Health Care Access and Utilization for Latino Youth in the United States: The Roles of Maternal Citizenship and Distress.

OBJECTIVES: We sought to determine the associations between maternal citizenship and health care access and utilization for US-born Latino youth and to determine whether maternal distress is a moderator of the associations. METHODS: Using 2010-2017 Integrated Public Use Microdata Series National Health Interview Survey data, multivariable logistic regressions were run to examine the associations among maternal citizenship and health care access and utilization for US-born Latino youth. Maternal citizenship and distress interactions were tested. RESULTS: Noncitizen mothers had higher odds of reporting uninsurance, lack of transportation for delaying care, and lower odds of health care utilization for their youth than citizen mothers. Compared with no distress, moderate and severe distress were positively associated with uninsurance, delayed medical care due to cost, lack of transportation, and having had an emergency department visit for their youth. Moderate distress was positively associated with youth having had a doctor's office visit. Noncitizen mothers with moderate distress were less likely to report their youth having had an emergency department visit than citizen mothers with moderate distress. Among severely distressed mothers, noncitizen mothers were more likely to report youth uninsurance and delayed care due to lack of transportation compared with citizen mothers. CONCLUSIONS: Health care access and utilization among US-born Latino youth are influenced by maternal citizenship and distress. Maternal distress moderates the associations among maternal citizenship and youth's health care access and use. Almost one-third of all US-born youth in the United States are Latino and current federal and state noninclusive immigration policies and anti-Latino immigrant rhetoric may exacerbate health care disparities.

Association of maternal characteristics with latino youth health insurance disparities in the United States: a generalized structural equation modeling approach.

BACKGROUND: Disparities in access to care persist for Latino youth born in the United States (US). The association of maternal characteristics, such as maternal citizenship status and insurance coverage, on youth health insurance coverage is unclear and is important to examine given the recent sociopolitical shifts occurring in the US. METHODS: We analyzed pooled cross-sectional data from the 2010-2018 National Health Interview Survey to examine the association of Latina maternal citizenship status on maternal insurance coverage status and youth uninsurance among US-born Latino youth. Our study sample consisted of 15,912 US-born Latino youth (ages < 18) with linked mothers. Our outcome measures were maternal insurance coverage type and youth uninsurance and primary predictor was maternal citizenship status. Generalized structural equation modeling was used to examine the relationships between maternal characteristics (maternal citizenship, maternal insurance coverage status) and youth uninsurance. RESULTS: Overall, 7% of US-born Latino youth were uninsured. Just 6% of youth with US-born mothers were uninsured compared to almost 10% of those with noncitizen mothers. Over 18% of youth with uninsured mothers were uninsured compared to 2.2% among youth with mothers who had private insurance coverage. Compared to both US-born and naturalized citizen Latina mothers, noncitizen Latina mothers had 4.75 times the odds of reporting being uninsured. Once adjusted for predisposing, enabling, and need factors, maternal uninsurance was strongly associated with youth uninsurance and maternal citizenship was weakly associated with youth uninsurance among US-born Latino youth. CONCLUSION: Maternal citizenship was associated with both maternal uninsurance and youth uninsurance among US-born Latino youth. Federal- and state-level health policymaking should apply a two-generational approach to ensure that mothers of children are offered affordable health insurance coverage, regardless of their citizenship status, thus reducing uninsurance among US-born Latino youth.

Cardiovascular disease behavioral risk factors among Latinos by citizenship and documentation status.

BACKGROUND: Studies have observed that recent Latino immigrants tend to have a physical health advantage compared to immigrants who have been in the US for many years or Latinos who are born in the United States. An explanation of this phenomenon is that recent immigrants have positive health behaviors that protect them from chronic disease risk. This study aims to determine if trends in positive cardiovascular disease (CVD) risk behaviors extend to Latino immigrants in California according to citizenship and documentation status. METHODS: We examined CVD behavioral risk factors by citizenship/documentation statuses among Latinos and non-Latino US-born whites in the 2011-2015 waves of the California Health Interview Survey. Adjusted multivariable logistic regressions estimated the odds for CVD behavioral risk factors, and analyses were stratified by sex. RESULTS: In adjusted analyses, using US-born Latinos as the reference group, undocumented Latino immigrants had the lowest odds of current smoking, binge drinking, and frequency of fast food consumption. There were no differences across the groups for fruit/vegetable intake and walking for leisure. Among those with high blood pressure, undocumented immigrants were least likely to be on medication. Undocumented immigrant women had better patterns of CVD behavioral risk factors on some measures compared with other Latino citizenship and documentation groups. CONCLUSIONS: This study observes that the healthy Latino immigrant advantage seems to apply to undocumented female immigrants, but it does not necessarily extend to undocumented male immigrants who had similar behavioral risk profiles to US-born Latinos.

