Health, health insurance coverage, health care service utilization and family structure among children of immigrants
Chang, Jin A.
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Family structure may alleviate or exacerbate barriers to better health and health care among children of immigrants, whose families tend to be highly interdependent and reliant on family cohesion as a survival strategy to manage challenges associated with immigrant status, such as policy restrictions, legal status issues, and linguistic barriers. Despite evidence has shown that children in single- and cohabiting-parent families have worse health and access to health care, very little is known about whether and how family structure plays a role in health and health care among children of immigrants. As a result, it is also unknown whether the relationship between family structure and these outcomes varies by immigrant generation, a significant indicator of health and access to health care. To this end, this three-paper dissertation examines the role of family structure on health, health insurance coverage, and health care service utilization among children of immigrants in different immigrant generations. This dissertation found that second- generation children of single parents are less likely to be in good health, and second-generation children of cohabiting parents have higher risk of being overweight or obese, compared to children of U.S.-born married parents. Another finding is that first- generation children of single and cohabiting parents residing in 33 Medicaid/CHIP eligibility expansion states had the greatest gains in overall and public health insurance coverage through Medicaid/CHIP expansion compared to their counterpart children in non-expansion states. Also, this policy change was associated with improved overall health insurance coverage among second-generation children in single-parent families. Lastly, a notable finding of this dissertation is that children of immigrants with married parents had most advantage in utilizing routine dental and medical care over time despite their lower initial rates of care use, compared to children of U.S.-born married parents. Although first-generation children with single parents had lower initial status of dental checkups as well, their rates of change in care use did not significantly increased unlike their counterpart children with married parents. Taken together, these three papers offer insights into the relationship between family structure and health and access to health care among children of immigrants during the post-ACA era. The findings of this dissertation have practical meaning under the current political environment in which formerly established policies and programs to address health care inequality between children of immigrants and non-immigrants are being challenged and restructured.