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.

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.

The Weight of Being Unauthorized? Legal Status Variation in the Association between US Exposure and Obesity among Hispanic Immigrants in Los Angeles.

We examine whether exposure to the US, experienced under certain conditions of disadvantage, namely immigrant legal status, is associated with body weight. Using the pooled, cross-sectional 2001 and 2008 Los Angeles Family and Neighborhood Survey (LAFANS) (n = 2063), we examine whether body mass index (BMI) and obesity vary by Hispanic immigrants' legal status and time exposure to the US. The increased risk of obesity associated with greater US exposure is more pronounced among unauthorized Hispanic immigrants compared to their legally resident coethnic peers, after adjusting for age and age-at-arrival. It is not only residing in the US that is associated with increases in body weight, but residing in the US as an unauthorized immigrant. Improved data and methods are needed to facilitate research of greater policy significance and a refined understanding of how health integration processes vary by legal status.

The Interaction and Impact of Social Support and Father Absence on Breastfeeding.

Background: Behaviors related to early childhood nutrition are influenced by a mother's social environment. In many low- and middle-income countries, breastfeeding rates have steadily declined. At the same time, many communities have a history of domestic or international migration that affects the family support systems for women and children remaining in these communities. While social support has been shown to be important to health behaviors conducive to maternal and child health, scant research examines whether social support moderates the impact of an absent father on breastfeeding. Objective: We aim to assess the relationship between father absence and breastfeeding duration and test whether social support moderates the impact of father absence on breastfeeding duration. Methods: We use data from the Social Networks and Health Information Survey (n = 292), a random household survey conducted in a municipality in Guanajuato, Mexico, to estimate Poisson regression models of breastfeeding duration. Results: In multivariate models, an absent father is negatively associated with breastfeeding, whereas social support is positively associated. A significant and positive interaction between father absence and social support suggests that at high levels of support, breastfeeding duration for women with absent fathers does not appear to be meaningfully different from women with present fathers. This suggests that receiving high levels of social support during pregnancy may mitigate the absence of the child's father. Conclusions: Social support interventions for mothers of infants should target mothers and children in households without a father. More research should also be directed at understanding how social support processes during pregnancy can affect breastfeeding in other low- and middle-income countries with high rates of emigration.

Depressive symptoms among mothers with young children-the role of family migration and social networks in Mexico.

BACKGROUND: Women who remain in migratory sending communities as their family members migrate internationally are at risk for depression. Limited research examines the association between the number of absent household members and a woman's mental health. AIMS: This study examines the association between residing in a migrant household and depressive symptoms for women in Mexico while accounting for social networks and social support. METHODS: Logistic regression analysis was employed using the Social Networks and Health Information Survey (SNHIS) (n = 320), a random household survey conducted in a medium-sized municipality in Guanajuato, Mexico. RESULTS: Multivariate results suggest that residing in a household with two or more migrants was associated with increased odds of depressive symptoms, while having immediate kin in the community reduced the odds of depressive symptoms. Social relationships in the community and social support were associated with reduced odds of depressive symptoms. Their inclusion in the models reduced the significance of but did not significantly mediate the association between residing in a household with multiple migrants and depressive symptoms. CONCLUSIONS: Services aimed at improving women's health should target women who reside in households with multiple migrants and focus on reducing the stress and mental health impacts associated with these relationships.

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.

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.

Disability, food insecurity by nativity, citizenship, and duration.

Prior research examines the prevalence of either disability or food insecurity among immigrants. We examine whether the presence of a disability operates as a stronger predictor of food insecurity among prime-aged immigrants relative to the US-born. Probit models estimate the relationship of disability with food insecurity among immigrants and distinguish by duration of US residence and citizenship status using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2014. Descriptively, food insecurity was highest among non-citizen immigrants with longer durations of US residence, compared to non-citizen immigrants with shorter durations and naturalized immigrants. Multivariate results suggest that among Hispanics, the association between disability and food insecurity was stronger among immigrants compared to US-born adults; the disability-food insecurity association varied by an immigrant's duration of US residence and citizenship status. The results emphasize the importance of disaggregating by citizenship status and duration of US residence.

Food insecurity and disability in the United States.

BACKGROUND: Households with a disabled adult are disproportionately food insecure, yet the mechanisms linking food insecurity to disability are under-specified. OBJECTIVE: To develop and empirically examine a model of the potential pathways connecting specific types of disability with food insecurity. METHODS: With pooled, repeated cross-sectional National Health and Nutrition Examination Survey data (1999-2014) including 38,354 participants, we ran probit models to estimate the probability of being food insecure as a function of different sets of disability measures and our control variables. We explored the extent to which these patterns differed for prime-aged individuals (19-59) from those age 60 and older. RESULTS: Work-limiting disabilities, functional limitations, and trouble managing money were associated with an increased likelihood of food insecurity for both prime-aged and older individuals, net of other forms of disability. Mobility limitations, trouble seeing, and trouble hearing increased the likelihood of food insecurity for prime-aged individuals only. CONCLUSION: These findings suggest that disabilities are associated with food insecurity through multiple pathways. Revised public health and policy solutions are needed to address the high rates of food insecurity among those with disabilities.

