Mexican immigrants and the utilization of U.S. health services: the case of San Diego

This paper examines survey data gathered from 2103 Mexican immigrants living or working in San Diego County, California, in order to explore four fundamental questions concerning the utilization of health services: (a) What type of health services do Mexican immigrants use? (b) When hospitals are used, do they tend to be emergency room services? (c) Do Mexican immigrants use preventive services? (d) To what extent do the utilization patterns of undocumented immigrants differ from their legally-immigrated counterparts? The socioeconomic profile of the sample is characterized through analysis of variables such as sex, age, length of residence in the U.S., occupation and income. Mexican immigrants, particularly the undocumented, are relatively young compared to the non-immigrant population, of short duration in the U.S. and earn low income. In addition, undocumented and legally-immigrated respondents are covered by medical insurance at rates far below the general population. Mexican immigrants, including the undocumented, use a variety of health services. Hospital services are not the primary source of care. However, when undocumented respondents did use hospital services, they were more likely to use emergency room care than their legally-immigrated counterparts, who were more likely to use out-patient services. Finally, undocumented respondents tended to neglect preventive services as evidenced by examination of the use of pre-natal care, general check-ups and dental services.     

Health care use among undocumented Latino immigrants

Using data from a 1996/1997 survey of undocumented Latino immigrants in four sites, we examine reasons for coming to the United States, use of health care services, and participation in government programs. We find that undocumented Latinos come to this country primarily for jobs. Their ambulatory health care use is low compared with that of all Latinos and all persons nationally, and their rates of hospitalization are comparable except for hospitalization for childbirth. Almost half of married undocumented Latinos have a child who is a U.S. citizen. Excluding undocumented immigrants from receiving government-funded health care services is unlikely to reduce the level of immigration and likely to affect the well-being of children who are U.S. citizens living in immigrant households.     

Variations in Healthcare Access and Utilization Among Mexican Immigrants: The Role of Documentation Status

The objective of this study is to identify differences in healthcare access and utilization among Mexican immigrants by documentation status. Cross-sectional survey data are analyzed to identify differences in healthcare access and utilization across Mexican immigrant categories. Multivariable logistic regression and the Blinder-Oaxaca decomposition are used to parse out differences into observed and unobserved components. Mexican immigrants ages 18 and above who are immigrants of California households and responded to the 2007 California Health Interview Survey (2,600 documented and 1,038 undocumented immigrants). Undocumented immigrants from Mexico are 27% less likely to have a doctor visit in the previous year and 35% less likely to have a usual source of care compared to documented Mexican immigrants after controlling for confounding variables. Approximately 88% of these disparities can be attributed to predisposing, enabling and need determinants in our model. The remaining disparities are attributed to unobserved heterogeneity. This study shows that undocumented immigrants from Mexico are much less likely to have a physician visit in the previous year and a usual source of care compared to documented immigrants from Mexico. The recently approved Patient Protection and Affordable Care Act will not reduce these disparities unless undocumented immigrants are granted some form of legal status.     

National farmworker database: establishing a farmworker cohort for epidemiologic research.

BACKGROUND: There is little research into the long-term health effects of pesticides and other agricultural exposures among seasonal and migrant farmworkers in the United States. We present results of a feasibility study that established a cohort of farmworkers for use in epidemiologic research. METHODS: Subjects consisted of migrant and seasonal farmworkers who joined the cohort while seeking social services through members of the Association of Farmworker Opportunity Programs (AFOP) and were entered in the National Farmworker Database (NFD) between the end of 1997 and March 1999. We designed an add-on interview with information that enhanced the utility of the database for epidemiologic research. RESULTS: We recruited and obtained basic demographic and employment information on 5,597 farmworkers at very modest cost and effort. Subjects were mostly seasonal (61.5%), female (56.7%), and Hispanic (67.4%), with a median age of 27. Most (62.6%) had not completed high school; almost all (99.1%) reported being U.S. citizens or permanent residents, an eligibility requirement for some of the services provided by AFOP. The majority (62.5%) had engaged in farmwork for less than 10 years, but had performed a wide variety of tasks on different crops, including row crops and tree fruits. Picking was the most common task reported. Most subjects had performed farmwork in Florida, North Carolina, Texas, Michigan, or Georgia. For usual source of health care, 63.7% reported use of U.S. hospitals or emergency rooms/clinics, 42.0% U.S. private physicians, and 29.7% migrant health clinics. Among subjects reporting a prior diagnosis of cancer, primary sources of health care for treatment of that cancer included U.S. private physicians (61.9%), U.S. hospitals or emergency rooms/clinics (23.8%), and migrant health clinics (10.5%). CONCLUSIONS: Results suggest that by adding a brief interview to the existing NFD data collection process, which was designed for other purposes, it is feasible to create an efficient tool for conducting longitudinal epidemiologic research among farmworkers.     

