Association for Public Policy Analysis & Management

Background:

Following the national trend, the proportions of children of immigrants residing in cohabiting and single parent families increase as immigrant generation increases. However, there is only limited knowledge about the role of family structures on health outcomes among children of immigrants. The lack of information is of concern because family arrangements may be particularly important to immigrants since immigrant families tend to be highly interdependent and rely on family cohesion as a response to immigrant challenges, such as linguistic barriers, poverty, limited access to resources, discrimination, and anti-immigrant sentiment. Thus, not having full parental human and financial resources due to absence of a parent or unstable parental involvement may indicate a less successful defense mechanism against the challenges for children which makes children more vulnerable to poor health outcomes. To this end, as the first study, this study investigates the association between family structure and health outcomes among children of immigrants driven by Andersen’s behavioral model.

Method:

This study uses the National Health Interview Survey (NHIS) data between 2010-2014 following the implementation of the ACA. The health outcomes include children’s general health status, chronic (overweight/obesity and asthma), and acute (injury and cold/flu) illnesses, all in a dichotomous variable form. The study’s predictor is a categorical variable with nine categories, which is constructed based on the combination of family structure (married, cohabiting, and single parent families) and immigrant generation (US-born natives, 2^nd generation, and 1^st generation). The final sample for the present study contains 55,152 children ages 0-17 who had at least one parent and whose information for all measures were available for the analyses. Analyses for the overweight/obesity outcome are based on a sub-sample of 11,377 children due to available data on children’s height and weight measures in the NHIS. This study employs logistic multivariate model to estimate the association between family structure-immigrant generation predictor and the child health outcomes controlling for predisposing, enabling, and need factors as covariates.

Results:

After controlling for multiple covariates, 2^nd generation children of single parent families had a higher risk of being in poor or fair health status (p<0.0001), and 2^nd generation children of cohabiting parent families had a higher prevalence of being overweight or obese (p<0.01) compared to native children of married parent families. At the same time, most of children of immigrants across family structure and generation had lower risk of having asthma, cold/flu, and injuries compared to native children of married parent families.

Conclusion:

The findings based on a wide range of health indicators suggest that family structure is an important health and disease determinant among children of immigrants, and 2^nd generation children in single and cohabiting parent family structures are particularly vulnerable to negative health outcomes. Strong patterns emerged indicating that children of immigrants tend to have low prevalence of having health outcomes (asthma, cold/flu, and injuries) that commonly require a diagnosis by physicians or visits to healthcare sites. The findings could serve as the basis for setting up national health objectives for different immigrant groups, informing policy.