Health Insurance Coverage Predicts Health Care Use among Latine Immigrants in Two Policy Contexts.

This study analyzed electronic health record (EHR) data from 2016 through 2019 from a federally qualified health center (FQHC) serving predominantly low-income Latine immigrants in the Washington, D.C. metropolitan area to examine how changes in health insurance coverage relate to changes in health care use. Federally qualified health center clients were insured for an average of 59% to 63% of their annual visits, but about one-third had no coverage throughout the year. Findings from descriptive regression and within-client fixed effects models indicate that in years with higher proportions of insured visits, clients averaged more medical visits and interpreter services but fewer mental health and care coordination visits. Latine immigrant clients in D.C., a city with a universal health insurance option, had health insurance coverage for 89% of their visits, and averaged more medical and fewer coordination visits relative to those in a neighboring county in a state without a universal insurance option.

Scars from a Previous Epidemic: Social Proximity to Zika and Fertility Intentions during the COVID-19 Pandemic.

We examine whether women's social proximity to Zika during the Zika epidemic predicts intentions to avoid a pregnancy because of the COVID-19 pandemic either directly or indirectly via subjective assessments of the pandemic. We apply path models on unique microdata from Brazil, the country most affected by Zika and an epicenter of COVID-19, to understand whether a novel infectious disease outbreak left lasting imprints shaping fertility intentions during a subsequent novel infectious disease outbreak. Findings show that Zika social proximity is associated with fertility intentions through an indirect path related to subjective assessment of the COVID-19 pandemic. These findings emerged regardless of whether a woman herself had or suspected she had Zika and speak to the transformative consequences of novel infectious disease outbreaks that go beyond mortality and health.

Measuring Fertility Intentions During Times of Crisis: An Example Using Survey Data Amid the Covid-19 Pandemic.

Fertility intentions-intentions regarding whether and when to have children-predict reproductive health outcomes. Measuring fertility intentions is difficult, particularly during macrostructural shocks, for at least two reasons: (1) fertility intentions may be especially volatile during periods of uncertainty and (2) macrostructural shocks may constrain data collection. We propose a set of indicators that capture how a macrostructural shock directly alters fertility intentions, with a particular focus on the Coronavirus disease 2019 (Covid-19) pandemic. We advance the conceptualization and construct of fertility intentions measures in three ways. First, we demonstrate the value of direct questions about whether women attributed changes in fertility intentions to the pandemic. Second, we highlight the importance of a typology that delineates fertility postponement, advancement, foregoing, and indecision. Third, we demonstrate the importance of incorporating a granular time window within a two-year period to capture short-term changes to fertility intentions. We exemplify the value of our proposed measures using survey data from a probabilistic sample of women aged 18-34 in Pernambuco, Brazil. We discuss the self-reported change in intentions due to Covid in wave 1 as well as panel change across waves. We further ground our contributions by uncovering important variations by social origin and parity.

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.

Identifying hidden Zika hotspots in Pernambuco, Brazil: a spatial analysis.

BACKGROUND: Northeast Brazil has the world's highest rate of Zika-related microcephaly. However, Zika case counts cannot accurately describe burden because mandatory reporting was only established when the epidemic was declining in the region. METHODS: To advance the study of the Zika epidemic, we identified hotspots of Zika in Pernambuco state, Northeast Brazil, using Aedes-borne diseases (dengue, chikungunya and Zika) and microcephaly data. We used Kulldorff's Poisson purely spatial scan statistic to detect low- and high-risk clusters for Aedes-borne diseases (2014-2017) and for microcephaly (2015-2017), separately. Municipalities were classified according to a proposed gradient of Zika burden during the epidemic, based on the combination of cluster status in each analysis and considering the strength of the evidence. RESULTS: We identified 26 Aedes-borne diseases clusters (11 high-risk) and 5 microcephaly clusters (3 high-risk) in Pernambuco. According to the proposed Zika burden gradient, our results indicate that the northeast of Pernambuco and the Sertão region were hit hardest by the Zika epidemic. The first is the most populous area of Pernambuco, while the second has one of the highest rates of social and economic inequality in Brazil. CONCLUSION: We successfully identified possible hidden Zika hotspots using a simple methodology combining Aedes-borne diseases and microcephaly information.

Fertility trends during successive novel infectious disease outbreaks: Zika and COVID-19 in Brazil.

