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State-Level Immigrant Policy Climates and Health Care Among U.S. Children of Immigrants

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Using a sample of 29,515 children from Wave 1 of the 2014 and 2018 Survey of Income and Program Participation, we examine the association between state-level immigrant policy climates and two dimensions of health care among children of immigrants: health insurance coverage and health provider visits. We find a negative association between state immigrant policy restrictiveness and health care use among first-generation children (i.e. those born outside the U.S.); state policy restrictiveness is associated with lower probabilities of health insurance and health provider visits for this group of children. The gaps between the first and third-generation in both outcomes increase linearly as policy restrictiveness increases, suggesting that such policies exacerbate disparities between first and third-generation children. We find no evidence of a significant association between state policy climate restrictiveness and the health care of second-generation children (i.e. those born in the U.S. with a foreign-born parent). Although there are disparities between second and third-generation children for these outcomes, there are no significant differences in the association between state policy restrictiveness and health insurance or health provider visits.

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Fig. 1
Fig. 2

Source 2014 and 2018 Survey of Income and Program Participation, Wave 1

Fig. 3

Source 2014 and 2018 Survey of Income and Program Participation, Wave 1

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  1. In supplementary analyses evaluating the representativeness of the foreign-born population in the SIPP (available from authors), we compared sociodemographic characteristics of foreign-born parents with at least one child aged 1–17 in the household in the 2014 and 2018 SIPP to the 2014 and 2018 American Community Survey. We found that the samples were similar in terms of age, racial composition, educational attainment, and health insurance coverage, but found that the 2014 and 2018 SIPP contain larger percentages of foreign-born parents who report speaking English very well and lower percentages who report speaking English not well or not at all. The overrepresentation of parents who speak English well may suggest that our regression results are conservative (see. Discussion).


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We thank Dashiell Nusbaum for excellent research assistance on this project.


This research was supported by a Pipeline Grant from the Russell Sage Foundation. Opinions reflect those of the authors and not necessarily those of the granting agencies. Russell Sage Foundation, Pipeline Grant, Molly Dondero, Pipeline Grant, Claire E. Altman

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MD conceptualized the study, conducted the data analysis, and wrote the manuscript. CA contributed to the conceptualization of the study and the writing and editing of the manuscript.

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Correspondence to Molly Dondero.

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The authors declare that they have no conflict of interest.

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See Table 4.

Table 4 Coding scheme for state immigrant policies, 2013 and 2017

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Dondero, M., Altman, C.E. State-Level Immigrant Policy Climates and Health Care Among U.S. Children of Immigrants. Popul Res Policy Rev 41, 2683–2708 (2022).

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