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

基本信息

批准号：
10388593
负责人：
Ye Ji Kim
金额：
$ 4.68万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
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/10388593
关键词：
Address Adolescent Adult Area Assimilations 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 Policy 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 Societies Sociology Source Surveys Training United States Work Yang adolescent health design health care service health care service utilization health disparity health service use high risk low socioeconomic status physical conditioning programs residence service utilization social epidemiology social structure theories welfare

项目摘要

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/摘要移民家庭的子女约占美国儿童的五分之一移民历史上一直面临着获得医疗保健的障碍，这反过来又具有持久性。健康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延伸。移民医疗服务利用理论包括移民特定因素，例如移民身份。然而，移民之间的移民医疗服务利用模式存在潜在的间接影响通过服务需求和保险状况来了解儿童健康服务的状况和利用情况，影响移民健康的一个关键宏观结构因素尚未得到研究。包括获得联邦资助的福利（例如医疗补助和儿童健康保险）的政策 1996年的福利改革对合法永久居民实行了五年的等待期。 2009 年，各州可以选择通过取消等待来扩大资格。该研究项目的总体目标是解决我们在健康知识方面的差距。通过更好地了解移民机制来提高移民儿童的服务利用和健康在目标 1 中，我们将估计卫生服务利用状况以及国家级政策限制的影响。通过两个假设，儿童移民身份对其医疗服务利用的间接影响使用路径分析的移民医疗服务利用的概念模型——首先通过儿童的需求医疗保健服务，使用家长报告的健康状况进行评估，其次通过儿童的健康状况进行评估保险状况，一种有利的资源，我们还将估计两者之间关系的总体影响。在目标 2 中，我们将评估州级的影响。取消 50 个州和特区对联邦资助的儿童健康项目的限制哥伦比亚，使用双重差分 (DD) 设计 DD 设计提供了合理的因果推论。取消 5 年等待期对移民儿童和青少年健康的影响。研究将使用两个来源的数据：全国儿童健康调查（目标 1：2016 – 2018 年；目标 2： 2007 年和 2011/12 年）；以及 Henry J. Kaiser 家庭基金会关于州取消 5 年期的年份的数据等待期（两个目标）。了解移民身份对医疗服务利用的影响和机制。宏观结构限制可能会凸显医疗保健服务的特定需求以及政策对健康的影响更好地调整医疗服务以满足所有公众的需求，包括移民和混合身份家庭的需求。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础，并与健康差异学者合作，以促进我的长期目标是成为一名独立研究员。