This study aims to estimate fertility trends in Brazil in the 2010s and early 2020s during a period of back-to-back novel infectious disease outbreaks - Zika virus and COVID-19. We use Brazilian Ministry of Health and Association of Civil Registrar data from 2011-2021 to measure general fertility rates at the national and state levels. We also used seasonal ARIMA model to forecast fertility rates by month and state in 2021 and compared these forecasts with observed fertility rates. We find that fertility rates were steady over 2011-2015 with no statistically significant variation, followed by a sharp decline during the Zika outbreak in 2016 followed by a return to pre-Zika levels after the end of the epidemic. Furthermore, to evaluate the effect of the COVID-19 pandemic, we make comparisons with observed and forecast rates from 2020-2021, showing that declines were generally larger for observed than for forecast rates, yet statistically insignificant. We argue that the resurgence of the COVID-19 pandemic in 2021 might lead to further declines, as women might have not had enough time to adjust rebound from either the effects of the Zika epidemic. We also discuss the importance of timely availability of live births data during a public health crisis with immediate consequences for fertility rates.

Current and Future Food Insufficiency During Covid-19: Examining Disparities by Race/Ethnicity and Recent Work Loss.

The Covid-19 pandemic, which began in early 2020, has eroded the previous decade's reductions in food insecurity. Pandemic-related food insufficiency has been concentrated among Black and Hispanic households and those who have experienced a recent work loss. Households with children are particularly vulnerable. Using the first twenty-one weeks of the US Census Bureau's Household Pulse Survey data from April 2020 through December of 2020, we examine the association between recent work losses and food insufficiency and document the extent to which the impact varies by race/ethnicity. Work loss is predictive of current and future food insufficiency, with the association most acutely experienced by Blacks and Hispanics and households with children. There is evidence of racial/ethnic disparities in current and future food insufficiency. The results provide insight into how the pandemic has widened racial/ethnic gaps in the experience of food insufficiency despite recent policy interventions.

Fertility trends during successive novel infectious disease outbreaks: Zika and COVID-19 in Brazil / Tendências de fecundidade durante sucessivas epidemias de doenças infecciosas novas: Zika e COVID-19 no Brasil / Tendencias de fecundidad durante los sucesivos brotes de nuevas enfermedades infecciosas: Zika y COVID-19 en Brasil

This study aims to estimate fertility trends in Brazil in the 2010s and early 2020s during a period of back-to-back novel infectious disease outbreaks - Zika virus and COVID-19. We use Brazilian Ministry of Health and Association of Civil Registrar data from 2011-2021 to measure general fertility rates at the national and state levels. We also used seasonal ARIMA model to forecast fertility rates by month and state in 2021 and compared these forecasts with observed fertility rates. We find that fertility rates were steady over 2011-2015 with no statistically significant variation, followed by a sharp decline during the Zika outbreak in 2016 followed by a return to pre-Zika levels after the end of the epidemic. Furthermore, to evaluate the effect of the COVID-19 pandemic, we make comparisons with observed and forecast rates from 2020-2021, showing that declines were generally larger for observed than for forecast rates, yet statistically insignificant. We argue that the resurgence of the COVID-19 pandemic in 2021 might lead to further declines, as women might have not had enough time to adjust rebound from either the effects of the Zika epidemic. We also discuss the importance of timely availability of live births data during a public health crisis with immediate consequences for fertility rates.

O objetivo desta contribuição de dados é estimar as tendências de fecundidade no Brasil nos anos 2010 e início dos anos 2020 durante epidemias consecutivas de doenças infecciosas novas, ou seja, Zika vírus e COVID-19. Utilizamos dados do Ministério da Saúde e do Registro Civil Nacional de 2011-2021 para calcular as taxas mensais de fecundidade nos níveis nacional e estadual. Também utilizamos o modelo ARIMA sazonal para prever taxas de fecundidade por mês e por estado em 2021, e comparamos essas previsões com as taxas de fecundidade observadas. Encontramos que as taxas de fecundidade eram estáveis entre 2011 e 2015, sem variação significativa, seguido por um declínio abrupto durante o surto de Zika em 2016, e seguido por sua vez por um retorno aos níveis pré-Zika depois do fim da epidemia. Além disso, para avaliar o efeito da pandemia de COVID-19, comparamos as taxas observadas e previstas de 2020-2021, mostrando que as quedas geralmente eram maiores nas taxas observadas do que nas previstas, porém sem significância estatística. Argumentamos que o recrudescimento da pandemia de COVID-19 em 2021 poderá levar a mais quedas nas taxas, na medida em que as mulheres não tenham tido tempo suficiente para reagir e se ajustarem aos efeitos da epidemia de Zika. Também discutimos a importância da disponibilidade oportuna de dados sobre nascidos vivos durante uma crise de saúde pública com consequências imediatas para as taxas de fecundidade.

