摘要：Objectives. We examined the health status and patterns of health care use of children in US immigrant families. Methods. Data from the 1999 National Survey of America’s Families were used to create 3 subgroups of immigrant children: US-born children with noncitizen parents, foreign-born children who were naturalized US citizens, and foreign-born children with noncitizen parents. Chi-square and logistic regression analyses were used to examine relationships between immigrant status and health access variables. Subgroup analyses were conducted with low-income families. Results. Foreign-born noncitizen children were 4 times more likely than children from native families to lack health insurance coverage and to have not visited a mental health specialist in the preceding year. They were 40% and 80% more likely to have not visited a doctor or dentist in the previous year and twice as likely to lack a usual source of care. US-born children with noncitizen parents were also at a disadvantage in many of these aspects of care. Conclusions. We found that, overall, children from immigrant families were in worse physical health than children from non-immigrant families and used health care services at a significantly lower frequency. Children of immigrant families have become the fastest growing and most ethnically diverse segment of the US child population. The 1990 US census revealed that about 15% of all children living in the United States were immigrant children or children of immigrant parentage. 1 , 2 Despite studies showing lower overall mortality and morbidity risks among immigrant than US-born infants, children, and adults, 3 – 9 children in immigrant families have been shown to fare less favorably on certain measures of well-being such as parent-reported health status. 2 Child birthplace and parental birthplace also have been found to affect insurance status and access to preventive health and dental services among US children and adolescents. 10 , 11 In addition, children from immigrant households are more likely to live in poverty than children from non-immigrant households; a quarter of low-income children in the United States are members of immigrant families. 12 – 14 Also, most children living in immigrant households are members of minority groups, and thus they have reduced access to health care services compared with non-Hispanic White children. 15 – 17 Moreover, among poor families, the joint effects of foreign birthplace and lack of health insurance coverage have been associated with lack of a usual source of care. 18 – 20 Of the many health issues faced by immigrants, those related to health care access and insurance are the most challenging. 21 – 27 Studies have shown that low-income immigrants are twice as likely to be uninsured as low-income US citizens. 21 , 28 , 29 Programs such as Medicaid and the State Child Health Insurance Program (SCHIP) were created to ensure access to health care among low-income children and families. 22 However, immigrants’ access to public insurance has been affected by public policy, 21 and policies that bar public coverage among recent immigrants target a group that already has limited access to the health care system. 24 One of the basic eligibility criteria that Medicaid applicants must satisfy is citizenship or legal residency status, and uninsured immigrant children who entered the United States after August 22, 1996, are ineligible for insurance coverage under SCHIP programs. Even immigrant families whose children are eligible for public insurance programs may be reluctant to enroll their children because they fear that enrollment will lead to problems with the authorities and affect their ability to become naturalized citizens, sponsor relatives, and reenter or remain in the country. 25 , 30 , 31 In addition to lack of health insurance, children’s access to care may be limited by their parents’ knowledge and understanding of health care needs and resources, as well as language barriers. 32 – 35 Noncitizen adults experience greater problems in accessing health care than other groups, often because of increased language and cultural barriers. 36 These problems leave them less connected with the health care system. 18 , 37 Moreover, reduced use of preventive services and higher prevalences of psychosocial deficits have been reported among immigrant children. 10 , 38 , 39 The relationships between children’s well-being and various factors such as their parents’ immigrant status, racial/ethnic disparities, family income, and health care status and use are interwoven and complex. To our knowledge, no studies have examined the joint and independent contributions of all of these factors to health insurance coverage and health care access among children in immigrant families. Using data from the 1999 National Survey of America’s Families (NSAF), we examined health insurance status and patterns of health service use among immigrant children who were naturalized citizens, those who had been born in the United States but whose parents were not citizens, and those who, along with their parents, had been born outside the United States. In our analyses, we assessed the independent effects of immigrant status while controlling for children’s demographic and socioeconomic characteristics. We placed special emphasis on examining relationships between citizenship status, health status, demographic characteristics, and health care access and use among children from low-income families (i.e., those with incomes below 200% of the federal poverty line [FPL]).