Physical and mental health characteristics of U.S.- and foreign-born adults: United States, 1998-2003

OBJECTIVE: This report presents national prevalence estimates of selected measures of physical health status and limitations, health care access and utilization, and mental health status among the civilian noninstitutionalized population of U.S.- and foreign-born adults aged 18 years and over in four race-ethnicity groups in the United States. METHODS: The estimates in this report were derived from the Family Core and Sample Adult components of the 1998-2003 National Health Interview Surveys, conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Estimates were generated and comparisons conducted using the SUDAAN statistical package to account for the complex survey sample design. Data were age adjusted to the 2000 U.S. standard population. RESULTS: In general, the foreign-born population was younger, less likely to have a high school diploma, more likely to be poor, heavily concentrated in the central cities of metropolitan areas, and more likely to live in large families, compared with their U.S.-born counterparts. Hispanic immigrants were the least likely to have health insurance or to have a usual source of health care compared with other immigrant groups. Non-Hispanic black and Hispanic adults, regardless of nativity, were more likely to be obese than non-Hispanic white and non-Hispanic Asian adults. However, non-Hispanic black and Hispanic immigrant adults were significantly less likely to be obese than their U.S.-born counterparts. Hispanic immigrants were more likely to be obese the longer they lived in the United States. Foreign-born nonHispanic black and Hispanic immigrant adults experienced fewer symptoms of serious psychological distress compared with their U.S.-born counterparts. CONCLUSIONS: There are significant differences in physical health status and mental health status among U.S.-born and foreign-born adults. Foreign-born adults enjoy considerable advantages over their U.S.-born counterparts for many health measures despite limited access to health care and unfavorable sociodemographic characteristics. Differences in the impact of length of stay in the United States on immigrant health suggest that the role of acculturation in understanding immigrant health is complex and may differ for various race/ethnicity groups.     

Changing SNAP-Participation Trends Among Farmworker Households in the U.S., 2003–2012

We investigated Supplemental Nutrition Assistance Program (SNAP) participation among citizen, documented and undocumented immigrant hired crop farmworkers for ten recent years. We analyzed population representative data from the National Agricultural Workers Survey for 2003–2012 (N?=?18,243 households). Time-chart, simple mean differences, and logistic regressions described farmworker household participation in SNAP. The 2008 financial crisis almost doubled SNAP-participation by agriculture households (6.5% in 2003–2007 vs. 11.3% in 2008–2012). The increasing SNAP-participation was found for citizen, documented and undocumented immigrant households. We found low participation among documented (OR 0.67, 95% CI 0.56–0.8) and undocumented immigrants (OR 0.63, 95% CI 0.54–0.74) compared to citizens. Low odds ratios (OR 0.70, 95% CI 0.55–0.89) were found for Hispanic-citizens as compared with non-Hispanic white-citizens. Our results may help inform the debate surrounding the effects of the financial crisis on SNAP-participation and on differences in participation among citizens, immigrants, Hispanics and non-Hispanics, the latter suggesting ethnic farmworker disparities in SNAP-participation.     

Health status and health care utilization among New York City home attendants: an illustration of the needs of working poor, immigrant women.