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.

Gender, migration and perceptions of HIV risk in Mexico.

This study examines the role that duty plays in men's and women's perceptions of HIV-related risk in Mexico, and how gender and migration influence these perceptions. We draw on qualitative data from the 2014 Study of Health and Migration in Mexico (SHMM), which included 24 in-depth interviews with migrant men and non-migrant women living in a medium-sized city in Guanajuato, Mexico. While men report migrating out of responsibility to provide for their families, this sense of duty also had implications for their sexual health behaviours. Duty permeates how residents in this migrant-sending community described their perceptions of HIV risk, with men and women drawing consistently on three aspects of duty: fidelity, gendered sexual expectations, and the burden of HIV prevention. We argue that a strong sense of duty can prompt gender role expansion for migrant men and limit gender role expansion for non-migrant women.

Father Absence, Social Networks, and Maternal Ratings of Child Health: Evidence from the 2013 Social Networks and Health Information Survey in Mexico.

Objectives To bridge the literature on the effect of father absence, international migration, and social networks on child health, we assess the association between father absence and maternal ratings of child poor health (MCPH). Next we test whether social networks of immediate and extended kin mediate the relationship between fathers' absence and MCPH. Methods Nested logistic regression models predicting MCPH are estimated using the 2013 Social Networks and Health Information Survey, collected in a migrant-sending community in Guanajuato, Mexico. These unique data distinguish among father absence due to migration versus other reasons and between immediate and extended kin ties. Results Descriptive results indicate that 25% of children with migrant fathers are assessed as having poor health, more often than children with present (15.5%) or otherwise absent fathers (17.5%). In the multivariate models, fathers' absence is not predictive of MCPH. However, the presence of extended kin ties for the mother was associated with approximately a 50% reduction in the odds of MCPH. Additionally, mother's poor self-assessed health was associated with increased odds of MCPH while the presence of a co-resident adult lowered the odds of MCPH. In sensitivity analysis among children with migrant fathers, the receipt of paternal remittances lowered the odds of MCPH. Conclusions for Practice Social networks have a direct and positive association with MCPH rather than mediating the father absence-MCPH relationship. The presence of extended kin ties in the local community is salient for more favorable child health and should be considered in public health interventions aimed at improving child health.

The mental well-being of Central American transmigrant men in Mexico.

To understand the mental health status of Central American migrant men travelling through Mexico to the U.S., we analysed the association between migration-related circumstances/stressors and psychological disorders. In-person interviews and a psychiatric assessment were conducted in 2010 and 2014 with 360 primarily Honduran transmigrant young adult males. The interviews were conducted at three Casas del Migrante (or migrant safe houses) in the migration-corridor cities of Monterrey, and Guadalupe, Nuevo Leon; and Saltillo, Coahuila. The results indicated high levels of migration-related stressors including abuse and a high prevalence of major depressive episodes (MDEs), alcohol dependency, and alcohol abuse. Nested logistic regression models were used to separately predict MDEs, alcohol dependency, and alcohol abuse, assessing their association with migration experiences and socio-demographic characteristics. Logistic regression models showed that characteristics surrounding migration (experiencing abuse, migration duration, and attempts) are predictive of depression. Alcohol dependency and abuse were both associated with marital status and having family/friends in the intended U.S. destination, while the number of migration attempts also predicted alcohol dependency. The results provide needed information on the association between transit migration through Mexico to the U.S. among unauthorised Central American men and major depressive disorder and alcohol abuse and dependency.

Becoming Overweight Without Gaining a Pound: Weight Evaluations and the Social Integration of Mexicans in the United States.

Mexican women gain weight with increasing duration in the United States. In the United States, body dissatisfaction tends to be associated with depression, disordered eating, and incongruent weight evaluations, particularly among white women and women of higher socioeconomic status. However, it remains unclear how overweight and obesity is interpreted by Mexican women. Using comparable data of women ages 20-64 from both Mexico (the 2006 Encuesta Nacional de Salud y Nutricion; N=17,012) and the United States (the 1999-2009 National Health and Nutrition Examination Surveys; N=8,487), we compare weight status evaluations among Mexican nationals, Mexican immigrants, U.S.-born Mexicans, U.S.-born non-Hispanic Whites, and U.S.-born non-Hispanic blacks. Logistic regression analyses, which control for demographic and social-economic variables and measured body mass index and adjust for the likelihood of migration for Mexican nationals, indicate that the tendency to self-evaluate as overweight among Mexicans converges with levels among non-Hispanic whites and diverges from blacks over time in the United States. Overall, the results suggest a U.S. integration process in which Mexican-American women's less critical self-evaluations originate in Mexico but fade with time in the United States as they gradually adopt U.S. white norms for thinner body sizes. These results are discussed in light of social comparison and negative health assimilation.

Gambling with life: Masculinity, risk, and danger in the lives of unauthorized migrant roofers.

