with health disparities scholars to foster my long-term goal of becoming an independent researcher.

项目摘要/摘要移民家庭的孩子在联合 国家。历史上且持续面对获得医疗保健的障碍，这又有持久的障碍 身心健康后果。卫生服务利用的理论框架 移民已被概念化为卫生服务使用行为模型的扩展。这 移民卫生服务理论的利用理论包括移民特异性因素，例如移民身份。 然而，移民卫生服务利用模型的潜在间接效应 身份和儿童卫生服务通过服务的需要和保险状态， 启用因素，尚未审查。影响移民健康的关键宏观结构因素 包括有关获得联邦资助的福利的保单，例如医疗补助和儿童健康保险 程序。 1996年的福利改革为合法永久居民实施了五年的等待期 获得公共利益。 2009年，各州可以选择通过删除等待来扩大资格 时期。这个拟议的研究项目的总体目标是解决我们对健康知识的差距 通过更好地了解移民的机制，服务利用和健康 卫生服务利用的状况以及国家级政策限制的影响。在AIM 1中，我们将估计 通过两个假设 使用路径分析的移民卫生服务利用的概念模型 - 首先是通过儿童的需求 使用父母报告的健康状况评估的医疗保健服务，其次是儿童 保险状态，启示资源。我们还将估计 移民身份和卫生服务利用。在AIM 2中，我们将评估州级的影响 删除对50个州和地区的联邦资助计划的限制 哥伦比亚，使用差异差异（DD）设计。 DD设计提供了合理的因果推断 删除5年等待期对移民儿童和青少年健康的影响。这 研究将使用来自两个来源的数据：国家儿童健康调查（AIM 1：2016 - 2018； AIM 2： 2007和2011/12）;以及亨利·凯撒（Henry J. 等待期（两个目标）。了解卫生服务利用中移民身份的机制和 宏观结构限制可能会突出医疗服务的特定需求，政策对健康的影响 更好地针对所有公共需求，包括移民和混合地位家庭的卫生服务。这 奖学金将为我提供机会和培训，以丰富我对社会学理论的理解， 加强我在社会流行病学方面的研究基金会，并参与健康差异学者以培养 我成为独立研究人员的长期目标。