Reports of insurance-based discrimination in health care and its association with access to care.

OBJECTIVES: We examined reports of insurance-based discrimination and its association with insurance type and access to care in the early years of the Patient Protection and Affordable Care Act. METHODS: We used data from the 2013 Minnesota Health Access Survey to identify 4123 Minnesota adults aged 18 to 64 years who reported about their experiences of insurance-based discrimination. We modeled the association between discrimination and insurance type and predicted odds of having reduced access to care among those reporting discrimination, controlling for sociodemographic factors. Data were weighted to represent the state's population. RESULTS: Reports of insurance-based discrimination were higher among uninsured (25%) and publicly insured (21%) adults than among privately insured adults (3%), which held in the regression analysis. Those reporting discrimination had higher odds of lacking a usual source of care, lacking confidence in getting care, forgoing care because of cost, and experiencing provider-level barriers than those who did not. CONCLUSIONS: Further research and policy interventions are needed to address insurance-based discrimination in health care settings.

Putting out the welcome mat-targeting outreach efforts under the Affordable Care Act: Evidence from the Minnesota Community Application Agent Program.

CONTEXT: An evaluation of the Minnesota Community Application Agent (MNCAA) Program was conducted for the MN Minnesota Department of Human Services and funded by the Health Resources and Services Administration's State Health Access Program grant. OBJECTIVE: The MNCAA evaluation assessed effectiveness in reaching disparate populations, explored overall program value, and sought lessons applicable to the Navigator programs required under the Affordable Care Act. DESIGN: Mixed-methods approach using quantitative analysis of tracking and payment data and interviews with key informants to elicit "lessons learned" about the MNCAA program. SETTING: The MNCAA program offers incentive payments and technical assistance to community partner organizations that assist individuals in applying for public health care coverage. PARTICIPANTS: A total of 140 unique community organizations participated in the MNCAA program in 2008 to 2012. Outreach staff and directors from participating MNCAAs and state/local government officials were interviewed. MAIN OUTCOME MEASURE(S): The article highlights a strategy for targeting outreach to individuals eligible for Medicaid coverage or subsidies under the Affordable Care Act by presenting evaluation findings from a unique outreach program to increase access to care for vulnerable populations in Minnesota. RESULTS: Almost two-thirds of applicants were successfully enrolled but lengthy waiting periods persisted. Seventy percent of applications came from health care organizations. Only 13% of applicants assisted by MNCAAs were new to public health care programs. Most MNCAAs believed that the incentive payment-$25 per successful enrollee-was insufficient. CONCLUSIONS: Significant expertise in enrolling individuals in public health care programs exists within a core group of community organizations. Incentives to leverage the capacity of community organizations must be accompanied by recruiting and training. Outreach providers and navigators also need timely access to client information. More investment in financial incentives will be required.

"It felt like hitting rock bottom": A qualitative exploration of the mental health impacts of immigration enforcement and discrimination on US-citizen, Mexican children.

Latino immigrant families in the United States were disproportionately affected by intensified interior immigration enforcement under the Trump administration. US-citizen children are victimized by policies targeting their immigrant parents; research is sparse regarding how these polices affect children who experience parental deportation and children who are at risk for parental deportation. Additionally, anti-immigrant rhetoric can result in increased discrimination that also threatens children's psychological health. This qualitative study (N = 22) explores children's lived experiences of discrimination, parental deportation or threat of parental deportation, and perceived impacts on mental health. Interviews conducted from 2019 to 2020 revealed that children who are directly affected by or at risk for parental deportation experience detrimental impacts to their psychological well-being. Children experience discrimination as Latinos and children of immigrants, which is also detrimental to their mental/emotional health. Incorporating children's perspectives is critical to informing public health interventions. Findings demonstrate the need for family-friendly immigration reform.

