The Intersection of State-Level Immigrant Policy Climates and Medicaid Expansion: an Examination Among Immigrants.

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.

Health Insurance Coverage: Logical Versus Survey Identification of the Foreign-Born.

Estimating rates of public benefit use for lawful permanent residents (LPRs) is difficult given the limited availability of nationally representative data that disaggregate the foreign-born population by legal status. Using the 2008 Survey of Income and Program Participation-the only national survey that distinguishes LPRs from other non-citizens-we employ logistic regression to compare estimates of health insurance coverage for legal immigrants using two methods to infer legal status: (1) a logical approach and (2) a survey-based approach. The logical approach, relative to the survey approach, yields a higher predicted probability of having any insurance for LPRs (adjPP = 0.70) compared to the survey approach (adjPP = 0.57) and a higher likelihood of having public health insurance (adjPP = 0.26 compared to adjPP = 0.09, respectively). These findings suggest that the logical approach may overestimate lawful immigrants' reliance on public benefits, which has implications for conclusions about recent changes to the public charge rule.

The Association Between Legal Status and Poverty Among Immigrants: A Methodological Caution.

Using nationally representative survey data, this research note examines the association between immigrant legal status and poverty in the United States. Our objective is to test whether estimates of this association vary depending on the method used to infer legal status in survey data, focusing on two approaches in particular: (1) inferring legal status using a logical imputation method that ignores the existence of legal-status survey questions (logical approach); and (2) defining legal status based on survey questions about legal status (survey approach). We show that the two methods yield contrasting conclusions. In models using the logical approach, among noncitizens, being a legal permanent resident (LPR) is counterintuitively associated with a significantly greater net probability of being below the poverty line compared with their noncitizen peers without LPR status. Conversely, using the survey approach to measure legal status, LPR status is associated with a lower net probability of living in poverty, which is in line with a growing body of qualitative and small-sample evidence. Consistent with simulation experiments carried out by Van Hook et al. (2015), the findings call for a more cautious approach to interpreting research results based on legal status imputations and for greater attention to potential biases introduced by various methodological approaches to inferring individuals' legal status in survey data. Consequently, the approach used for measuring legal status has important implications for future research on immigration and legal status.

Global patterns in overweight among children and mothers in less developed countries.

OBJECTIVE: Past research has identified increases in national income and urbanization as key drivers of the global obesity epidemic. That work further identified educational attainment and urban residence as important moderators of the effects of national income. However, such work has tended to assume that children and adults respond in the same way to these factors. In the present paper, we evaluate how the socio-economic and country-level factors associated with obesity differ between children and their mothers. DESIGN: We modelled the associations between maternal education, country-level income and urban residence with mother's and children's weight status. SETTING: We analysed ninety-five nationally representative health and nutrition surveys conducted between 1990 and 2008 from thirty-three less developed countries. SUBJECTS: Our sample included children aged 2-4 years (n 253 442) and their mothers (n 228 655). RESULTS: Consistent with prior research, we found that mothers' risk of overweight was positively associated with economic development, urban residence and maternal education. Additionally, economic development was associated with steeper increases in mothers' risk of overweight among those with low (v. high) levels of education and among those living in rural (v. urban) areas. However, these associations were different for children. Child overweight was not associated with maternal education and urban residence, and negatively associated with national income. CONCLUSIONS: We speculate that the distinctive patterns for children may arise from conditions in low- and middle-income developing countries that increase the risk of child underweight and poor nutrition.