BACKGROUND: This paper examines the occupational experiences of unauthorized immigrants employed in one of the most dangerous occupations in the United States: roofing. METHODS: We draw on 40 in-depth interviews with return migrants in Guanajuato, Mexico, to examine how the adoption of masculinity, dangerous working conditions, the labor market structure, and absence of legal status exacerbates injuries for unauthorized roofers. FINDINGS: Undocumented men return to Mexico injured with chronic pain, health complications, and trauma. We find that men "do gender" that is adopt masculine beliefs, when they skirt safety practices, police each other's behaviors, withhold their emotions, experience heightened stress, and engage in poor health behaviors. It is a combination of dangerous working conditions, economic insecurity, and men seeking to fulfill their masculine roles that all combine to create unsafe working conditions and lead to injuries.

What Does Self-rated Health Mean? Changes and Variations in the Association of Obesity with Objective and Subjective Components Of Self-rated Health.

There are concerns about the meaning of self-rated health (SRH) and the factors individuals consider. To illustrate how SRH is contextualized, we examine how the obesity-SRH association varies across age, periods, and cohorts. We decompose SRH into subjective and objective components and use a mechanism-based age-period-cohort model approach with four decades (1970s to 2000s) and five birth cohorts of National Health and Nutrition Examination Survey data (N = 26,184). Obese adults rate their health more negatively than non-obese when using overall SRH with little variation by age, period, or cohort. However, when we decomposed SRH into objective and subjective components, the obesity gap widened with increasing age in objective SRH but narrowed in subjective SRH. Additionally, the gap narrowed for more recently born cohorts for objective SRH but widened for subjective SRH. The results provide indirect evidence that the relationship between obesity and SRH is socially patterned according to exposure to information about obesity and the availability of resources to manage it.

Maternal ratings of child health and child obesity, variations by mother's race/ethnicity and nativity.

We examined whether indicators of child health, focusing on obesity, are associated with maternal ratings of child health (MRCH) and its variation by mother's ethnicity/nativity, focusing on Hispanics. The early childhood longitudinal study, kindergarten cohort kindergarten-eighth grade waves (n = 48,814) and nested general linear mixed modeling are used to examine excellent MRCH. The only indicator of child health that varies by mother's ethnicity/nativity for MRCH is child obesity. Child obesity did not influence MRCH for foreign-born Hispanic mothers, especially among less acculturated mothers, though significant differences among immigrants by acculturation were not found. However, among native-born white, black, and Hispanic mothers child obesity was associated with a lower likelihood of excellent MRCH even after controls for socioeconomic characteristics, family characteristics, and other indicators of child health are included. MRCH reflect not only child's actual health, but also the mother's perception of what contributes to poor child health. Our findings suggest that less acculturated foreign-born Hispanic mothers are less likely to associate child obesity with poor child health. Cultural orientations that prefer heavier children or are unlikely to associate child obesity with poor child health may contribute to the higher levels of obesity found among their children.

Migrant youth's emerging dietary patterns in Haiti: the role of peer social engagement.

OBJECTIVE: The present study examines whether rural-to-urban migrant youth consume a greater diversity of high-sugar beverages and fried snacks (HSBFS) compared with their peers who remain in rural areas. It also tests whether the association between migration and HSBFS diversity is moderated by migrant youth's social engagement with their peers. DESIGN: Participants were recruited in August and September 2011 following the completion of primary school (6th grade) and shortly before many rural youth migrate to urban areas. Participants were re-interviewed six months later. HSBFS diversity was assessed at follow-up; analyses control for baseline and follow-up characteristics. SETTING: Baseline interviews occurred in rural Southeast Haiti. Follow-up interviews of migrants occurred at urban destinations in Haiti. SUBJECTS: The sample includes 215 youth (mean age 15.9 years; 43.3 % female; 21.9 % rural-to-urban migrants) who were interviewed at baseline and follow-up. RESULTS: Rural-to-urban migrant youth consumed a greater diversity of HSBFS products at follow-up than their rural counterparts (b=0.70, P≤0.05). Moreover, we found that this relationship varied by level of peer social engagement. Youth who migrated and had a high degree of peer social engagement consumed 2.2 additional types of HSBFS products daily than their counterparts who remained in rural areas and had low peer social engagement. CONCLUSIONS: Higher HSBFS diversity among migrant youth is consistent with the patterns proposed by the nutrition transition. Interactions with peers may have an important influence as migrant youth adopt new dietary preferences. Emerging dietary patterns among youth migrants have important implications for health trajectories and the development of degenerative diseases.

Using Discrete-time Event History Fertility Models to Simulate Total Fertility Rates and Other Fertility Measures.

Event history models, also known as hazard models, are commonly used in analyses of fertility. One drawback of event history models is that the conditional probabilities (hazards) estimated by event history models do not readily translate into summary measures, particularly for models of repeatable events, like childbirth. In this paper, we describe how to translate the results of discrete-time event history models of all births into well-known summary fertility measures: simulated age- and parity-specific fertility rates, parity progression ratios (PPRs), and the total fertility rate (TFR). The method incorporates all birth intervals, but permits the hazard functions to vary across parities. It also can simulate values for groups defined by both fixed and time-varying covariates, such as marital or employment life histories. We demonstrate the method using an example from the National Survey of Family Growth (NSFG) and provide an accompanying data file and Stata program.