In this paper, the health needs and health care utilization patterns of home attendants and their families have been studied as an illustration of those likely to be found among working poor, immigrant women and their children. Despite tremendous growth in the number of immigrants, studies to date provide only limited information regarding the specific health needs and patterns of health care utilization among such women and their children. As part of a longitudinal study on the impact of insurance on health status and health care utilization, 387 female, immigrant home attendants were interviewed. Data were also gathered on 355 of their minor children. These women and children were found to be less likely than other Americans to make use of basic health services, despite the fact that they are more likely to indicate fair or poor health status. This is true even in comparison to poor or uninsured Americans. Immigrant attendants in fair or poor health report an average annual visit rate of 4.1 ambulatory care visits for themselves and 2.2 for their children, as compared to 8.4 for poor adults and 4.4 for poor children in national samples. These findings illustrate the likelihood that poor, immigrant women make limited use of American medical care, and face barriers to health care that appear even greater than those faced by the uninsured and the poor.     

Undocumented immigrants and their use of medical services in Orange County, California

Does an undocumented immigration status predict the use of medical services? To explore this question, this paper examines medical care utilization of undocumented Latino immigrants compared to Latino legal immigrants and citizens, and non-Latino whites in Orange County, California. Data were collected through a random sample telephone survey of 805 Latinos and 396 non-Hispanic whites between January 4 and January 30, 2006. Findings show that undocumented immigrants had relatively low incomes and were less likely to have medical insurance; experience a number of stresses in their lives; and underutilize medical services when compared to legal immigrants and citizens. Predictors of use of medical services are found to include undocumented immigration status, medical insurance, education, and gender. Undocumented Latinos were found to use medical services less than legal immigrants and citizens, and to rely more on clinic-based care when they do seek medical services.     

Parental Immigration Status is Associated with Children’s Health Care Utilization: Findings from the 2003 New Immigrant Survey of US Legal Permanent Residents

Our objective was to examine the association between parental immigration status and child health and health care utilization. Using data from a national sample of immigrant adults who had recently become legal permanent residents (LPR), children (n = 2,170) were categorized according to their parents’ immigration status prior to LPR: legalized, mixed-status, refugee, temporary resident, or undocumented. Logistic regression with generalized estimating equations was used to compare child health and health care utilization by parental immigration status over the prior 12 months. Nearly all children in the sample were reported to be in good to excellent health. Children whose parents had been undocumented were least likely to have had an illness that was reported to have required medical attention (5.4 %). Children whose parents had been either undocumented or temporary residents were most likely to have a delayed preventive annual exam (18.2 and 18.7 %, respectively). Delayed dental care was most common among children whose parents had come to the US as refugees (29.1 %). Differences in the preventive annual exam remained significant after adjusting for socioeconomic characteristics. Parental immigration status before LPR was not associated with large differences in reported child health status. Parental immigration status before LPR was associated with the use of preventive annual exams and dental services. However, no group of children was consistently disadvantaged with respect to all measures.     

Immigration legal status and use of public programs and prenatal care

This study assessed impacts of immigrants' legal status on utilization of prenatal care and public programs by non-citizen women. Interviews and chart reviews of 171 women were conducted less than 48 hours after delivery at an urban hospital. Among non-citizens, 67% were legally documented. No differences in prenatal care adequacy by legal status were detected among non-citizens, who as a group had less health insurance, worse socioeconomics, and less program use compared to U.S. citizens. Non-citizens also were less aware of newborn's citizenship and eligibility for public programs and benefits. Non-citizens utilized fewer programs while reporting greater economic hardship than citizens; however, non-citizens selectively used programs important for pregnancy. Given changes in eligibility for federal programs and high rates of reported food insecurity and socioeconomic hardship among non-citizens, monitoring for adverse effects on utilization of prenatal care and birth outcomes is needed.     

Giving birth across the border: the San Diego-Tijuana connection.