El objetivo de esta aportación de datos es estimar las tendencias de fecundidad en Brasil en la década de 2010 y principios de 2020, durante el período de brotes consecutivos de nuevas enfermedades infecciosas -ZIKV y COVID-19. Se usaron datos procedentes del Ministerio de Salud y del Registro Civil Nacional (ARPEN) desde 2011-2021 para calcular mensualmente las tasas de fecundidad en nivel nacional y en el estado. Se utilizó el ARIMA estacional para pronosticar las tasas de fecundidad por mes y estado en 2021, y se compararon estas predicciones con las tasas de fecundidad observadas. Encontramos que las tasas de fecundidad se mantuvieron estables entre 2011 y 2015, sin variaciones significativas, seguido de un fuerte descenso durante el brote de Zika en 2016, para posteriormente volver a los niveles anteriores al Zika tras el fin de la epidemia. Asimismo, con el fin de evaluar el efecto de la pandemia de COVID-19, hicimos comparaciones con lo observado y la previsión de tasas desde 2020-2021, que muestran que los descensos fueron en general mayores para los índices observados que para los previstos, aunque insignificantes desde el punto de vista estadístico. Sostenemos que el resurgimiento de la pandemia de COVID-19 en 2021 podría provocar nuevos descensos, ya que las mujeres podrían no haber tenido suficiente tiempo para adaptarse a los efectos de la epidemia de Zika. También se discute la importancia de disponer a tiempo de los datos de los nacidos vivos durante una crisis de salud pública con consecuencias inmediatas para las tasas de fecundidad.

Intersections of Adolescent Well-Being: School, Work, and Weight Status in Brazil.

Socioeconomic and health disadvantages can emerge early in the life course, making adolescence a key period to examine the association between socioeconomic status and health. Past research on obesity in adolescence has focused on family measures of socioeconomic status, overlooking the role of individual-level nascent indicators of socioeconomic disadvantage. Using measured height and weight from nationally representative data from Brazil, we estimate sibling fixed effects models to examine the independent effects of nascent socioeconomic characteristics-school enrollment and work status-on adolescent overweight and obesity, accounting for unobserved genetic and environmental factors shared by siblings. Results show that school enrollment is associated with lower odds of overweight and obesity. Working is not significantly associated with overweight/obesity risk. However, adolescents not enrolled but working face the highest risk of overweight/obesity. Findings suggest that adolescents face added layers of disadvantage from being out of school, with important implications for the accumulation of health disadvantages.

Immigrant policies as health policies: State immigrant policy climates and health provider visits among U.S. immigrants.

The geographic dispersion of the U.S. immigrant population has occurred alongside a dramatic increase in state-level immigration laws that has unfolded unevenly across states, creating markedly different state immigrant policy climates. Although not all such laws are health-related, they have potential implications for immigrants' health care utilization. Using data from the 2014 Survey of Income and Program Participation, we leverage the geographic variation in the restrictiveness of state immigrant policy climates to examine the association between state-level immigrant policies and health provider visits-a fundamental indicator of health care utilization-among immigrant adults. Results indicate that restrictive immigrant policy climates exacerbate nativity gaps in health provider visits among working-age adults and, to a lesser extent, among older adults. Our findings suggest that even immigrant policies not directly related to health have consequences for immigrants' health care utilization.

Dietary Assimilation among Mexican Children in Immigrant Households: Code-switching and Healthy Eating across Social Institutions.

Immigrant health assimilation is often framed as a linear, individualistic process. Yet new assimilation theory and structural theories of health behavior imply variation in health assimilation as immigrants and their families interact with different US social institutions throughout the day. We test this idea by analyzing how two indicators of dietary assimilation-food acculturation and healthy eating-vary throughout the day as Mexican children in immigrant households consume food in different institutional settings. Using individual fixed-effects models and data from the National Health and Nutrition Examination Survey, we find that Mexican children in immigrant households (N = 2,337) engage in "dietary code-switching," eating more acculturated but not necessarily less healthy food in schools and more acculturated but less healthy food in restaurants compared to homes. Findings advance theory and knowledge about how social institutions condition dietary assimilation in particular and health assimilation more broadly.

Healthy Eating among Mexican Immigrants: Migration in Childhood and Time in the United States.

Past research on immigrant health frequently finds that the duration of time lived in the United States is associated with the erosion of immigrants' health advantages. However, the timing of U.S. migration during the life course is rarely explored. We draw from developmental and sociological perspectives to theorize how migration during childhood may be related to healthy eating among adult immigrants from Mexico. We test these ideas with a mechanism-based age-period-cohort model to disentangle age, age at arrival, and duration of residence. Results show that immigrants who arrived during preschool ages (2-5 years) and school ages (6-11 years) have less healthy diets than adult arrivals (25+ years). After accounting for age at arrival, duration of residence is positively related to healthy eating. Overall, the findings highlight the need to focus more research and policy interventions on child immigrants, who may be particularly susceptible to adopting unhealthy American behaviors during sensitive periods of childhood.

The Weight of Inequality: Socioeconomic Status and Adolescent Body Mass in Brazil.