Las familias inmigrantes latinas en los Estados Unidos se vieron desproporcionadamente afectadas por las acciones del servicio de inmigración bajo la administración de Trump. Los niños y niñas con ciudadanía estadounidense son víctimas de las políticas dirigidas a sus padres inmigrantes; las investigaciones son escasas con respecto a cómo estas políticas afectan a los menores afectados por la deportación de sus padres así como los que corren riesgo de que sus padres sean deportados. Además, la retórica antiinmigrante puede provocar un aumento en la discriminación, lo cual también representa una amenaza para la salud psicológica de estos niños y niñas. Este estudio cualitativo (N = 22) explora las experiencias de discriminación y de deportación o amenaza de deportación de los padres vividas por los menores así como los impactos percibidos en su salud mental. Las entrevistas realizadas entre 2019 y 2020 revelan que las niñas y niños directamente afectados por la deportación o el riesgo de deportación de sus padres sufren un impacto perjudicial en su bienestar psicológico. Los menores experimentan discriminación como latinos e hijos de inmigrantes, lo cual también perjudica su salud mental y emocional. Es crucial que se incorporen las perspectivas de estos menores al informar las intervenciones de salud pública. Los hallazgos demuestran la necesidad de una reforma migratoria que sea solidaria con las familias.

Knowledge, skills, and qualities for effectively facilitating an adolescent girls' group.

Nurses employed in a variety of school settings often rely on group-format approaches to support the health and well-being of adolescent girls. The process of selecting an effective facilitator, and evaluating the impact of a facilitator on intervention process and outcomes, is rarely described. The purpose of this article was to synthesize the literature regarding facilitator knowledge, skills, and qualities to provide school-based researchers and practitioners with a framework for selecting and evaluating group facilitators. Literature was reviewed between Fall of 2008 and Spring of 2011. Findings were synthesized into categories that provide the organization for this article (why groups, why a facilitator, and the knowledge, skills, and qualities of an effective girls' group facilitator). Nurses need to carefully identify, select, and equip those who serve as facilitators because group successes, evidenced in the ways girls grow and support each other in growth, are the result of a successful, well-matched facilitator-group participant experience.

Feasibility and acceptability of a school-based coping intervention for Latina adolescents.

Latino girls (Latinas) experience disproportionate rates of emotional distress, including suicidal ideation, which may be indicative of inadequate coping abilities. Prevention of mental health problems, a U.S. public health priority, is particularly critical for Latina adolescents due to lack of access to mental health treatments. The purpose of this study was to examine the feasibility of Project Wings, a 14-session stress management/coping intervention. Latinas in school (ages 15-21) met weekly for 2-hr with two bilingual experienced facilitators to participate in sharing circles, relaxation exercise, and skill building. Intervention participation and post-intervention focus group data were analyzed. Fall semester intervention (n = 10) occurred during school (72% attendance rate); spring semester intervention (n = 11) was after school (84% attendance rate). Focus group data confirmed acceptability. Latina adolescents will participate in a school-based, group-based stress management/coping intervention. The findings offer insights about intervention recruitment and retention that are specifically relevant to school nurses. Future research includes intervention testing using a randomized study design.

Insurance Coverage and Health Care Utilization Among Asian Youth Before and After the Affordable Care Act.

OBJECTIVE: We examined changes in insurance coverage and health care utilization associated with the Affordable Care Act (ACA) among subgroups of Asian youth relative to non-Latino white youth. METHODS: Data were from the 2010 to 2017 American Community Survey and National Health Interview Survey. Difference-in-difference models were used to examine changes in insurance coverage and health care utilization associated with the ACA among subgroups of Asian youth relative to white youth and subgroups of Asian youth in households below 200% of the federal poverty level relative to comparable white youth. RESULTS: Since the implementation of the ACA, insurance coverage increased among all Asian subgroups and white youth. The magnitude of the increase in insurance coverage was larger among Asian subgroups than white youth. More pronounced increases were found among almost all Asian subgroups in households below 200% federal poverty level. Changes in health care utilization were limited and varied by subgroup. Increases in well-child visits were observed only among Chinese and "other" Asian youth. CONCLUSIONS: Insurance coverage increased among Asian youth after the implementation of the ACA. Improvements in health care utilization were limited and differed by subgroups. Programs to improve health care utilization should be tailored to Asian youth according to subgroup.

Insurance-Based Disparities In Access, Utilization, And Financial Strain For Adults With Psychological Distress.

Limited provider participation within Medicaid and narrow provider networks on health insurance Marketplaces pose potential barriers to accessing and using the health care system for people with behavioral health needs. We compared employer-sponsored insurance, Medicaid, and Marketplace coverage for people with psychological distress across three domains of health care: access, utilization, and financial strain. We found evidence that adults with psychological distress reported greater difficulty accessing health care relative to those without such distress, regardless of insurance source. Among adults with psychological distress, Medicaid enrollees were more likely to use care and less likely to experience health-related financial strain than those enrolled in employer-sponsored insurance were. However, people with Marketplace coverage were more likely to experience barriers across all domains, relative to people with the other two coverage sources. Policy makers should be cognizant of the participation of providers within Medicaid and the Marketplaces and work to make network breadth more transparent.