Large immigration flows of young Mexican women to the U.S.-Mexico border are increasing the demand for maternity services in the Southwest. To date no attempt has been made to determine how U.S. births are distributed among stable, permanent residents and transient migrants, such as border residents of Mexico who enter the U.S. temporarily, yet long enough to use health services. This exploratory study examines factors associated with childbirth in California by border residents of Tijuana, Mexico. Data on 184 women, 15-44 years old, who gave birth between 1982-87, were examined using a household survey and focus group discussions. The findings indicate that 10.4% of the sample crossed the border to give birth in the United States. Socio-economic and legal status, spoken English proficiency, history of U.S. residency, annual visits across the border, single parenthood and primiparity were factors significantly associated with childbirth in the United States. These factors, in addition to social class differentials in attitudes towards U.S. obstetrical care and citizenship-by-birth need to be examined in future studies of cross-border utilization of services. The findings also demonstrate that most U.S. deliveries were in the private sector and paid for out of pocket, representing a very low public health burden. Changes in Medicaid legislation, which have extended maternity care coverage to the undocumented, may encourage deliveries in the public sector. These effects, coupled with the bridging effects that newly legalized immigrant networks exert on friends and relatives, familiarizing them with U.S. health care resources, will require monitoring to determine changes in demand for U.S. maternity care by this population.     

Health Status and Health Care Utilization Among New York City Home Attendants: An Illustration of the Needs of Working Poor,Immigrant Women

In this paper, the health needs and health care utilization patterns of home attendants and their families have been studied as an illustration of those likely to be found among working poor, immigrant women and their children. Despite tremendous growth in the number of immigrants, studies to date provide only limited information regarding the specific health needs and patterns of health care utilization among such women and their children. As part of a longitudinal study on the impact of insurance on health status and health care utilization, 387 female, immigrant home attendants were interviewed. Data were also gathered on 355 of their minor children. These women and children were found to be less likely than other Americans to make use of basic health services, despite the fact that they are more likely to indicate fair or poor health status. This is true even in comparison to poor or uninsured Americans. Immigrant attendants in fair or poor health report an average annual visit rate of 4.1 ambulatory care visits for themselves and 2.2 for their children, as compared to 8.4 for poor adults and 4.4 for poor children in national samples. These findings illustrate the likelihood that poor, immigrant women make limited use of American medical care, and face barriers to health care that appear even greater than those faced by the uninsured and the poor.     

Accessing Primary Care: HIV+ Caribbean Immigrants in the Bronx

This article describes an ecology of health seeking behavior among Bronx residing HIV+ Caribbean immigrants participating in an arm of a U.S. government-funded multi-site evaluation of peer services in the utilization of HIV primary care. Standardized repeat measures were administered at baseline and three four-month intervals. Clinical markers were obtained through medical chart review. Additionally, local data included ethnographic interviews, focus groups, and progress notes. Clinical outcomes were positive for the 55 subjects, 23 of whom were undocumented. Alienation from family, women’s vulnerability to family violence, and difficulties with disclosure, employment, and health care were compounded by undocumented immigration status. Retention was encouraged by the community based site, high levels of peer interaction, and supportive services. Without consideration of broader contexts, peer driven interventions are potentially limited and the realities of immigrant health care are misunderstood through lack of recognition of competing needs.     

Access to Preventive Services for Adults of Mexican Origin

Immigrants arrive in the U.S. with better than average health, which declines over time. Clinical preventive services can prevent or delay some of that decline, but little research in this area focuses specifically on Mexican immigrants who are the largest contemporary immigrant group. This article finds that recent Mexican immigrants were the least likely to receive preventive care services, even after adjusting for sociodemographic differences in the population. Long-stay Mexican immigrants were more similar to U.S.-born Mexican Americans in preventive service use rates, who in turn had lower rates than U.S.-born non-Latino whites. Monolingual Spanish speaking Mexican immigrants were the least likely to have obtained preventive services. Having no usual source of care is the strongest predictor of the underuse. The persistent gap in preventive services across all subgroups of adults of Mexican origin suggests structural barriers to their preventive care.     

Self care: Japan and the U.S. compared.