The high rate of obesity among adolescents is a global public health problem that has recently expanded to affect middle- and low-income countries. Brazil, which is undergoing a relatively rapid nutrition transition and has inadequate health systems, is currently experiencing the consequences of increasing rates of overweight and obesity concomitantly with the consequences of generations of malnourishment. Given this scenario, Brazil is an ideal context for examining the relationship between family socioeconomic status (SES) and adolescent body mass, as well as how this relationship varies across very different regions within the same country and across the body mass index (BMI) continuum. Guided by a framework that integrates nutrition transition and fundamental cause theories, we use unique nationally representative data with measured height and weight for all household members to conduct quantile regression models. The results suggest that family socioeconomic conditions are important theoretical factors associated with adolescent BMI, but that the way in which family SES impinges on adolescent BMI varies across regions characterized by different locations in the nutrition transition and varying levels of economic development. We also find that family socioeconomic disadvantages operate very differently according to BMI status. The results show that the socioeconomic gradient of adolescent BMI varies by stages of the nutrition transition and economic development and across BMI percentiles.

Racial Inequality in Education in Brazil: A Twins Fixed-Effects Approach.

Racial disparities in education in Brazil (and elsewhere) are well documented. Because this research typically examines educational variation between individuals in different families, however, it cannot disentangle whether racial differences in education are due to racial discrimination or to structural differences in unobserved neighborhood and family characteristics. To address this common data limitation, we use an innovative within-family twin approach that takes advantage of the large sample of Brazilian adolescent twins classified as different races in the 1982 and 1987-2009 Pesquisa Nacional por Amostra de Domicílios. We first examine the contexts within which adolescent twins in the same family are labeled as different races to determine the characteristics of families crossing racial boundaries. Then, as a way to hold constant shared unobserved and observed neighborhood and family characteristics, we use twins fixed-effects models to assess whether racial disparities in education exist between twins and whether such disparities vary by gender. We find that even under this stringent test of racial inequality, the nonwhite educational disadvantage persists and is especially pronounced for nonwhite adolescent boys.

Generational status, neighborhood context, and mother-child resemblance in dietary quality in Mexican-origin families.

Children of immigrants in the United States often grow up in very different nutrition environments than their parents. As a result, parent-child concordance in diet may be particularly weak in immigrant families. Yet, little is known about parent-child dietary resemblance in immigrant families and how local contexts shape it. This study uses data from the 1999/2000-2009/2010 Continuous National Health and Nutrition Examination Survey to examine mother-child resemblance in dietary quality in Mexican-origin families in the United States. We investigate how immigrant generational status and neighborhood context shape the association between mothers' and children's dietary quality. We find that mother-child resemblance in dietary quality is weaker for first-generation children relative to third-generation children. However, residence in an immigrant enclave strengthens the mother-child association in dietary quality for first-generation children. Findings offer a unique within-family perspective of immigrant health. Results suggest that the healthy eating advantage of Mexican immigrant mothers may not be sustained across family generations and that Mexican immigrant mothers may face unique challenges in promoting healthy eating among their children.

Maternal age at first birth and adolescent education in Brazil.

BACKGROUND: Brazil has witnessed dramatic changes in its fertility patterns in recent decades. The decline to below-replacement fertility has been accompanied by increases in the proportion of children born to young mothers. Yet we know little about the well-being of children born to young mothers in Brazil. OBJECTIVE AND METHODS: Using data from the 2006 Pesquisa Nacional de Demografia e Saúde and a quasi-natural experimental approach, this study examines the implications of maternal age at first birth for the education of Brazilian adolescents. RESULTS: We find that being born to a young mother is associated with educational disadvantages in adolescence, but that these disadvantages are attenuated once we account for mothers' selection into early childbearing. We also find that, in southern Brazil, adolescents born to young mothers have poorer educational outcomes compared with their peers born to older mothers, but that in northern Brazil no such disparities exist. CONCLUSIONS: Adolescent educational disadvantages associated with being born to a young mother are not an artifact of selectivity, at least in southern Brazil. Regional variation in the effect of maternal age at first birth on adolescent education suggests the important role of the extended family and the father's presence as mechanisms through which disadvantages operate.

School stratification in new and established latino destinations.

The growth and geographic diversification of the school-age Latino population suggest that schools in areas that previously had very few Latinos now serve many of these students. This study uses the 1999-2000 Schools and Staffing Survey and the Education Longitudinal Study of 2002 to compare public high schools in new and established Latino destinations. We examine school composition, school quality indicators, instructional resources and access to advanced math courses. We find that schools in new destinations display more favorable educational contexts according to a number of measures, but offer fewer linguistic support services than schools in established destinations. We also find evidence of a within-school Latino-white gap in advanced math course taking in new destinations, suggesting greater educational stratification within schools in those areas.