Consumers' Perceptions And Choices Related To Three Value-Based Insurance Design Approaches.

The burden of rising health care costs is being shifted to consumers, and 30 percent of health care costs are attributed to wasteful spending on low- or no-value services. Value-based insurance design (VBID) is intended to encourage the use of high-value services or discourage the use of low-value services by aligning cost with quality. During the summer and fall of 2016, this mixed-methods study used focus groups and a quantitative analysis of survey data to explore consumer decision making in Northern California. When presented with three common VBID approaches, the focus groups favored value-based benefit design the most (41 percent), followed by reference pricing (28 percent) and narrow networks (21 percent). When presented with VBID scenarios, participants were skeptical of the value-based trade-offs and reported seeking information they wanted instead of relying on information that health plans provide. Engaging consumers to successfully reduce waste through VBID will require clarifying trade-offs to support consumers' processes for arriving at high-value decisions as well as reaching out to consumers through trusted sources and networks.

Implementing federal health reform in the States: who is included and excluded and what are their characteristics?

OBJECTIVE: To estimate the characteristics and number of nonelderly adults eligible and ineligible for Affordable Care Act (ACA) expansions. DATA SOURCES AND SETTINGS: Two secondary data sources are used in this analysis: the 2008 Panel of the Survey of Income and Program Participation (SIPP) and the 2009 American Community Survey (ACS). STUDY DESIGN: We use multiple imputation to incorporate model-based uncertainty into the prediction of immigration status into the ACS from the SIPP. Key variables include place of birth, year of entry to the U.S., and health insurance coverage. DATA COLLECTION/EXTRACTING METHODS: No primary data are used in this study. PRINCIPLE FINDINGS: We estimate that potentially 3.5 million nonelderly adults will be excluded from the ACA Medicaid Expansion and 2 million from the health insurance exchanges because of their immigration status. We also find significant differences in estimates of excluded nonelderly adults across states. CONCLUSIONS: Over 15 percent of income-eligible uninsured nonelderly adults will be potentially excluded from the ACA coverage expansions due to their immigration status. Policy makers must be careful to exclude ineligible nonelderly adults before estimating the impact of the ACA on coverage rates.

The projected effect of the Affordable Care Act on dental care for adult Medicaid enrollees.

Fewer than half of all U.S. states provide dental care for non-elderly adult Medicaid enrollees. Although the Affordable Care Act (ACA) expands Medicaid eligibility for adults, states are not required to offer dental care to adults. We project the effect of the ACA on patient-identified barriers to dental care based on a framework developed using data from a 2008 survey of Minnesota Medicaid enrollees with and without an annual dental visit. The rate of annual visits (55%) was below that of all Minnesotans (79%) with 40% reporting difficulties accessing services. We found no racial/ethnic disparities in annual dental visits among adult Medicaid enrollees. Adult Medicaid recipients with no annual visit reported individual (51%), provider (27%), and system-level (22%) barriers. Hmong, Somali, and American Indian adults were more likely than others to report barriers to receiving dental care. We project that the ACA will not reduce barriers to dental care for adult Medicaid enrollees.

Need, availability, and quality of interpreter services among publicly insured Latino, Hmong, and Somali individuals in Minnesota.

Limited English proficiency (LEP) is a common barrier that negatively affects access to health care and quality of care. Prior studies have examined interpreter services as a means of ameliorating LEP, but have focused on Spanish-language services, largely overlooking comparisons with other, less-established ethnic groups. Furthermore, few if any studies have assessed the quality of interpreter services provided. Data come from 2,489 Hispanic/Latino, Hmong, and Somali enrollees of public health insurance programs in Minnesota. We employ weighted, regression-adjusted comparisons of enrollee-reported need and availability of interpreters, access to professional and consistent interpreters, and problems with quality of interpreter-assisted communication. Compared with Latinos, Hmong and Somali enrollees reported greater needs and more communication problems, Somali enrollees reported lower availability, and Hmong enrollees reported lower access to professional interpreters. Further training of interpreters for relatively less-established ethnic groups is needed to increase availability of professional, high-quality communication among publicly insured ethnic minorities.