Experience of common symptoms and subsequent self care behaviors among older adults are compared between Japan and the United States, two industrial countries with different cultural backgrounds and health insurance systems. Based on a modification of the Health Belief Model, perceived susceptibility to illness and belief in the efficacy of physician care were selected as major explanatory concepts for the decision to use self care for a complaint. Among 900 respondents in Japan and 728 in the United States, in three communities of varying size, self evaluations of good health, an indicator of low susceptibility, were very similar. Although Japanese respondents claimed fewer experiences of physician error, they still expressed lower preference for physician care than did those in the U.S. In addition, the Japanese reported far fewer symptoms than their U.S. counterparts during a three month period, and were more likely to use self care, even for symptoms they considered more serious. Disparate effects of such variables as good health behaviors, presence of a chronic condition and desire for autonomy are discussed in terms of cultural differences in the two countries.     

Health characteristics and utilization of public sector health facilities among migrant agricultural workers in Orange County, New York

Publicly subsidized medical clinics were established to provide migrant farmworkers with minimal access to mainstream medical care. Nevertheless, migrant farmworkers delay treatment of health problems and refrain totally from use of medical facilities. The present study explores the health status and utilization of subsidized migrant clinics by farmworkers in a vegetable production county (Orange County) in upstate New York. Multivariate analysis indicated that economic resources, mental health status, health insurance coverage, language, education and utilization of acute care facilities are important predictors of these decisions.     

Associations of Poor Housing with Mental Health Among North Carolina Latino Migrant Farmworkers

This analysis examines the associations of housing conditions with mental health among migrant farmworkers. Data are from a 2010 cross-sectional study conducted in 16 North Carolina counties. Interviews and housing inspections were completed with 371 farmworkers in 186 camps. Mental health measures included depression (Center for Epidemiologic Studies Depression Scale, CES-D), anxiety (Personality Assessment Inventory, PAI), and alcohol misuse (Alcohol Use Disorders Identification Test, AUDIT-C). Housing measures were number of people per sleeping room, perceived security of self and belongings, having a key to dwelling’s door, having bedroom storage, toilet privacy issues, and number of housing regulation violations. Sixty (16.7%) participants had substantial depressive symptoms (CES-D ≥10), 31 (8.8%) had substantial anxiety (PAI ≥27), and 185 (50.1%) had the potential for alcohol misuse (AUDIT-C ≥4). Those with 5+ persons sleeping per room were more likely to have a depression score ≥10 (31.5% vs. 13–14%, P = .01) and an anxiety scores ≥27 (19.6% vs. 5–9%, P = .02). Those who did not feel they or their belongings were secure were more likely to have a depression score ≥10 (19.4% vs. 9.1%, P = .01). Those without a key were more likely to have an anxiety score ≥27 (11.5% vs. 5.1%, P = .04). Those with no bedroom storage were more likely to have a depression score ≥10 (28.9% vs. 14.9%, P = .03). This article suggests links between poor housing and farmworkers’ mental health. These results inform regulations surrounding farmworker housing and inform health care providers on how to prevent and treat poor mental health among migrant farmworkers.     

Participation in the Women,Infants, and Children (WIC) Program as Reported by Documented and Undocumented Farm Worker Adults in the Households

ABSTRACT

Debate surrounds the provision of Women, Infants, and Children (WIC) benefits to undocumented immigrants. Few studies are available to estimate use of WIC services by documented and undocumented households using nationally representative data. The authors analyzed data from the National Agricultural Workers Survey (NAWS) annual cross-sections from 1993 through 2009 (N = 40,896 person-years). Household documentation status is defined by the status of the adults in the household, not children. Simple mean differences, logistic regressions, and time charts described household participation in WIC over 2-year intervals. Without adjustments for covariates, 10.7% of undocumented farm workers’ households and 12.4% of documented households received WIC benefits, yielding an odds ratio of 0.84 (95% confidence interval [CI]: 0.76–0.94). Logistic regressions revealed that for the same number of children in the household, participation by undocumented persons was higher than participation by documented persons. Time charts and logistic regressions with interaction terms showed a stronger correspondence between participation in WIC and number of children <6 years old in undocumented households than documented households. Undocumented farm workers’ households were only a little less likely to participate in WIC than documented farm workers’ households, and undocumented households’ participation was especially responsive to the presence of children. These results are consistent with the legal requirements for WIC participation, which do not distinguish between documented and undocumented households. These results may be helpful in the debate surrounding the effects of undocumented workers on WIC participation and costs.